Proximal Medial Gastrocnemius Release versus Open Plantar Fasciotomy in Recalcitrant Plantar Fasciitis: A Multicenter Prospective Cohort Study

Background: Plantar fasciitis is a leading cause of chronic heel pain, often requiring surgical intervention when conservative treatments fail. Open plantar fasciotomy (OPF) and proximal medial gastrocnemius recession (PMGR) are two widely used procedures, yet their comparative effectiveness remains unclear. This study evaluates their impact on pain relief, functional recovery, and health-related quality of life (HRQOL). Methods: In this multicenter prospective cohort study, 50 patients with recalcitrant plantar fasciitis unresponsive to at least nine months of conservative treatment underwent either OPF or PMGR. Standardized surgical techniques and postoperative rehabilitation were implemented. Outcomes included pain (Visual Analogue Scale, VAS), function (American Orthopaedic Foot & Ankle Society, AOFAS score), HRQOL (SF-36), and patient satisfaction, assessed preoperatively and at 1, 3, 6, and 12 months postoperatively. Results: Both procedures significantly improved pain and function at 12 months (p < 0.05). However, PMGR resulted in greater pain reduction (p = 0.009) and a significantly faster return to full activity (median: 5 vs. 10 weeks; p < 0.001). Patient satisfaction was high in both groups (p = 0.63), and postoperative complications were rare and comparable (p = 0.222). Conclusion: While both OPF and PMGR are effective, PMGR offers superior pain relief and faster recovery, particularly in patients with gastrocnemius tightness. These findings support a tailored approach to surgical decision-making based on patient-specific biomechanics.