Functional Outcomes of Gastrocnemius Recession for Isolated Gastrocnemius and Gastrocnemius-Soleus Contractures

Abstract

Category: Ankle Introduction/Purpose: Contracture of the gastrocnemius muscle with or without involvement of the soleus muscle has long been proposed as an etiologic factor in the development of chronic pathology of the foot and ankle including among others plantar fasciitis, hallux valgus, metatarsalgia, and symptomatic pes planovalgus deformity. Very few studies have analyzed the effect on strength and function of the gastrocnemius recession and those that have, are limited by sample size and functional outcome tools utilized. This prospective study reports on strength and functional effect of the gastrocnemius recession utilizing a validated outcome measure on the largest sample size yet reported. Methods: We developed two treatment arms to achieve our aims. Twenty-four patients (25 extremities) underwent a gastrocnemius recession for isolated gastrocnemius and gastrocnemius-soleus contracture. In one arm, eight patients (8 extremities) prospectively underwent range of motion, isokinetic and isometric testing pre-operatively and at 3 and 6 months post-operatively. Validated functional outcomes were also assessed using the Foot Function Index (FFI). In the second arm, an additional sixteen patients (17 extremities) prospectively completed the validated functional outcomes using the FFI. Variables were compared across three time intervals with repeated measure ANOVA with Bonferroni post hoc testing and t testing between control and operative sides was with IBM SPSS Statistics-Version 22. Results: The average age in the 24 patients (25 extremities) was 58.4 ± 15.2 years-old. Treatment for symptomatic pes planovalgus was the most common reason for surgery (10, 40%). Significant improvement in functional outcomes were observed across all three time points (p < 0.001) based on a multivariate repeated measures ANOVA for all 3 subscales (pain, disability, activity limitation) of the FFI. The improvement was significantly greater between pre-operative and 6 months post-operative intervals (p < 0.001) although significant improvements were observed between pre-operative and 3 months post-operative intervals (p=0.001). Range of motion significantly improved between pre-operative and 6 months post-operative intervals (p=0.023) and between 3 and 6 months post-operative intervals (p=0.012). No differences were observed in isokinetic and isometric testing. Conclusion: Analysis of results demonstrates improved range of motion and functional outcomes of the gastrocnemius recession between pre-operative and 6 months post-operative intervals for isolated gastrocnemius and gastrocnemius-soleus contracture.