Surgical Anatomy of the Proximal Release of the Gastrocnemius: A Cadaveric Study

Abstract

The importance of isolated gastrocnemius contracture in disorders of the foot and ankle has been established in recent years. The aim of this study was 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. 15 cadaveric extremities were dissected using a posterior approach 1 cm 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 assessed. Approach to the medial head of gastrocnemius was safe. Conversely the variable anatomy of the nerves in the approach to the lateral head meant 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. In this study we describe a safe posterior approach to the medial aponeurosis of the gastrocnemius and also describe the different sizes of the medial and lateral gastrocnemius heads. We conclude that the approach to the medial head of gastrocnemius is free from neurovascular structures and that release of the medial head alone may be efficacious in the operative treatment of isolated gastrocnemius tightness that has failed non-operative treatment.