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.

Introduction: A long first metatarsal is a recognized contributing factor to the development of hallux rigidus. It is possible to identify a sub-group of patients with a long first metatarsal and early hallux rigidus. L.S. Barouk & P. Barouk have recently described the use of a modified Weil shortening osteotomy for the treatment of this sub-group of patients. The purpose of the study was to evaluate the early results of a modified Weil’s osteotomy of the first metatarsal in selected patients with hallux rigidus.

Materials and Methods: Fifteen patients with mild to moderate OA of the first MTP joint in whom the first metatarsal was at least as long as the second underwent a shortening and plantar-displacing Weil’s osteotomy.

Results: At a minimum follow-up of six months all patients’ symptoms improved dramatically and the range of motion was improved in all cases. One patient, a 19 year old professional footballer, developed a stress fracture of the second metatarsal which went on to heal and he was able to return to professional football. One patient developed transfer metatarsalgia. There were no cases of AVN and all patients were satisfied with the outcome of surgery.

Discussion: There are many treatment strategies for hallux rigidus. Fusion surgery provides excellent pain relief but joint preserving surgery is preferable. Cheilectomy is reliable but has a significant failure rate. Joint replacements remain experimental. Debridement of the joint in combination with longitudinal decompression of the first MTPJ provides greater range of motion than cheilectomy alone in the subgroup of patients who have a long first metatarsal.

Conclusions: These early results suggest that in selected individuals with hallux rigidus associated with a long first metatarsal, a modified Weil’s osteotomy can improve the range of motion of the first MTP joint and result in significant pain relief.