What to Know: Gastrocnemius Recession for Plantar Fasciitis

Suffering from plantar fasciitis and wondering if gastrocnemius recession surgery might be the answer? 

With recent research pointing to tight calf muscles as a possible cause for this painful foot condition, gastrocnemius recession surgery has shown promising results for many patients. 

In this comprehensive guide, we'll walk you through the ins and outs of this innovative treatment, exploring its benefits, success rates, and the various surgical techniques available. 

We'll also delve into the recovery process and potential complications to help you make an informed decision about whether this surgery could be the right solution for your stubborn plantar fasciitis. 

Why does Gastrocnemius Recession Surgery Help Plantar Fasciitis?

The exact cause of plantar fasciitis is somewhat ellusive, but recent research points to tight calf muscles as a possible culprit. 

The close connection between the Achilles tendon and the plantar fascia suggests that a contracted calf muscle could increase tension, limit ankle flexibility, and strain the foot tissues. Recent findings support this theory by showing a strong link between calf tightness and plantar fasciitis severity.

As a result, it stands to reason that loosening the calf muscles through calve stretching exercises or surgical methods might help manage plantar fasciitis. Previous research has shown promising results after gastronemeus recession surgery. However, there's still no widespread agreement on using this procedure for stubborn cases of plantar fasciitis, and various alternative treatments exist.

Who Does a Gastrocnemius Recession Work Best For? 

Various conservative treatments exist, such as anti-inflammatory meds, physical therapy, steroid injections, and insoles. Studies show in 90% of cases, these methods offer relief within a year. However, if the pain persists, surgical procedures like plantar fasciotomy can be considered.

There has been one study that analyzed which factors might predict post-surgery results. The study found no significant links between factors like age, gender, height, weight, body mass index, or type of surgery and postoperative pain, foot function, or overall health scores. None of these factors could predict patient satisfaction or whether the surgery met their expectations.

Success Rate of Gastroc Recession for Plantar Fasciitis: 

So while researchers have not pinned down exactly who this surgery works for it has shown some decent success.

For instance, Monteagudo et al. found that patients who had gastroc recession surgery experienced better improvements in pain and function compared to those who had plantar fasciotomy. This led the researchers to believe that gastrocnemius release is a more successful and satisfying treatment option. 

Moreover, Molund et al. discovered that people who underwent this procedure had significantly better scores in pain, function, and quality of life after 12 months.

Benefits of Gastrocnemius Recession for Plantar Fasciitis 

You now know that a gastrocnemius recession can help you recover from plantar fasciitis but how? 

There are specific improvements provided by a gastroc release such as increasing ankle flexibility, speeding up the recovery process, and even enhancing gastrocnemius muscle strength.

 Let's dive into these benefits:

Flexibility Improvements

Three studies (Hoefnagels et al, Molund et al, and Chimera et al) found that patients had a significant increase in ankle flexibility after surgery when their knees were fully straightened.

Getting Back on Your Feet

Monteagudo et al's study showed that patients who had the gastrocnemius recession surgery could comfortably walk after just one week, compared to over four weeks for those who had plantar fasciotomy. 

They also returned to work and sports quicker: on average, three weeks to get back to work and five weeks to play sports again, while the fasciotomy group took 12 and 16 weeks, respectively.

Improved Calf Muscle Strength

Hoefnagels et al reported that a year after the surgery, all patients could do 20 heel raises with both legs and five with a single leg. 

In Gamba et al's study, no patient in either the gastrocnemius recession or plantar fasciotomy group showed reduced strength at their final checkup. 

Molund et al's study found significant improvement in toe-raise endurance and a slight decrease in jumping height after surgery, with no major differences between the gastrocnemius recession and non-surgical treatment groups.

The Different Types of Gastroc Recession for Plantar Fasciitis 

Various techniques have been developed to address plantar fasciitis by targeting the gastrocnemius muscle, which is responsible for causing tension in the plantar fascia. 

We'll explore four different surgical approaches—proximal medial gastrocnemius recession, the Strayer technique, the gastrocslide procedure, and the endoscopic technique at the musculotendinous junction—and discuss their application in multiple studies. 

Although it's difficult to compare these methods directly due to the limited number of studies and inconsistent outcome measures, gaining insight into these techniques may help you make an informed decision on the best course of action for your plantar fasciitis. 

Proximal medial gastoc recession 

The proximal medial gastrocnemius recession involves surgically releasing or lengthening the tight gastrocnemius muscle near its origin on the medial side (the inner part of the leg). This release reduces tension on the plantar fascia, which in turn alleviates pain and inflammation associated with plantar fasciitis.

During the procedure, the surgeon makes a small incision on the medial side of the calf, close to where the gastrocnemius muscle originates. The muscle fibers are carefully dissected and partially released from their origin. This allows the muscle to lengthen, thereby increasing ankle dorsiflexion range of motion and reducing tension on the plantar fascia.

Strayer approach

In the Strayer technique, the surgeon makes an incision distal to the musculotendinous junction, which is the point where the gastrocnemius muscle transitions to the Achilles tendon. This area is significant because it is where the muscle fibers and tendon meet, providing a unique opportunity for the surgeon to lengthen the muscle without compromising the integrity of the tendon itself.

Once the incision is made, the surgeon carefully separates the muscle fibers and partially releases the gastrocnemius muscle.

Gastrocslide procedure 

The gastroslide procedure involves making small, controlled cuts or "piecrusting" in the gastrocnemius-soleus complex, just below the thick, rounded part of the gastrocnemius muscle.

"Piecrusting" is a term used to describe a technique where small incisions or perforations are made in a structure, allowing it to stretch and lengthen without causing significant damage. This controlled lengthening helps to relieve tension in the calf muscles and tendons, 

Endoscopic Technique at the Level of the Musculotendinous Junction 

During the procedure, a surgeon makes small incisions near the musculotendinous junction, where the gastrocnemius muscle transitions into the Achilles tendon. 

The surgeon then inserts an endoscope, a small tube with a camera and light, through the incisions to visualize the surgical area. Using specialized instruments, the surgeon carefully cuts and releases the tight gastrocnemius muscle fibers, allowing the muscle to stretch and reducing tension on the plantar fascia.

Recovery Time after Gastrocnemius Recession for Plantar Fasciitis 

After surgery, the recovery process can vary depending on the specific treatment plan prescribed by your surgeon, as noted in five different studies. While all patients were allowed to put weight on their feet as they felt comfortable, there were differences in the types of support used during recovery. 

Chimera et al. mentioned the use of a walking boot, while Hoefnagels et al. described a two-week plaster cast followed by a four-week night splint. 

Monteagudo et al. and Gamba et al. used a rigid open shoe for the first two weeks post-surgery. In contrast, 

Molund et al. didn't use any casts, boots, or rigid shoes after the procedure. Unfortunately, it's tough to compare the effectiveness of these different recovery approaches due to the wide variety of outcome measurements used in these studies.

What Problems Can Occur After Gastrocnemius Recession?

You should never rush into surgery without knowing the complications that can occur and your surgeon will discuss these with you. 

But in a nutshell, the studies on postoperative complications after surgery for plantar fasciitis looked at 106 feet. They found some complications like nerve issues, problems with wound healing, and other miscellaneous issues. 

The breakdown is as follows: 

• 2 people had nerve problems (1.9%), 

• 2 folks had trouble with their wounds healing (1.9%)

• 5 patients experienced other issues like one case of complex regional pain syndrome, three cases of lingering pain and swelling (two of which got better within a year), and one person with a calf hematoma. (4.7%). 

All in all, the total complication rate across the board was 8.5%. 

But What if I Don’t Want Surgery?

I feel you – nobody's thrilled about going under the knife. It's a nerve-wracking, painful ordeal, not to mention the downtime needed for recovery.

The secret to dodging the surgical bullet lies in a rehab program that tackles the root of plantar fasciitis. You'll want a plan that zeroes in on hip and arch strengthening while also focusing on calf and plantar fascia stretching.

Well, you're in luck! I've got just the ticket – a simple, step-by-step rehab program to help you kick plantar fasciitis to the curb, all packed in an ebook. Say goodbye to time-consuming PT sessions 2-3 times a week for 6 weeks, and hello to healing from the cozy confines of your own home.

Give it a try – you won't regret it.

Conclusion

if you're struggling with plantar fasciitis and conservative treatments just aren't cutting it, gastrocnemius recession surgery might be your knight in shining armor. By releasing the tension in your calf muscles, this procedure can potentially alleviate pain, improve flexibility, and get you back on your feet faster than you can say "plantar fasciitis." Though it's essential to weigh the pros and cons and remember that individual results may vary, the studies we've discussed paint a promising picture for this innovative treatment. So, if you're ready to kick plantar fasciitis to the curb, talk to your doc about whether the gastrocnemius recession could be the game changer you've been searching for.