Plantar Fasciitis Surgery | Calf Release (PMGR) Results

Why a tight calf matters in heel pain

Plantar fasciitis causes pain under the heel, often worst with the first steps in the morning. Most cases settle within a year with stretching, insoles and physiotherapy. A few do not.

A tight calf muscle (gastrocnemius) is strongly linked to plantar fasciitis. It limits how far the ankle bends upwards and puts extra strain on the plantar fascia with every step. We check for it with a simple test, comparing ankle movement with the knee straight and bent.

The operation

The proximal medial gastrocnemius release (PMGR) lengthens the tight calf without touching the painful heel.

• A 3 cm cut in the crease behind the knee.
• Usually done under local anaesthetic as a day case.
• No cast or boot afterwards; most people walk normally straight away.
• Stretching exercises continue after surgery.

Operating on the plantar fascia itself can weaken the arch and needs a longer recovery, so we prefer to treat the cause first.

What our study found

We followed 21 heels in 17 patients for an average of two years. All had more than a year of pain despite treatment, on average almost four years.

• 17 of 21 heels (81%) were pain free or much better. None were worse.
• More than half of those who improved noticed it within one to two weeks.
• 15 of 17 patients (88%) would recommend the operation to a family member.
• Calf strength was preserved in almost all patients.
• There were no major complications.

The study had no comparison group, so it cannot prove the operation is better than waiting. Fast improvement after years of pain suggests the release made the difference. This paper was published under the spelling Abbassian.

Reference: Abbassian A, Kohls-Gatzoulis J, Solan MC. Proximal medial gastrocnemius release in the treatment of recalcitrant plantar fasciitis. Foot & Ankle International 2012;33(1):14–19. doi:10.3113/FAI.2012.0014

Mr Abbasian sees patients at Guy’s Hospital and in private practice in London. Book a consultation.