Hospital Universitario Quirón Salud, Pozuelo de Alarcón, Madrid, Spain.
Instituto de Ortopedia y Trauma IJS, Rosario, Santa Fe, Argentina.
Foot Ankle Int. 2024 Aug;45(8):833-838. doi: 10.1177/10711007241242792. Epub 2024 May 7.
Recalcitrant plantar fasciitis (RPF) is characterized by its unresponsiveness to conservative treatments, and its surgical management remains controversial. Although there is some evidence to suggest that gastrocnemius recession can be an effective treatment for RPF, no large series of patients with mid- to long-term follow-up has been published. The objective of this study was to compare physical performance, as measured by the Foot and Ankle Ability Measure activities of daily living score (FAAM-ADL), and pain levels before and 1 year after undergoing proximal medial gastrocnemius recession (PMGR) as a treatment for RPF. Additionally, we aimed to assess this cohort of patients in the mid- to long-term follow-up.
This retrospective cohort study included 167 patients who underwent PMGR to address RPF between 2009 and 2021. Patients were examined with the FAAM ADL, visual analog scale (VAS) and satisfaction scores at baseline, 1 year, and at the end of follow-up. Other variables recorded were weight, duration of symptoms until surgery, time between surgery to substantial clinical improvement, calf power and Silfverskiold test, and postoperative complications.
We observed that before surgery patients had an FAAM-ADL score of 22.5 (SD 11.1) and a VAS score of 8.6 (SD 9.3). One year after surgery, patients had an FAAM-ADL score of 89 (SD 17) and VAS of 1.33 (SD 2) ( < .01). We also observed that the FAAM-ADL score in the long-term follow-up (>12.5 years) group had a median of 86.4 (SD 22.6), the VAS score was 1.90 (SD 2.84), and the patient satisfaction score had a median of 1 (interquartile range 0-1). Regarding complications, we observed 1 lateral gastrocnemius recession and 1 sural nerve neuritis.
Our study provides substantial evidence supporting the use of PMGR as an effective treatment for RPF. The long-term follow-up and large sample size of our series contribute to the existing literature on this topic.
顽固性足底筋膜炎（RPF）的特征是对保守治疗无反应，其手术治疗仍存在争议。虽然有一些证据表明腓肠肌松解术可以有效治疗 RPF，但没有发表关于中至长期随访的大量患者系列研究。本研究的目的是比较接受近端内侧腓肠肌松解术（PMGR）治疗 RPF 前后的日常生活活动得分（FAAM-ADL）和疼痛水平，并评估该患者队列的中至长期随访结果。
这是一项回顾性队列研究，纳入了 2009 年至 2021 年间接受 PMGR 治疗 RPF 的 167 名患者。患者在基线、1 年和随访结束时接受 FAAM-ADL、视觉模拟评分（VAS）和满意度评分检查。还记录了体重、症状持续到手术的时间、手术到明显临床改善的时间、小腿力量和西尔弗斯凯德试验以及术后并发症等其他变量。
我们观察到，手术前患者的 FAAM-ADL 评分为 22.5（SD 11.1），VAS 评分为 8.6（SD 9.3）。手术后 1 年，患者的 FAAM-ADL 评分为 89（SD 17），VAS 评分为 1.33（SD 2）（ < .01）。我们还观察到，长期随访（>12.5 年）组的 FAAM-ADL 评分中位数为 86.4（SD 22.6），VAS 评分为 1.90（SD 2.84），患者满意度评分为 1（四分位距 0-1）。关于并发症，我们观察到 1 例外侧腓肠肌松解术和 1 例腓肠神经神经炎。
我们的研究为 PMGR 作为 RPF 有效治疗方法提供了充分的证据。我们的系列研究具有长期随访和较大的样本量，为该主题的现有文献做出了贡献。
