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Plantar heel pain is a common condition causing substantial pain and disability.
Gastrocnemius
recession surgery lengthens the calf muscle and takes the pressure off of this
area. The results from this randomised clinical trial showed that the proximal
medial gastrocnemius recession with a stretching program significantly improved
ankle dorsiflexion, average forefoot plantar pressure and chronic plantar
pain.
Plantar
heel pain is a common condition causing substantial pain and disability.
Gastrocnemius recession has been reported as a useful treatment option, but
there is a lack of prospective clinical and biomechanical outcome data. This
study aimed to examine the clinical and biomechanical outcomes of gastrocnemius
recession and stretching as compared to a stretching exercise protocol for the
patients with plantar heel pain which lasted for more than 12
months.
Forty
patients with plantar heel pain for more than one year were randomised to a
home stretching exercise program only or to surgery consisting of a proximal
medial gastrocnemius recession in addition to stretching exercises. The primary
outcome was the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot
score at 12 months. Secondary clinical outcomes were the visual analogue scale
(VAS) and Short Form-36 (SF-36) pain scores. The biomechanical outcome
parameters included ankle dorsiflexion, Achilles function examined by a test
battery with six independent tests, and plantar pressure investigated by
pedobarography. The data were obtained at baseline and follow-up of
12-months.
The
AOFAS score surged from 59.5 (42-76) to 88.0 (50-100) and 52.5 (37-73) to 65.5
(31-88) for the operative group and nonoperative group. AOFAS, VAS pain, and
SF-36 scores were significantly better in the operative as opposed to the
nonoperative group at 12-month follow-up. Ankle dorsiflexion surged from 6
degrees (-3 to 15) to 10.5 degrees (0 to 23). There was no between-group
difference observed for Achilles function at follow-up. The average forefoot
plantar pressure for the operative group surged from 536 KPa (306-708) to 642
KPa (384-885) at follow-up.
Proximal
medial gastrocnemius recession with a stretching program was found to be a safe
and efficient method for the treatment of chronic plantar heel pain.
Foot Ankle Int.
Proximal Medial Gastrocnemius Recession and Stretching Versus Stretching as Treatment of Chronic Plantar Heel Pain
Molund M et al.
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