title: Proximal medial gastrocnemius release in the treatment of recalcitrant plantar fasciitis.
abstract: 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. In this paper, we report our results with an isolated release of the proximal medial head of gastrocnemius for recalcitrant PF.
  
  
  METHODS
  We prospectively followed a consecutive series of 21 heels in 17 patients following a Proximal Medial Gastrocnemius Release (PMGR). PF was diagnosed clinically and confirmed radiologically in all cases. To be included, at least 1~year of conservative treatment must have been tried and an isolated gastrocnemius contracture confirmed clinically using Silfverskiold's test preoperatively. Outcome measures included a 5-point Likert scale as well as subjective and objective calf weakness assessments. Final followup was on average 24 (range, 8 to 36) months after the surgery.
  
  
  RESULTS
  Seventeen of the 21 heels (81%) reported total or significant pain relief following the surgery and none reported worsening of their symptoms. The majority did not have subjective or objective evidence of calf weakness. There were no `major' complications and only one case that suffered a `minor' complication.
  
  
  CONCLUSIONS
  We believe a PMGR is a simple way of treating a patient with PF who has failed to respond to conservative management. In our series, the results were favorable, the recovery fast and the morbidity low.
authors.affiliation: Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK. aabbassian@gmail.com
authors.forename: Ali
authors.initials: A
authors.lastname: Abbassian
authors.forename: Julie
authors.initials: J
authors.lastname: Kohls-Gatzoulis
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Solan
mesh_terms: D000328:Adult; D000368:Aged; D001696:Biomechanical Phenomena; D002908:Chronic Disease; D003286:Contracture / Q000601:surgery; D036981:Fasciitis, Plantar / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000503:physiopathology / Q000601:surgery*; D010147:Pain Measurement; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome