Proximal Medial Gastrocnemius Release Versus Open Plantar Fasciotomy for the Surgical Treatment in Recalcitrant Plantar Fasciitis

Abstract

Background: Plantar fasciitis is a common cause of foot pain. If conservative treatment fails, there is no consensus as to the best surgical management for recalcitrant plantar fasciitis (RPF). The aim of this study was to compare the results obtained from proximal medial gastrocnemius release (PMGR) with those obtained from open plantar fasciotomy (OPF) in terms of pain, satisfaction, health-related quality of life, and American Orthopaedic Foot & Ankle Society (AOFAS) score. Methods: This is a prospective randomized trial conducted between 2012 and 2016. Patients with RPF for at least 9 months were included. Diagnosis was clinically made. The exclusion criteria were neuropathic heel pain; a history of previous foot fracture, surgery, or deformity; rheumatoid arthritis; or the need for long-term analgesic administration. After ruling out other conditions with magnetic resonance or ultrasound imaging, patients were randomized to be operated on with OPF or PMGR independently of the Silfverskjold test. Follow-up was carried out for up to 1 year. The AOFAS, visual analog scale (VAS) for pain, SF-36, and Likert scale for satisfaction were used to evaluate the results obtained. The analysis was done with 21 patients in the OPF group and 15 in the PMGR group. The demographic data (age, sex, body mass index, duration of symptoms, and positivity to the Silfverskjold test) of the groups were comparable. Results: No differences were found in terms of the AOFAS ( P = .24), VAS ( P = .14), or any item of the SF-36. Satisfaction was very good in 85.8% of the PMGR group and 89.5% of the OPF group ( P = .27). Faster recovery was observed in the PMGR group. Conclusion: OPF and PMGR provided good results for patients with RPF. Neither was superior to the other relative to pain, AOFAS score, satisfaction, or the SF-36. We recommend PMGR as the first option in RPF surgical management in order to avoid potential biomechanical complications related to OPF. Level of Evidence: Level I, therapeutic randomized controlled trial.

Clinical And Plantar Fascial Morphologic Changes After Proximal Medial Gastrocnemius Release Treatment of Recalcitrant Plantar Fasciitis

“…Moreover, good clinical and functional results have been supported by new findings. 11,23,24 Regarding surgical treatment and MRI findings, studies by Yu et al 31,32 have described the pre-vs post-MRI changes in partial plantar fasciotomy. Those authors studied asymptomatic individuals who had had a partial fasciotomy after 24 months (range 11-46).…”

“…This study is a part of a randomized controlled trial of surgical treatment in RPF. 11 Fifteen patients were included in the proximal medial gastrocnemius release group. Two patients did not show up for the scheduled postoperative MRI, leaving 13 patients between 30 and 68 years old enrolled in the study.…”

“…Surgical technique and clinical outcomes have been thoroughly described in a previous published work. 11 The results in terms of pain, satisfaction, function, and self-reported health perception have been recorded using the visual analog scale for pain, Likert satisfaction, and American Orthopaedic Foot & Ankle Society hindfoot scales and the 36-Item Short Form Health Survey (SF-36) questionnaire, respectively. All patients were evaluated with a new MRI at 1 year postoperatively to compare the imaging changes to the preoperative MRI.…”

“…1 Currently, one of the most accepted operative treatments for RPF is the release of the proximal medial gastrocnemius owing to its low rate of complications and good functional results. 11,23 MRI findings like plantar fascia thickness or other qualitative variables (bone marrow edema, a high-signal intensity area in the fascia or tear of the fascia) have been used to assess the effectiveness of plantar fasciitis treatment. MRI findings have been assessed before and after conservative treatment and have been proposed as an indicator of a good response in terms of pain and function.…”

Endoscopic Partial Plantar Fasciotomy via 2 Medial Portals vs Mini-Open Procedure for Refractory Plantar Fasciitis

“…However, for patients with ineffective response to conservative treatment with refractory plantar fasciitis, surgical intervention can be recommended. 11 Partial plantar fasciotomy is an accepted, evidence-based procedure for refractory plantar fasciitis with good clinical results. 4,8 The mini-open and endoscopic surgeries have been used recently for their advantages of less trauma, less scarring, and rapid postoperative recovery.…”