Gastrocnemius Recession in Recalcitrant Plantar Fasciitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

TL;DR

Gastrocnemius recession is a safe and effective surgery for chronic heel pain when conservative treatments fail, improving foot function and reducing pain.

Contribution

This study provides the first systematic review and meta-analysis confirming gastrocnemius recession's efficacy for recalcitrant plantar fasciitis.

Findings

Gastrocnemius recession significantly improves foot function and ankle mobility in patients with chronic heel pain.

The procedure reduces pain and offers better postoperative recovery compared to plantar fasciotomy.

Benefits of the surgery can last up to six years with minimal complications.

Abstract

Background: Recalcitrant plantar fasciitis (RPF) is a common cause of chronic heel pain, resistant to conservative treatment in up to 10% of cases. A biomechanical association exists between isolated gastrocnemius contracture and increased tension on the plantar fascia. In this context, gastrocnemius recession (GR) has emerged as a surgical intervention aimed at reducing fascial strain and improving functional outcomes. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines and registered with PROSPERO (CRD420251028862). Randomized controlled trials evaluating the efficacy of GR in patients with RPF were included. Searches were performed in PubMed, Cochrane Library, and Web of Science. Risk of bias was assessed using the RoB 2 tool, and the certainty of evidence was evaluated using the GRADE approach. Primary outcomes included foot function (AOFAS), pain (VAS), and ankle dorsiflexion range (FDTPA). Results: Five studies encompassing 150 patients were included. Meta-analysis revealed statistically significant improvements in foot function (AOFAS, standardized mean difference [SMD] = 0.81; 95% CI: 0.26–1.36), pain reduction (VAS, SMD = −1.17; 95% CI: −1.99 to −0.36), and ankle dorsiflexion (FDTPA, SMD = 0.74; 95% CI: 0.26–1.22). GR demonstrated advantages over plantar fasciotomy in terms of postoperative recovery and preservation of fascial structure. No major complications were reported, and some studies documented sustained benefits up to six years postoperatively. Moderate to high heterogeneity was observed, largely due to variations in surgical technique and follow-up durations. Conclusions: Gastrocnemius recession is a safe and effective surgical option for treating RPF, particularly in patients with isolated gastrocnemius contracture and failure of conservative therapies. It significantly improves foot function, reduces pain, and enhances ankle mobility, with durable long-term outcomes. Trial Registration: This systematic review is registered with PROSPERO (CRD420251028862).

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