Combination Endoscopic Plantar Fasciotomy and Gastrocnemius Recession in the Treatment of Recalcitrant Plantar Fasciitis: Clinical Outcomes From a Case Series

Background: Classically, the gold standard surgical management of recalcitrant plantar fasciitis has been plantar fasciotomy. Recent research has established a correlation between posterior leg tightness and plantar fasciitis. As a result, surgeons are increasingly performing a gastrocnemius recession to manage this condition. The purpose of this report was to assess clinical outcomes in patients undergoing a combined endoscopic partial plantar fasciotomy and a gastrocnemius recession for the treatment of plantar fasciitis. Methods: Surgery was performed on 37 feet (35 patients), of which 31 (29 patients) were retrospectively reviewed. Preoperative and follow-up measures of pain, limitations on daily activities, and maximum walking distance were assessed. Patient satisfaction, complications, and recovery time were recorded. Results: The mean follow-up was 3.02 (range, 1-6.67) years. The mean visual analog score for pain decreased from 9.3 preoperatively to 1.5 at final follow-up. At the most recent follow-up, 21 of 31 (67.6%) patients were completely pain free, and 28 of 31 (90.3%) were very satisfied or satisfied with the surgery. Twenty-eight of 31 patients (90.3%) returned to activity without any limitations. Complications were seen in 5 patients, including 3 patients with persistent pain. Conclusion: Our study demonstrated that endoscopic partial plantar fasciotomy combined with gastrocnemius recession was associated with improved pain and function in this case series. However these findings should be considered preliminary; prospective comparative studies are needed. Level of Evidence: Level IV, case series.