Understanding And Managing Equinus Deformities
- Volume 24 - Issue 5 - May 2011
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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.
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.