A Promising Alternative Surgical Approach to Plantar Fasciotomy

Gastroc recession is a possible alternative to plantar fasciotomy for patients with recalcitrant heel pain from plantar fasciitis, according to a small systematic review

What’s the Claim?

A recent small systematic review suggests that gastrocnemius release is effective in relieving symptoms of heel pain believed to be from chronic plantar fasciitis, perhaps even more effective than plantar fascia release.

How’s It Stack Up?

This is a tricky one. Of the six studies included in this systematic review, only two were randomized trials, and only one compared gastrocnemius recession (performed as a proximal medial recession) to plantar fasciotomy. In that RCT, there were no between-group differences, though it was a small trial with only 15 patients in the gastroc recession group. And in that study — as in the observational studies included in this systematic review — patients generally improved regardless of the treatment applied. Perhaps the most telling study was the only other randomized trial in the mix, which found that patients who had more than a year of symptoms did better with gastroc recession than with stretching. This makes sense, since those patients probably had been stretching all along and were, quite literally, aching for an alternative. The source studies here may charitably be characterized as “preliminary” — all the usual kinds of bias (selection bias, transfer bias, and assessment bias) likely led the authors to overestimate the benefit of the treatment being studied. And with only 118 patients in the 6 studies included (as well as a variety of comparator treatments in the control groups), one needs to interpret this one with particular modesty.

What’s Our Take?