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

IF 1.3 4区 医学 Q2 Medicine
Aysha Rajeev, Kailash Devalia
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引用次数: 0

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.

慢性足跟疼痛:通过改良手术技术减少腓肠肌-跟腱-足底筋膜(GAP)负荷是否能改善预后?
本研究评估跟腱重建术(ATR)和腓肠肌近端内侧松解术(PMGR)治疗顽固性跟腱病(AT)和足底筋膜病(PF)的疗效。对72例保守治疗无效的慢性足跟痛患者进行回顾性分析。患者分为Haglund畸形、跟腱病或腓肠肌紧绷伴足底筋膜病。其中45例诊断为AT, 27例诊断为PF。AT患者行分离脱离、清创、Haglund畸形切除、改良双排无结缝线去张力重建。PF患者行PMGR。采用术前和术后曼彻斯特-牛津足问卷(MOxFQ)、EQ-5D和EQ-VAS评分评估结果。平均随访41.2个月(范围36-66个月)。两组的所有结局指标均有显著改善。ATR组术前MOxFQ平均评分由67.77±20.41提高至21.46±12.38。EQ-5D由19.34±7.81改善至4.52±2.58,EQ-VAS由48.64±10.91改善至69.34±18.75。最后随访时,PF组MOxFQ由41.35±10.04改善至18±16.82,EQ-5D由14.14±2.71改善至8.64±5.15,EQ-VAS由44.67±17.94改善至71.87±28.35。了解腓肠肌-跟腱足底筋膜(GAP)复合体的生物力学,并通过改良的跟腱重建和近端腓肠肌释放来发展一种结构化的治疗算法,从而获得显著的功能和症状改善。证据等级:四级。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Foot & Ankle Surgery
Journal of Foot & Ankle Surgery ORTHOPEDICS-SURGERY
CiteScore
2.30
自引率
7.70%
发文量
234
审稿时长
29.8 weeks
期刊介绍: The Journal of Foot & Ankle Surgery is the leading source for original, clinically-focused articles on the surgical and medical management of the foot and ankle. Each bi-monthly, peer-reviewed issue addresses relevant topics to the profession, such as: adult reconstruction of the forefoot; adult reconstruction of the hindfoot and ankle; diabetes; medicine/rheumatology; pediatrics; research; sports medicine; trauma; and tumors.
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