This retrospective study compared two surgeries for chronic plantar fasciitis that failed at least 9 months of conservative care. Thirty patients underwent partial proximal fasciotomy (PPF) and 30 underwent proximal medial gastrocnemius release (PMGR). Groups were matched for age, BMI, symptom duration, and prior treatments.
Surgeons treating recalcitrant plantar fasciitis long defaulted to fasciotomy, but success rates were variable and less than 50% of patients in some series were completely satisfied. The gap this paper addresses is simple: if gastrocnemius tightness is the biomechanical driver, cutting the fascia treats the symptom while leaving the cause untouched.
When a patient with chronic plantar fasciitis has a positive Silfverskiöld test (dorsiflexion improves with knee flexion), isolated gastrocnemius tightness is present and PMGR is the more rational surgical option. This paper supports offering PMGR as first-line surgery for recalcitrant CPF rather than reserving it as a salvage after failed fasciotomy.
Before operating, confirm the diagnosis excludes Baxter's neuropathy and tibialis posterior pathology — both were exclusion criteria here and can mimic plantar fasciitis clinically. The histologic finding that chronic plantar fasciitis shows degenerative fasciosis (not inflammation) also explains why anti-inflammatory treatments have inconsistent results in the chronic setting.
This retrospective study compared two surgeries for chronic plantar fasciitis that failed at least 9 months of conservative care. Thirty patients underwent partial proximal fasciotomy (PPF) and 30 underwent proximal medial gastrocnemius release (PMGR). Groups were matched for age, BMI, symptom duration, and prior treatments.
Surgeons treating recalcitrant plantar fasciitis long defaulted to fasciotomy, but success rates were variable and less than 50% of patients in some series were completely satisfied. The gap this paper addresses is simple: if gastrocnemius tightness is the biomechanical driver, cutting the fascia treats the symptom while leaving the cause untouched.
When a patient with chronic plantar fasciitis has a positive Silfverskiöld test (dorsiflexion improves with knee flexion), isolated gastrocnemius tightness is present and PMGR is the more rational surgical option. This paper supports offering PMGR as first-line surgery for recalcitrant CPF rather than reserving it as a salvage after failed fasciotomy.
Before operating, confirm the diagnosis excludes Baxter's neuropathy and tibialis posterior pathology — both were exclusion criteria here and can mimic plantar fasciitis clinically. The histologic finding that chronic plantar fasciitis shows degenerative fasciosis (not inflammation) also explains why anti-inflammatory treatments have inconsistent results in the chronic setting.