Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
Foot Ankle Int. 2023 May;44(5):459-468. doi: 10.1177/10711007231159105. Epub 2023 Mar 23.
There has been an established relationship between increased loading on the Achilles tendon and tension on the plantar fascia. This supports the idea that either tight gastrocnemius and soleus muscles or contractures of the Achilles tendon are risk factors for plantar fasciitis. Gastrocnemius recession has gained popularity as a viable surgical intervention for cases of chronic plantar fasciitis due to isolated gastrocnemius contracture. To our knowledge, this is the first study to investigate Patient-Reported Outcome Measurement Information Systems (PROMIS) scores in patients with plantar fasciitis before and after gastrocnemius recession.
The Electronic Medical Record was queried for medical record numbers associated with Current Procedural Terminology code 27687 (gastrocnemius recession). Our study included all patients with a preoperative diagnosis of chronic plantar fasciitis with treatment via isolated gastrocnemius recession with 1-year minimum follow-up. Forty-one patients were included in our study. Patient variables were collected via chart review. Preoperative and postoperative PROMIS scores were collected in the clinic.
We followed up 41 patients with a median age of 48 years (interquartile range [IQR] 38-55) and median body mass index of 29.02 (IQR 29.02-38.74) for 1 year post surgery. Preoperative and postoperative PROMIS scores improved for physical function from 39.3 to 44.5 ( = .0005) and for pain interference from 62.8 to 56.5 ( = .0001). PROMIS depression scores were not significantly different ( = .6727). Visual analog scale (VAS) scores significantly decreased from 7.05 to 1.71 ( < .0001).
In this case series, we found the gastrocnemius recession to be an effective option for patients with refractory pain in plantar fasciitis. Our PROMIS and VAS data confirm this procedure's utility and highlight its ability to significantly decrease pain and improve physical function in patients with chronic plantar fasciitis, although final median scores did not reach normative standards for the population, suggesting some residual pain and/or dysfunction was, on average, present. Based on the results of this study, the authors conclude that gastrocnemius recession is a reasonable treatment option for chronic plantar fasciitis patients who fail nonoperative management.
Level III, retrospective cohort study.
跟腱承受的负荷增加与足底筋膜的张力之间存在着既定的关系。这支持了这样一种观点，即腓肠肌和比目鱼肌紧张或跟腱挛缩是足底筋膜炎的危险因素。由于孤立的腓肠肌挛缩，腓肠肌切除术已成为治疗慢性足底筋膜炎的一种可行的手术干预措施，备受关注。据我们所知，这是第一项研究，调查了接受腓肠肌切除术的足底筋膜炎患者术前和术后的患者报告结局测量信息系统（PROMIS）评分。
通过电子病历查询与当前程序术语代码 27687（腓肠肌切除术）相关的病历号。我们的研究包括所有接受孤立性腓肠肌切除术治疗的慢性足底筋膜炎患者，随访时间至少 1 年。我们的研究共纳入 41 例患者。通过病历回顾收集患者变量。在诊所收集术前和术后的 PROMIS 评分。
我们对 41 例患者进行了随访，中位年龄为 48 岁（四分位距 [IQR] 38-55），中位体重指数为 29.02（IQR 29.02-38.74），术后 1 年。腓肠肌切除术前后，躯体功能的 PROMIS 评分从 39.3 提高到 44.5（=.0005），疼痛干扰的 PROMIS 评分从 62.8 提高到 56.5（=.0001）。抑郁评分的 PROMIS 无显著差异（=.6727）。视觉模拟评分（VAS）从 7.05 显著下降到 1.71（<.0001）。
在本病例系列研究中，我们发现腓肠肌切除术是治疗难治性足底筋膜炎疼痛患者的有效选择。我们的 PROMIS 和 VAS 数据证实了该手术的有效性，并强调其能够显著减轻慢性足底筋膜炎患者的疼痛并改善其躯体功能，尽管最终的中位数评分并未达到人群的正常标准，表明平均仍存在一些残余疼痛和/或功能障碍。基于这项研究的结果，作者得出结论，对于经非手术治疗失败的慢性足底筋膜炎患者，腓肠肌切除术是一种合理的治疗选择。
III 级，回顾性队列研究。
