Gastrocnemius Release in the Management of Chronic Plantar Fasciitis: A Systematic Review.

BACKGROUND: This systematic review aims to summarize the outcomes of gastrocnemius recession in the treatment of plantar fasciitis. METHODS: A systematic review was performed according to PRISMA guidelines using the PubMed, Embase, Emcare, Web of Science, Scopus, and CINAHL databases. A 2-stage title/abstract and full text screening process was performed independently by 2 reviewers. Randomized controlled trials, cohort, and case-control studies reporting the results of gastrocnemius recession in patients with plantar fasciitis were included. The MINORS and Joanna Briggs Institute Criteria were used to assess study quality and risk of bias. RESULTS: A total of 285 articles were identified, with 6 of these studies comprising 118 patients being ultimately included. Significant postoperative improvement in American Orthopaedic Foot & Ankle Society, visual analog scale, 36-Item Short Form Health Survey, Foot Forum Index, and Foot and Ankle Ability Measure scores were reported. Included studies also described an increase in ankle dorsiflexion range of motion and plantarflexion power. An overall pooled complication rate of 8.5% was seen, with persistent postoperative pain accounting for the most common reported complication. Gastrocnemius recession is associated with greater postoperative improvement than plantar fasciotomy and conservative stretching exercises. CONCLUSION: The current evidence demonstrates that gastrocnemius recession is effective in the management of plantar fasciitis, specifically in patients with gastrocnemius contracture who do not respond to conservative treatment. LEVEL OF EVIDENCE: Level III, Systematic review of level I-III studies.

Reperfusion seizures: a manifestation of cerebral reperfusion injury after administration of recombinant tissue plasminogen activator for acute ischemic stroke.

Reperfusion injury has been well described in medical literature; cerebral reperfusion injury is commonly seen in association with vascular surgical procedures such as carotid endarterectomies and stent placement procedures. Cerebral reperfusion injury can manifest as blood-brain barrier breakdown, cortical irritability, and epileptic seizures. Seizures induced by cerebral reperfusion have not been documented or reported after thrombolytic therapy for acute ischemic stroke. We report a patient who received intravenous recombinant tissue plasminogen activator within 3 hours of stroke symptom onset and developed the new-onset symptom of continuous, primary motor seizure activity within 20 minutes of recombinant tissue plasminogen activator administration. These epileptic seizures originated in the same area as the acute brain ischemia and occurred during the anticipated period of cerebral reperfusion. In this article we describe a case report and then discuss the pathophysiology and mechanisms that may underlie reperfusion epileptic seizures as a manifestation of cerebral reperfusion injury.