Chronic heel pain: Can reducing gastrocnemius-achilles-plantar fascia (GAP) Workload through modified surgical technique improve outcomes?

Abstract

This study evaluates the efficacy of Achilles tendon reconstruction (ATR) and proximal medial gastrocnemius release (PMGR) for treating recalcitrant Achilles tendinopathy (AT) and plantar fasciopathy (PF). A retrospective analysis was conducted on 72 patients with chronic heel pain resistant to conservative treatment. Patients were categorized into those with Haglund's deformity, Achilles tendinopathy, or gastrocnemius tightness with Plantar fasciopathy. Among them, 45 patients were diagnosed with AT and 27 with PF. Patients with AT underwent split detachment, debridement, excision of Haglund's deformity, and de-tensioning reconstruction using a modified double-row knotless suture. Patients with PF underwent PMGR. Outcomes were assessed using pre- and postoperative Manchester-Oxford Foot Questionnaire (MOxFQ), EQ-5D, and EQ-VAS scores. The mean follow-up duration of 41.2 months (range: 36-66 months). Significant improvements were observed in all outcome measures for both groups. In the ATR group, the mean preoperative MOxFQ score improved from 67.77 ± 20.41 to 21.46 ± 12.38. EQ-5D improved from 19.34 ± 7.81 to 4.52 ± 2.58, and EQ-VAS improved from 48.64 ± 10.91 to 69.34 ± 18.75. In the PF group, the MOxFQ improved from 41.35 ± 10.04 to 18 ± 16.82, EQ-5D from 14.14 ± 2.71 to 8.64 ± 5.15, and EQ-VAS from 44.67 ± 17.94 to 71.87 ± 28.35 at the final follow-up. Understanding the biomechanics of the Gastrocnemius Achilles Plantar fascia (GAP) complex and developing a structured treatment algorithm with detensioning the GAP complex through modified Achilles tendon reconstruction and proximal gastrocnemius release, yields a significant functional and symptomatic improvement.