Understanding And Managing Equinus Deformities

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Stephen L. Barrett, DPM, MBA, FACFAS

Essential Postoperative Pearls

The postoperative management of the endoscopic gastrocnemius recession technique is subordinate to the extent required by other simultaneously performed procedures. If one only performs an isolated endoscopic gastrocnemius recession, then patients can immediately bear weight in a tall walking boot. Encourage the patient to remove the boot and perform gentle active movement of the ankle, foot and lower leg. Casting or other complete immobilization is not recommended as this could increase the possible development of a deep venous thrombosis.

   Within the last two years, my postoperative regimen includes the use of an intermittent compression and cooling device, which has greatly reduced postoperative edema and discomfort. Preferably, one should have the patient using the device the day of surgery. The endoscopic gastrocnemius recession is usually a minimally painful procedure if one performs it properly.

In Summary

Surgeons who add surgical treatment of equinus (whether endoscopic or open) to their armamentarium, if it is not already present, will find optimization of patient surgical outcomes and increased patient satisfaction. For many surgeons, this will require a huge mental paradigm shift but, in my opinion, the overwhelming improvement in patient outcomes will make the surgeon glad to have embraced the seemingly difficult change.

   The minimally invasive endoscopic gastrocnemius recession technique allows for improved lower extremity biomechanical function, which frequently obviates the need for additional surgical procedures, many of which have a greatly increased postoperative morbidity. Additionally, since the endoscopic gastrocnemius recession frequently allows for the obviation of what patients thought would be required from a planned surgical reconstruction, sometimes they perceive the procedure as relatively “non-invasive.”

   Dr. Barrett is an Adjunct Professor within the Arizona Podiatric Medicine Program at the Midwestern University College of Health Sciences. He is a Fellow of the American College of Foot and Ankle Surgeons.

   Dr. Barrett is a paid medical consultant for Instratek, Inc., which manufactures the instrumentation used in this endoscopic gastrocnemius recession technique. He has no financial relationship with Maldonado Medical, the company that manufactures the TEC system.


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Neal M. Blitz, DPM, FACFASsays: May 14, 2011 at 7:41 pm

I am not sure that endoscopic gastroc recessions should be termed "gastroc recessions." They are really gastrosoleal recessions.

Anatomically, the gastroc muscles form an muscular-free aponeurosis that inserts onto the soleus aponeurosis and together form the Achilles. The muscular free portion of the gastroc is termed the "gastroc run-out." In some cases, there is no run-out and the gastroc muscle inserts directly on the soleus aponeurosis.

Nonetheless, if you transect deep to muscle, then both the gastroc and soleus aponeurosis have been transected.

The clinical effect is unclear, but the anatomy is the anatomy.

Neal M. Blitz, DPM, FACFAS
Chief of Foot Surgery & Associate Chairman of Orthopaedics
Bronx-Lebanon Hospital Center

Blitz NM, Eliot DJ. Anatomical Aspects of the Gastrocnemius Aponeurosis and its Muscular-Bound Portion. A Cadaveric Study. Part II. J Foot Ankle Surg 47(6):533-40, 2008

Blitz NM, Rush SM. The Gastrocnemius Intramuscular Aponeurotic Recession. A Simplified Method of Gastrocnemius Recession. J Foot Ankle Surg 46(2):133-8, 2007

Blitz NM, Eliot DJ. Anatomical Aspects of the Gastrocnemius Aponeurosis and its Insertion. A Cadaveric Study. J Foot Ankle Surg 46(2):101-8, 2007

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