Instep Plantar Fasciotomy With and Without Gastrocnemius Recession

Plantar fasciitis is one of the most common causes of heel pain. Approximately 2 million
Americans seek treatment for plantar fasciitis every year, with 10% of the population
developing plantar fasciitis over a lifetime. The vast majority of cases respond to
conservative care; however, the 5-10% of cases that are recalcitrant to conservative
measures may require surgical intervention. Several surgical options do exist and are cited
in the literature for treatment of recalcitrant plantar fasciitis. One such approach is the
instep plantar fascial release, utilizing an approximately 2-3 cm plantar incision over the
prominent fascial band, just distal to the fat pad of the heel. It has been demonstrated
that many patients with plantar fasciitis also have an isolated contracture of the
gastrocnemius, known as gastrocnemius equinus. Gastrocnemius recession is performed to
correct an isolated gastrocnemius contracture and recent studies have demonstrated its
successful use in the treatment of recalcitrant foot pain. To date, no prospective studies
exist examining the utilization of the gastrocnemius recession in combination with instep
plantar fascial release in the treatment of recalcitrant plantar fasciitis. This prospective
randomized trial will aim to compare the use of instep plantar fasciotomy both with and
without gastrocnemius recession in the treatment of plantar fasciitis.

Inclusion Criteria:

- Patients that have failed conservative treatment for greater than 6 months.

- Patients with recalcitrant plantar fasciitis and simultaneous gastrocnemius
contracture in the ipsilateral limb. Contracture will be defined as the inability to
dorsiflex the ankle past neutral with the knee in extension.

Exclusion Criteria:

- Adjunctive procedure at the time of surgery.

- History of heel spur surgery, plantar fasciotomy or extracorporeal shockwave therapy.