Proximal Medial Gastrocnemius Recession and Stretching Versus Stretching as Treatment of Chronic Plantar Heel Pain
| Autor: | Marius Molund, Fredrik Nilsen, Kjetil Hvaal, Jan Hellesnes, Elisabeth Ellingsen Husebye |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent media_common.quotation_subject Medial gastrocnemius Plantar fasciitis Recession Young Adult 03 medical and health sciences 0302 clinical medicine Muscle Stretching Exercises medicine Humans Orthopedics and Sports Medicine Aged Pain Measurement media_common Gastrocnemius recession 030222 orthopedics Foot business.industry Treatment options 030229 sport sciences Middle Aged Combined Modality Therapy Fasciotomy Surgery Treatment Outcome Fasciitis Plantar Female Heel Chronic Pain medicine.symptom business Plantar heel pain Follow-Up Studies |
| Zdroj: | Foot & Ankle International. 39:1423-1431 |
| ISSN: | 1944-7876 1071-1007 |
| DOI: | 10.1177/1071100718794659 |
| Popis: | Background: Plantar heel pain is a common disorder that can lead to substantial pain and disability. Gastrocnemius recession has been described as an operative treatment option, but there is a lack of prospective clinical and biomechanical outcome data. The aim of this study was to evaluate the clinical and biomechanical outcomes of gastrocnemius recession and stretching compared with a stretching exercise protocol for patients with plantar heel pain lasting more than 12 months. Methods: Forty patients with plantar heel pain lasting more than 1 year were randomized to a home stretching exercise program only or to surgery consisting of a proximal medial gastrocnemius recession in addition to stretching exercises. The main outcome was the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score at 12 months. Secondary clinical outcomes were the Short Form–36 (SF-36) and visual analogue scale (VAS) pain scores. The biomechanical outcome parameters were ankle dorsiflexion, Achilles function evaluated by a test battery with 6 independent tests, and plantar pressure evaluated by pedobarography. All data were obtained at baseline and at 12-month follow-up. Results: The AOFAS score increased from 59.5 (42-76) to 88.0 (50-100; P < .001) for the operative group and from 52.5 (37-73) to 65.5 (31-88; P = .138) for the nonoperative group. The AOFAS, VAS pain, and SF-36 scores were significantly better in the operative compared with the nonoperative group at 12-month follow-up ( P < .05). Ankle dorsiflexion increased from 6 degrees (–3 to 15) to 10.5 degrees (0 to 23; P < .001). No between-group difference was observed for Achilles function at follow-up. The average forefoot plantar pressure for the operative group increased from 536 KPa (306-708) to 642 KPa (384-885) at follow-up ( P < .001). Conclusion: Proximal medial gastrocnemius recession with a stretching program was a safe and efficient method of treating chronic plantar heel pain. Level of Evidence: Level 1, randomized clinical trial. |
| Databáze: | OpenAIRE |
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