Today, I'll be discussing our paper entitled Partial Possible Remedial Superficial Release of the Proximal Curl Fascia in Patients with a Positive SILFER Scale Test, a Case Series of Clinical Outcomes and a Novel Technique. Here are our disclosures. A SILFER scale test is a clinical examination finding that identifies an isolated gashenemous contracture. An isolated gashenemous contracture presents in the setting of numerous foot and ankle pathologies and is often managed with a gashenemous recession. Partial Possible Remedial Superficial Release or PMSR of the proximal curl fascia is a less invasive surgical technique compared to gashenemous recession. The purpose of our study was to describe the surgical technique and evaluate clinical outcomes following partial PMSR of the proximal curl fascia in patients with a positive SILFER scale test. Retrospective chart review was carried out to identify patients who had a partial PMSR of the curl fascia from January to October of 2021 for the treatment of an isolated gashenemous contracture. These patients had completed the FADI score preoperatively and then again at final follow-up. Paired samples t-tests were performed to identify significance of the difference in pain and function preoperatively and postoperatively with statistical significance set at p values less than 0.05. Descriptive statistics were used for demographic variables. The patients were position prone with the feet off the end of the table. A transverse incision was made 2 cm distal to the flexion crease starting at the intermuscular line of the gashenemous muscle 4 cm medially. Subcutaneous dissection was performed, so it's identified the neurovascular bundle. A 7 cm horizontal incision was performed to the superficial posterior fascia in the medial gashenemous head. The medial gashenemous muscle was not sectioned. Regards to the postoperative protocol, patients were immobilized in a functional weight-bearing boot and could ambulate as tolerated on day 1 and sutures were subsequently removed between days 14 and 21. Regards to the patient demographics, 26 patients were included, 8 of these patients had undergone an additional or concomitant procedure. The mean age of the cohort was 40.6 years and the mean follow-up was 9.4 weeks. Four patients presented with isolated metatarsalgia, three patients presented with metatarsalgia and plantar fasciitis, six patients presented with metatarsalgia, plantar fasciitis and a cavus foot deformity, five patients presented with plantar fasciitis, three patients presented with both plantar fasciitis and insertion of Achilles tendinopathy, four patients presented with non-insertion of Achilles tendinopathy and one patient presented with FHL tendinopathy. Our study found that improvement in clinical outcomes via operative management of an isolated gashenemous contracture was found. The preoperative FADI improved from a score of 47.5 to 80.5 at final follow-up. Dorsiflexion improved from a preoperative score of minus 1.2 degrees to a postoperative range of motion of 10.7 degrees. All patients had a negative silver scale test at final follow-up. So in conclusion, partial post-remedial superficial release, or PMSR, of the cural fascia was found to be an effective outpatient procedure for patients with an isolated gashenemous contracture. Patients who have failed conservative treatment can expect notable improvement with satisfactory FADI scores following the procedure. Future prospective studies should be conducted with a larger patient cohort and without any additional compounding procedures to accurately assess the efficacy of PMSR for isolated gashenemous

Partial Possible Remedial Superficial Release

Proximal Curl Fascia

Positive SILFER Scale Test

Isolated Gashenemous Contracture

Clinical Outcomes