Ann R Coll Surg Engl 2013; 95: 228–229 We read with interest the review on plantar fasciitis (PF) by Cutts et al. While this was an excellent account of the pathology and management of the condition, it was disappointing that management using a gastrocnemius release was totally excluded, especially as the authors had recognised reduced ankle dorsiflexion and tightness of the Achilles tendon as risk factors for PF. In fact, a number of modern series reported in the literature have used this technique in preference to local surgery on the plantar fascia. Riddle et al found that individuals with ≤0o of dorsiflexion are 23 times more likely to get PF compared with the group of individuals who had >10o of ankle dorsiflexion.1 Cheung et al showed a relationship between the PF and equinus.2 Achilles tendon loading has twice the amount of straining effect on the plantar fascia than body weight. They concluded that lengthening of the Achilles tendon may benefit PF. Patel and DiGiovanni found that 83% of 254 patients with PF had limited dorsiflexion and 57% of 254 had an isolated gastrocnemius contracture.3 Maskill et al performed gastrocnemius recession on 25 patients with PF who had failed 6 months of conservative therapy.4 The average visual analogue scale score improved from 8.1 to 1.9 at 19.5 months. We reported on proximal gastrocnemius lengthening on 21 heels with chronic PF.5 At follow-up, 81% had reported total or significant pain relief following the surgery. Local surgery on the plantar fascia has a poorer outcome and longer recovery with problems associated with lateral column dysfunction and arch collapse. We believe that a gastrocnemius release is a simple way of treating a patient with PF who has failed to respond to conservative management and that it should be considered before plantar fascia release when surgical intervention is contemplated.

This RRFSS Monitor describes the sun safety behaviours of Waterloo Region adults aged 18 and older. The purpose of the Sun Safety module is to determine the proportion of adults using protective measures against sun exposure. From January to December of 2008, 1201 adults were asked about recent sunburns and from January to December of 2010 another 1209 adults were asked about sunburns. Questions pertaining to sun safety behaviours were only asked during the months of May to September, resulting in a sample size of 501 adults in 2008 (waves 89 to 93) and 401 adults in 2010 (cycle 5).