The Royal Orthopaedic Hospital, Northfield, Birmingham, United Kingdom.
The Royal Orthopaedic Hospital, Northfield, Birmingham, United Kingdom.
J Foot Ankle Surg. 2022 Mar-Apr;61(2):396-400. doi: 10.1053/j.jfas.2021.10.029. Epub 2021 Nov 1.
Plantar fasciitis is a common cause of heel pain. Recalcitrant plantar fasciitis can be difficult to manage. Medial gastrocnemius recession is increasingly being used to treat recalcitrant plantar fasciitis, with advocates describing fewer complications and quicker recovery time than other surgical options. This systematic review aimed to determine the effectiveness of gastrocnemius recession for the treatment of patients with recalcitrant plantar fasciitis. Multiple databases were searched using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The level of evidence of each study was assessed according to the American Academy of Orthopaedic Surgeons Levels of Evidence. The level of bias for each study was assessed using the National Institutes of Health (NIH) Study Quality Assessment Tools. Seven studies were retrieved: 3 retrospective case series, 1 retrospective study that compared gastrocnemius recession to open plantar fasciotomy, 1 prospective cohort study (pre-post study with no control group), and 2 randomized controlled trials. All 6 studies that assessed pre- and postoperative pain using the Visual Analogue Scale showed a large reduction in pain postoperatively. Four studies that assessed pain at 12 months postoperatively showed a weighted mean of 76.06 ± 10.65% reduction in pain. No major complications were reported. Minor complications included sural neuritis. This review found a consistent reduction in pain following gastrocnemius release in patients with recalcitrant plantar fasciitis, suggesting it is a very promising treatment. However, the included studies are limited by low quality study designs and inherent biases, limiting the strength of recommendation. Further definitive, well-designed trials are required.
足底筋膜炎是足跟痛的常见原因。顽固性足底筋膜炎较难治疗。腓肠肌内侧头肌切开术越来越多地用于治疗顽固性足底筋膜炎，其支持者描述称，与其他手术方法相比，该方法并发症更少，恢复时间更快。本系统评价旨在确定腓肠肌内侧头肌切开术治疗顽固性足底筋膜炎患者的疗效。根据系统评价和荟萃分析首选报告项目（Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines），使用多个数据库进行搜索。根据美国矫形外科医师学会证据等级（American Academy of Orthopaedic Surgeons Levels of Evidence）评估每项研究的证据水平。使用美国国立卫生研究院（National Institutes of Health，NIH）研究质量评估工具（Study Quality Assessment Tools）评估每项研究的偏倚程度。共检索到 7 项研究：3 项回顾性病例系列研究、1 项将腓肠肌内侧头肌切开术与开放式足底筋膜炎切开术进行比较的回顾性研究、1 项前瞻性队列研究（无对照组的前后研究）和 2 项随机对照试验。6 项使用视觉模拟评分法（Visual Analogue Scale）评估术前和术后疼痛的研究均显示术后疼痛明显减轻。4 项评估术后 12 个月疼痛的研究显示，疼痛减轻的加权平均值为 76.06 ± 10.65%。未报告重大并发症。轻微并发症包括腓肠神经痛。本综述发现，顽固性足底筋膜炎患者行腓肠肌松解术后疼痛持续减轻，表明该治疗方法很有前景。然而，纳入的研究受到低质量研究设计和固有偏倚的限制，限制了推荐的强度。需要进一步开展设计严谨的确定性试验。
