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.