Five-Year Minimum Patient-Reported Outcomes Following Isolated Gastrocnemius Recession for Plantar Fasciitis and Achilles Tendinopathy

Abstract

Category: Hindfoot; Other Introduction/Purpose: Plantar fasciitis and Achilles tendinopathy are common foot and ankle overuse conditions encountered in clinical practice. Treatment modalities for these diagnoses vary however, isolated gastrocnemius recession may be a viable treatment option for these conditions when conservative management has failed. There is little published on the long-term outcomes of this procedure with very few studies able to report on the five-year reported outcomes in these patients. Here, we assess patient-reported outcome in those with a minimum of five-year follow up that underwent isolated gastrocnemius resection for the above indications. Methods: A retrospective analysis of patients that underwent gastrocnemius recession at our facility from 2011 to 2018 was conducted. Patients were selected if they underwent an isolated gastrocnemius recession specifically due to Achilles tendinopathy or plantar fasciitis. Patients were excluded if they had a history of musculoskeletal disorders of a history of previous recession. Basic patient demographics, chronic use of fluoroquinolones and NSAIDs, duration of symptoms, presence of rheumatoid arthritis, history of previous foot and ankle operations, and surgical complications were all recorded. To evaluate outcomes, we utilized Foot Function Index (FFI) scores as well as the Patient Reported Outcomes Measurement Information System (PROMIS) survey. Results: A total of 141 patients met inclusion criteria with all individuals completing both the PROMIS survey and 115 completing the FFI survey. The average time point at which outcomes were collected was 6.6 years postoperatively. Postoperative PROMIS scores for physical function, pain interference, and depression were all within one standard deviation of the reference population. The average PROMIS physical function, pain interference, and depression scores for this population was 45.67, 50.87, and 41.20, respectively. The mean FFI scores were 28.58 for pain, 36.11 for disability, 21.11 for activity limitation with an average total FFI of 31.40. Six patients developed surgical site infection, 36 patients reported postoperative symptoms of sural neuropathy with 12 reporting complete resolution of the neuropathy, and four patients required revisional surgery. Conclusion: With the limited data regarding the long-term outcomes of gastrocnemius recession, we sought to explore patient- reported outcomes in terms of pain, disability, physical function, depression, and pain interference. Our results prove that gastrocnemius recessions for Achilles tendinopathy and plantar fasciitis can lead to long term satisfaction for patients and can expect relatively low complication rates during the process. Additionally, the high retention rate of patients answering all required patient surveys further strengthens the findings reported here.