Abstract
Introduction: Gastrocnemius contracture, as demonstrated by Silfverskiold’s test, is increasingly recognised as an underlying cause of painful disorders of the foot and ankle. Elevated pressure beneath the forefoot and symptoms in the hindfoot and ankle are produced as a result of the biomechanical imbalance. Adaptive shortening of the gastrocnemius can be treated by a supervised stretching program. Night splintage and serial casting are other useful non-operative treatments. Refractory cases may be considered for surgical release of the gastrocnemius.
Materials and Methods: The purpose of this study was to follow-up all those patients who were treated with a medial proximal gastrocnemius release with a minimum follow-up of six months.
Results: Eighty procedures were performed in sixty-five patients. There was one post operative infection. One patient has diminished sensation in the distribution of a branch of the saphenous nerve. There was an improvement in ankle dorsiflexion with the knee extended in all patients. Those patients with heel pain felt their symptoms had improved in the majority of cases.
Discussion: Release of the gastrocnemius aponeurosis at the gastrosoleus junction may be performed open or endoscopically. Both techniques place the sural nerve at risk of injury. Proximal release of the gastrocnemius is an alternative technique. Proponents of this method release both the medial and lateral heads through a single transverse skin incision over the popliteal fossa. It has been postulated that release of the medial head alone is sufficient to overcome the muscle contracture. Advantages of this approach include a smaller skin incision and a surgical field more distant from neurovascular structures.
Conclusion: The proximal medial gatrocnemius release is a safe, well tolerated, and effective procedure for those patients who fail an appropriate stretching program. In selected patients it can be preformed under local anaesthetic and light sedation.
Correspondence should be addressed to: D. Singh, BOFAS, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
