Analysis of the efficacy of eccentric training of the gastrocnemius muscle in the treatment of recurrent plantar fascitis

Introduction: Plantar fasciitis is a common disease that requires a comprehensive and individual approach to treatment. Despite the widespread prevalence of this condition, the opinion on the etiology and treatment of plantar fasciitis is still extremely controversial. Today, there are quite a large number of scientific and practical publications confirming that functional shortening of the gastrocnemius muscle is the cause of a number of diseases of the foot and ankle. One of these pathologies is plantar fasciitis (PF), which can often develop secondarily as a result of disorders of the biomechanics of the foot, including as a result of functional shortening of the gastrocnemius muscle. This article presents an analysis of the results of using eccentric training of the gastrocnemius muscle in the treatment of recurrent plantar fasciitis.

Purpose: to analyze the clinical efficacy of eccentric training of the gastrocnemius muscle in the treatment of recurrent after conservative treatment plantar fasciitis.

Materials and Methods: We prospectively reviewed the results of eccentric training of the gastrocnemius muscle in 102 patients (128 feet) with diagnosed plantar fasciitis recurring after at least one year of conservative treatment. Patients were divided into 2 groups depending on the results of the Silfverskiold test: group 1 - patients with a positive Silfverskiold test (77 patients; 97 feet), group 2 - patients with a negative Silfverskiold test (25 patients; 31 feet). The diagnosis of plantar fasciitis was confirmed instrumentally using MRI and ultrasound. The training period was 12 weeks. The average follow-up period was 20 months (6-24) from the end of training. At the control examination, the volume of dorsiflexion of the foot and subjective assessment of the patients' condition were assessed using the SF-36 and AOFAS scales. Pain syndrome was assessed using the VAS scale.

Results: In both groups, statistically significant increase in the volume of dorsiflexion of the foot and improvement in the condition according to the results of the questionnaires for assessing the quality of life (SF-36), AOFAS and VAS scale were noted at the end of the training cycle and in the long-term period. However, in group 1 (patients with a positive Silfverskiold test), the positive dynamics were more statistically significant than in group 2 (patients with a negative Silfverskiold test).

In some patients (11 patients, 19 feet: 9 patients (15 feet) - in group 1; 3 patients (4 feet) - in group 2) at the end of the training course, a slight decrease in pain syndrome was noted, in connection with which these patients underwent surgical intervention: proximal release of the medial head of the gastrocnemius muscle was performed in 10 patients (18 feet). One patient (2 feet) with a significant limitation of dorsiflexion of the foot, which persisted after the end of the course of eccentric training of the gastrocnemius muscle, and a negative Silveskold test underwent lengthening of the gastrocnemius-soleus complex according to Strayer.

Discussion: Plantar fasciitis in the majority of cases correlates with functional shortening of the gastrocnemius muscle. Today there is a wide choice of conservative methods for treating plantar fasciitis in orthopedic practice. Surgical intervention should be considered in case of ineffectiveness of conservative treatment. In patients with clinically and instrumentally confirmed diagnosis of plantar fasciitis, recurring after conservative treatment, in the absence of other causes of heel pain and with clinically confirmed presence of isolated functional shortening of the gastrocnemius muscle, eccentric training of the gastrocnemius muscle is highly effective and can be considered an additional stage of conservative treatment before making a decision on surgical intervention and a mandatory component of postoperative rehabilitation.

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