Abstract
Research Type:
Level 4 – Case series
Introduction/Purpose:
Plantar fasciitis is a prevalent foot condition, often resolving without surgery. However, a subset of patients experiences persistent symptoms beyond 12 months, necessitating interventions like Proximal Medial Gastrocnemius Recession (PMGR). PMGR is hypothesized to alleviate plantar fasciitis by increasing ankle dorsiflexion and decreasing tension in the plantar fascia. The procedures potential effects on gait remain unclear.
Methods:
A subgroup of 29 patients with chronic plantar fasciitis, treated with Proximal Medial Gastrocnemius Recession (PMGR) and stretching as part of the Plantar Fasciitis Cohort Study, was selected for this pre- and 3-month postoperative three-dimensional gait analysis (3DGA) study. Eligibility criteria included symptoms persisting for over 12 months, failure of conservative treatments, and confirmed gastrocnemius tightness. Gait analysis was performed using a 3D motion capture system. The primary outcome was maximal ankle dorsiflexion during stance. Secondary outcomes included other kinematic, kinetic, and tempo-spatial gait variables potentially influenced by PMGR, the Gait Deviation Index (GDI), and passive ankle dorsiflexion.
Results:
Maximal ankle dorsiflexion during stance showed no significant change postoperatively (13.5°(12.2,14.9) vs. 14.3°(13.2,15.3), p = 0.21). Secondary outcomes, including ankle dorsiflexion at maximal knee extension, ankle dorsiflexion at foot strike, foot progression angle, knee extension at maximal ankle dorsiflexion, maximal knee extension during stance, ankle power and GDI scores, remained within normal ranges and showed no clinically significant changes. Passive ankle dorsiflexion increased significantly postoperatively, yet this did not translate to detectable changes in gait patterns. Patients demonstrated no notable gait deviations compared to a normative population pre- or post-surgery.
Conclusion:
Findings suggest that gait patterns are robust, and that increased joint range of motion does not necessarily affect gait mechanics. Patients and healthcare professionals can be reassured that PMGR is a safe and effective treatment option for chronic plantar fasciitis, with no significant impact on gait patterns. Further studies are needed to explore the biomechanical mechanisms underlying symptom improvement.
3DGA parameters
Recorded in the Stance Phase