Plantar fasciopathy: A current concepts review

Abstract

Plantar fasciopathy is very prevalent, affecting one in ten people in their lifetime.Around 90% of cases will resolve within 12 months with conservative treatment.Gastrocnemius tightness has been associated with dorsiflexion stiffness of the ankle and plantar fascia injury.The use of eccentric calf stretching with additional stretches for the fascia is possibly the non-operative treatment of choice for chronic plantar fasciopathy.Medial open release of approximately the medial third of the fascia and release of the first branch of the lateral plantar nerve has been the most accepted surgical treatment for years.Isolated proximal medial gastrocnemius release has been reported for refractory plantar fasciopathy with excellent results and none of the complications of plantar fasciotomy. Cite this article: EFORT Open Rev 2018;3:485-493. DOI: 10.1302/2058-5241.3.170080.

Keywords: fasciotomy; gastrocnemius recession; heel pain; plantar fasciitis.

Fig. 1

Silfverskiöld test reveals gastrocnemius tightness when there is an equinus deformity with knee extended (a) which disappears when the knee is flexed (b).

Fig. 2

At the end of the second rocker of gait, in the presence of a tight gastrocnemius, repetition of subtle longitudinal tension moments may result in injury to the plantar fascia.

Fig. 3

Medial open approach with proximal partial fasciotomy.

Fig. 4

Surgical approach for proximal medial gastrocnemius release at the popliteal fossa.

Fig. 5

With the help of a blunt instrument, the proximal medial gastrocnemius head is exposed to be safely released.