Macroscopic changes in sural nerve after gastrocnemius recession: a cadaver study

Moon, Andrew S.; DeBell, Henry; Peng, Jianguang; McKissack, Haley; Chinnakkannu, Karthikeyan; Moraes, Leonardo; Brahmbhatt, Ashish; Alexander, Bradley

doi:10.1016/j.foot.2020.101682

Cited by 2 publications

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“…This is likely due to stretching of the nerve during the GR, which is a known complication. 43 One patient (2.5%) developed cellulitis that resolved with a short course of oral antibiotics. One patient (2.5%) underwent a plantar fasciectomy at 1-year for persistent debilitating symptoms.…”

Section: Discussionmentioning

confidence: 99%

PROMIS Scores for Plantar Fasciitis Before and After Gastrocnemius Recession

et al. 2023

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Background: 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. Methods: 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. Results: 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 ( P = .0005) and for pain interference from 62.8 to 56.5 ( P = .0001). PROMIS depression scores were not significantly different ( P = .6727). Visual analog scale (VAS) scores significantly decreased from 7.05 to 1.71 ( P < .0001). Conclusion: 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 of Evidence: Level III, retrospective cohort study.

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Section: Discussionmentioning

confidence: 99%

PROMIS Scores for Plantar Fasciitis Before and After Gastrocnemius Recession

et al. 2023

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“…Many of the complications described following gastrocnemius recession are common peri-operative complications such as wound infection, hypertrophic scaring or DVT, which may occur following any surgical procedure [ 12 ]. One specific concern regarding gastrocnemius recession, particularly in distal recession techniques, is the incidence of sural nerve injury [ 6 , 32 , 36 ]. However, our review shows that while sural nerve injury was the most common complication, the overall incidence remained relatively low at 5/123 (4.1%) cases.…”

Section: Discussionmentioning

confidence: 99%

Gastrocnemius release is an effective management option for Achilles tendinopathy: a systematic review

Arshad

Shdefat

Iqbal

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose This systematic review aims to summarise the outcomes of gastrocnemius release in the management of Achilles Tendinopathy. Methods A systematic review was performed according to PRISMA guidelines. A computer-based search was performed in PubMed, Embase, Cinahl, Scopus and ISI Web of Science. Two independent reviewers performed both title/abstract and full-text screening according to a-priori selection criteria. English-language original research studies reporting outcomes for gastrocnemius recession in patients with Achilles tendinopathy were included. Study quality and risk of bias were assessed using the MINORS criteria. Results Of the 229 articles identified following database searching, nine studies describing 145 cases of gastrocnemius recession were included in the review. Clinically important differences were reported across a range of validated patient reported outcome scores including VISA-A, FFI, FAAM and VAS pain score. Outcomes appear to be superior in patients with noninsertional Achilles tendinopathy, however further research is required to confirm this. Studies also reported an increase in ankle dorsiflexion range of motion and a good rate of return to sport/work. The overall complication rate was 10/123 (8.1%), with sural nerve injury being the most common complication, occurring in 5/123 (4.1%) of cases. Conclusion The results of this review suggest gastrocnemius release to be an effective treatment option in the management of patients with Achilles tendinopathy, who have gastrocnemius contracture and have previously failed to respond adequately to non-operative treatment. Level of evidence Level IV.

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Macroscopic changes in sural nerve after gastrocnemius recession: a cadaver study

Cited by 2 publications

References 14 publications

PROMIS Scores for Plantar Fasciitis Before and After Gastrocnemius Recession

PROMIS Scores for Plantar Fasciitis Before and After Gastrocnemius Recession

Gastrocnemius release is an effective management option for Achilles tendinopathy: a systematic review

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