**6. Pain in foot**

Diabetic patients without ulcers tend to have less neuropathy. They frequently develop painful foot problems including Achilles tendinitis, plantar fasciitis, foot arthritis and metatarsalgia.

McGlamery and Kitting stated that tight Achilles is the underlying cause of most foot problems and that permanent correction is only achieved by correction of Achilles tightness [7]. Achilles tightness is common in patients with Charcot foot, plantar fasciitis, Achilles tendinitis, metatarsalgia, foot arthritis, Morton's neuroma and hallux valgus [66, 67].

Gastrocnemius recession (GR) has been recommended for the treatment of these problems in patients without neuropathy or diabetes [8–12, 68]. Anderson et al. felt that gastrocnemius tightness causes metatarsalgia, plantar fasciitis, Achilles tendinitis and arch pain [10, 68]. Achilles tightness, can cause progressive arch collapse, foot arthritis and flat foot which can progress to posterior tibial tendon dysfunction and heel valgus. High (94%, 32/34) patient satisfaction has been reported using GSR for plantar fasciitis. Anderson felt GR not only helped the pain of these conditions but prevents the progression described above [10, 68]. Several authors recommend GR for pain relief in patients with arch collapse, foot and ankle arthritis, Achilles tendinitis, plantar fasciitis, posterior tibial tendinitis [8–12, 68]. GR may be useful in preventing these problems and foot ulcers so is especially useful in diabetic patients [10, 27].
