Instep Plantar Fasciotomy With and Without Gastrocnemius Recession

Surgical Treatment of Plantar Fasciitis: Instep Plantar Fasciotomy With and Without Gastrocnemius Recession

Plantar fasciitis is one of the most common causes of heel pain. Approximately 2 million Americans seek treatment for plantar fasciitis every year, with 10% of the population developing plantar fasciitis over a lifetime. The vast majority of cases respond to conservative care; however, the 5-10% of cases that are recalcitrant to conservative measures may require surgical intervention. Several surgical options do exist and are cited in the literature for treatment of recalcitrant plantar fasciitis. One such approach is the instep plantar fascial release, utilizing an approximately 2-3 cm plantar incision over the prominent fascial band, just distal to the fat pad of the heel. It has been demonstrated that many patients with plantar fasciitis also have an isolated contracture of the gastrocnemius, known as gastrocnemius equinus. Gastrocnemius recession is performed to correct an isolated gastrocnemius contracture and recent studies have demonstrated its successful use in the treatment of recalcitrant foot pain. To date, no prospective studies exist examining the utilization of the gastrocnemius recession in combination with instep plantar fascial release in the treatment of recalcitrant plantar fasciitis. This prospective randomized trial will aim to compare the use of instep plantar fasciotomy both with and without gastrocnemius recession in the treatment of plantar fasciitis.

Subjective and objective measurements which scale a patients' pain and function collected at selected intervals and compared to pre-operatively.

Participant chart will be reviewed for any adjunctive treatment required following their surgical intervention

Participant chart will be reviewed for any complications that occurred during their one year follow-up, including but not limited to: Recurrence of symptoms, no improvement, infection, tear or rupture of plantar fascia following procedure

A patient submitted survey regarding their activity level and ability to perform those activities pain free.

change from baseline (within 30 days prior to intervention) activity level at 3 months, 6 months, and one year

change from baseline (within 30 days prior to intervention) pain level at 3 months, 6 months, and one year

Inclusion Criteria: Patients that have failed conservative treatment for greater than 6 months. Patients with recalcitrant plantar fasciitis and simultaneous gastrocnemius contracture in the ipsilateral limb. Contracture will be defined as the inability to dorsiflex the ankle past neutral with the knee in extension. Exclusion Criteria: Adjunctive procedure at the time of surgery. History of heel spur surgery, plantar fasciotomy or extracorporeal shockwave therapy.