Many of you have asked me about potential treatments you’ve heard about about for chronic plantar fasciitis and other foot ailments. Two that continue to come up in conversation: GS surgery and ESWT.

In short, here is what my experience shows:

Gastrocnemius Slide (GS) surgery, also known as the Strayer Procedure

What It Is: Lengthening the triceps surae or Achilles tendon.

Pros: Potentially, you arrive quicker at your desired result and it requires less effort and diligence on your part. This surgery indeed does address the underlying cause.

Cons: First and foremost, money! Also, the risk involved – which is inherent to any surgery – should be considered (infection, nerve damage, scaring, etc.). But, there are also risks specific to GS, including over-lengthening of the muscle – potentially a real problem; permanent calf weakness; DVT, to name a few. All of these are low incidence, but as they say: you can’t win the lottery unless you play (lose in this case), or when you fall under that 2-3% chance of complication!

Recovery is not easy with the procedure, and 6 weeks immobilization and 2-6 weeks of no weight bearing is what you can expect.

Conclusion: I don’t support the surgery as a primary way of treating plantar fasciitis. For those who fail a bona fide six month course of stretching, and their problem remains recalcitrant, then I would consider this surgery.

Again, it comes down to the fact that stretching fixes the real problem in almost all cases. But it requires patience!

Extracorporeal Shock Wave Therapy (ESWT)

What It Is: Sound waves used to penetrate your heel; some doctors feel it may stimulate the healing of soft tissue and relieve pain.

Pros: Can be considered an alternative treatment to surgery, which has its risks, as mentioned.

Cons: Consistent medical research supporting the efficacy of the treatment is lacking. It’s felt to be legit, but really, only by docs — mostly podiatrists . Another generally unspoken aspect of this treatment is the immobilization, and often rest, required afterwards. It is my belief that if there any improvement with this form of treatment, the immobilization is likely responsible.

The use of ESWT is also used because these docs really have problems helping patients because they do not know or do not accept that the correct treatment is so simple. And they can’t make much jack doing it the right way. That really is the crux of the biscuit for a lot of docs, which guides their practice habits.

Conclusion: This is a classic example of a treatment that falls under the classification of “might help your pain reduction, but is expensive and won’t fix the real problem.”

Finally, show me doctors, orthopaedic surgeons or podiatrists who are doing a fair amount of gastroc lenthenings and/or ESWT and I will show you docs who need the ortho-bling, have alimony payments, or they just enjoy the high life.

Further reading: