Gastrocnemius Recession as Treatment for Refractory Achilles Tendinopathy: A Case Report

Gentchos, Christopher E.; Bohay, Donald R.; Anderson, John G.

doi:10.3113/fai.2008.0620

Cited by 36 publications

(27 citation statements)

References 38 publications

(24 reference statements)

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“…Treating the resulting inflammatory process can no doubt temporarily alleviate symptoms; however, it is still at best palliative and fails to treat the underlying cause. No wonder mentions and anecdotal evidence pointing out the failure of conservative treatment of these resulting problems [Appendix A ] dominates in our literature ( 11 , 21 , 23 , 62 – 64 ).…”

Section: Discussionmentioning

confidence: 98%

The Split Second Effect: The Mechanism of How Equinus Can Damage the Human Foot and Ankle

Amis

2016

Front. Surg.

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We are currently in the process of discovering that many, if not the majority, of the non-traumatic acquired adult foot and ankle problems are caused by a singular etiology: non-neuromuscular equinus or the isolated gastrocnemius contracture. There is no question that this biomechanical association exists and in time much more will be uncovered. There are three basic questions that must be answered: why would our calves tighten as we normally age, how does a tight calf, or equinus, actually cause problems remotely in the foot and ankle, and how do the forces produced by equinus cause so many seemingly unrelated pathologies in the foot and ankle? The purpose of this paper is to address the second question: how does a tight calf mechanically cause problems remotely in the foot and ankle? There has been little evidence in the literature addressing the biomechanical mechanisms by which equinus creates damaging forces upon the foot and ankle, and as a result, a precise, convincing mechanism is still lacking. Thus, the mere concept that equinus has anything to do with foot pathology is generally unknown or disregarded. The split second effect, described here, defines exactly how the silent equinus contracture creates incremental and significant damage and injury to the human foot and ankle resulting in a wide variety of pathological conditions. The split second effect is a dissenting theory based on 30 years of clinical and academic orthopedic foot and ankle experience, keen clinical observation along the way, and review of the developing literature, culminating in examination of many hours of slow motion video of normal and abnormal human gait. To my knowledge, no one has ever described the mechanism in detail this precise.

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Section: Discussionmentioning

confidence: 98%

The Split Second Effect: The Mechanism of How Equinus Can Damage the Human Foot and Ankle

Amis

2016

Front. Surg.

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“…Gastrocnemius contractures have been described to be a cause of generalized forefoot, midfoot, and more recently, hindfoot pain. 1,2 Gastrocnemius tightness increases the amount of tension on the Achilles tendon insertional site resulting in tendinitis and acute or chronic pain. Therefore, an isolated lengthening of the gastrocnemius muscle may be a more simple and effective procedure for relieving and improving patient’s posterior hindfoot pain.…”

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confidence: 99%

Isolated Gastrocnemius Recession for Treatment of Insertional Achilles Tendinopathy

Tallerico

Greenhagen

Lowery

2014

Foot & Ankle Specialist

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“…The many indications for gastrocnemius recession in the literature includenon-insertional Achilles tendinopathy, flatfoot, lower back pain or strain, knee hyperextension (genu recurvatum), plantar fasciitis, midfoot pain or arthritis, lateral foot pain, and nerve entrapment. It is also indicated in children with equinus foot deformity, spasticity, or cerebral palsy [ 3 – 9 ].…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided gastrocnemius recession: a new ultra–minimally invasive surgical technique

Villanueva¹,

Iborra²,

Rodríguez³

et al. 2016

BMC Musculoskelet Disord

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BackgroundIsolated gastrocnemius contracture is thought to lead to numerous conditions. Although many techniques have been described for gastrocnemius recession, potential anesthetic, cosmetic, and wound-related complications can lead to patient dissatisfaction. Open and endoscopic recession techniques require epidural anesthesia, lower limb ischemia, and stitches and may lead to damage of the sural nerve, which is not under the complete control of the surgeon at all stages of the procedure.The purpose of this study was to evaluate the safety and efficacy of a new technique based on ultrasound-guided ultra–minimally invasive gastrocnemius recession.MethodsWe performed a pilot study with 22 cadavers to ensure that the technique was effective and safe. In the second phase, we prospectively performed gastrocnemius recession in 23 patients (25 cases) with chronic non-insertional Achilles tendinopathy, equinus foot, and other indications. In the clinical study, we evaluated the range of dorsiflexion before and after the procedure, clinical outcomes with VAS and AOFAS scores, and potential complications, including neurovascular injuries.ResultsWe achieved complete release of the gastrocnemius tendon in all cases in the cadaveric study, with no damage to the sural nerve or vessels and minimal damage to the underlying muscle fibers. Ankle dorsiflexion increased for every patient in the study (mean, 14°; standard deviation, 3°) and was maintained throughout follow-up. The mean preoperative VAS score was 7 (6–9), which improved to 0 (0–1). The AOFAS Ankle-Hindfoot Score improved from a mean of 30 (20–40) to 93 (85–100) at 6 months. No major complications were observed. All patients returned to their previous sports after 6 months.ConclusionsAfter cadaveric and clinical study, we considered the technique to be safe and effective to perform ultrasound-guided ultra–minimally invasive gastrocnemius recession using a 1-mm incision in vivo. This novel technique represents an alternative to open techniques, with encouraging results and with the advantages of reducing pain, obviating lower limb ischemia, deeper anaesthesia, thus decreasing complications and contraindications and accelerating recovery.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-1265-7) contains supplementary material, which is available to authorized users.

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Gastrocnemius Recession as Treatment for Refractory Achilles Tendinopathy: A Case Report

Cited by 36 publications

References 38 publications

The Split Second Effect: The Mechanism of How Equinus Can Damage the Human Foot and Ankle

The Split Second Effect: The Mechanism of How Equinus Can Damage the Human Foot and Ankle

Isolated Gastrocnemius Recession for Treatment of Insertional Achilles Tendinopathy

Ultrasound-guided gastrocnemius recession: a new ultra–minimally invasive surgical technique

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