Background

Most patients with Achilles tendinopathy (AT) are treated successfully with physiotherapy ie eccentric calf training. In some patients gastrocnemius contracture persists. Three other publications have reported improvement in AT following gastrocnemius release, but this is the first series of patients to have proximal medial gastrocnemius release (PMGR) for AT. The purpose of this study was to review patients with refractory non-insertional and insertional AT treated by PMGR with a minimum followup of 18 months.

Background: Isolated Gastrocnemius contracture has been implicated as the cause of a number of foot and ankle conditions. Plantar Fasciitis (PF) is one such condition that can be secondary to altered foot biomechanics as a result of gastrocnemius contracture. We perform an isolated proximal medial head of gastrocnemius release (PMGR) as a day-case procedure. This is to report our results of this procedure in the treatment of recalcitrant PF.

Material and Methods: We prospectively followed a consecutive series of 22 heels in 18 patients following a PMGR. To be included, at least one year of conservative treatment must have been tried and isolated Gastrocnemius contracture confirmed clinically using Silfverskiold’s test pre-operatively. Outcome measures included the visual analogue pain score (VAS) and a 5-point Likert scale of postoperative success. Subjective and objective calf weakness was also evaluated. Final follow up was at an average of 25 months (range: 12 to 36 months) after the surgery.

Results: Two patients were lost to follow up. In the remaining 20 heels the average VAS for pain had improved from 9.4 to 1.8 (P< 0.001). Fourteen heels (70%) were pain free or significantly better at final follow up. There was no objective evidence of calf weakness and only one patient (5%) felt subjectively weaker on the released side. There were no ‘major’ complications and only 2 cases (10%) suffered a ‘minor’ complication. One was a case of superficial wound sepsis and the other was of prolonged calf pain following the surgery. Both resolved spontaneously and without further intervention.

Conclusions: A PMGR is a simple way of treating patients with PF who fail to respond to conservative management. The results, in our series, have been favorable and the morbidity low. We recommend the use of gastrocnemius release once non-operative management has failed.