PROXIMAL MEDIAL GASTROCNEMIUS RELEASE IN TREATMENT OF RECURRENT PLANTAR FACCIITIS - OUR EXPERIENCE

Introduction: Functional shortening of the gastrocnemius muscle is currently considered the cause of multiple foot and ankle disorders. One of these pathologies is plantar fasciitis (PF), which can often be secondary to changes in the biomechanics of the foot. Purpose: to analyze the effectiveness of the isolated proximal release of the medial head of the gastrocnemius muscle in treatment of recurrent plantar fasciitis after failed attempts of conservative treatment.
Materials and Methods: We prospectively reviewed the results of proximal release of the medial head of the gastrocnemius in six patients (eight feet) with plantar fasciitis that recurred after at least one year of conservative treatment. The diagnosis of plantar fasciitis was confirmed with MRI and ultrasound. The average follow-up period was 20 months (3-24). During the follow-up, physical examination was performed, the strength of the gastrocnemius muscle of the operated limb was examined, and the results were assessed using the SF-36 and AOFAS scales. Pain was assessed using the VAS scale.
Results: At the last follow-up, no patient noted weakness of the gastrocnemius muscle of the operated limb. The mean SF-36 (physical component) score increased from 48.75 preoperatively to 60.93 at the final visit; the mean SF-36 score (emotional component) increased from 51.75 preoperatively to 61.9 at the final visit. The AOFAS score increased from 48.0 preoperatively to 65.4 at last follow-up. When analyzing the dynamics of pain, an improvement was noted on the VAS scale from 5.75 before surgery to 1.27 at the last follow-up.
Discussion: Plantar fasciitis in the majority of cases is associated with functional shortening of the gastrocnemius muscle. In the practice of an orthopedic surgeon, there is a large number of conservative methods of treating plantar fasciitis. Surgery should be considered when the conservative treatment fails. In patients with a confirmed diagnosis of recurrent plantar fasciitis, in the absence of other causes of heel pain and in the presence of confirmed functional shortening of the gastrocnemius muscle, the PMGR (proximal medial head of the gastrocnemius muscle release) procedure has shown clinical effectiveness and should be considered a primary surgical technique.

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