Introduction: The importance of isolated gastrocnemius contracture in disorders of the foot and ankle has been established in recent years. The aim of this study is to describe the proximal anatomical approach to the medial and lateral heads of gastrocnemius and to compare the sizes of the medial and lateral heads of the gastrocnemius. Method: 15 cadaveric knees were dissected using a posterior approach 1cm below the level of the skin crease. Proximity of cutaneous nerves and major vessels was noted. The heads of the gastrocnemius were dissected from their origin and the cross sectional anatomy was defined. Results: Approach to the medial head of gastrocnemius is safe. Conversely the variable anatomy of the nerves in the approach to the lateral head means that extreme care must be taken if complications are to be avoided. The aponeurosis of the medial head of gastrocnemius was 2.4 times the cross-sectional area compared to the lateral head. Conclusion: In this study we describe a safe posterior approach to the medial aponeurosis of gastrocnemius and also describe the different sizes of the medial and lateral gastrocnemius heads. We propose that the release of the medial head alone is safe and likely to be efficacious in the surgical treatment of isolated gastrocnemius tightness that has failed non-operative treatment

Previous studies of adult acquired flatfoot have reported the results of treatment. No study has described the clinical characteristics of a consecutive series. In a ten-year period we managed 166 patients with adult acquired flatfoot. Forty were male and 126 female The median age of the men was 56 years and of the women 60 years (p=0.149). Twenty-eight had bilateral problems and 78% had gastrocnemius/soleus tightness. We used the Truro classification. There were 26 stage 1 patients, with a median age of 45 years. Eight were male and 18 female. Eight had features of enthesopathy but rheumatological investigations were negative. There were 84 stage 2 patients, with a median age of 61 years; 23 were male and 61 female. Twenty-five patients were stage 3, with a median age of 59 years; 5 were male and 20 female. 23 patients were in stage 4, with a median age of 67 years; 4 were male and 19 female. Six patients were stage 5, with a median age of 67.5 years; all were female. There were two patients in stage 6, aged 81 and 85 years, both female. The stage 1 patients were significantly younger than the others (p< 0.001); there were no other significant differences in ages or sex ratios. Most patients had predominantly soft-tissue problems. However, we identified 33 whose problems related mainly to osteoarthritis. These patients had a higher median age (62.5 years versus 58 years, p=0.0138) and stiffer deformities (p< 0.0001). Most patients (131, 78.9%) were managed solely with orthotics, shoe adaptations and physiotherapy. Thirty-five patients were offered surgery. Twenty-eight procedures were performed on 23 patients. Surgery was commoner in the arthritic group (15/33 offered surgery versus 20/133, p=0.001)