The Effect Of Isolated Gastrocnemius Contracture And Surgical Gastrocnemius Recession On Strength And Function

Abstract

Isolated gastrocnemius contracture (IGC), characterized as reduced ankle dorsiflexion with full knee extension, has been linked to foot injuries limiting function and activities of daily living. Patients with IGC may be unable to produce normal plantarflexion force. Gastrocnemius recession surgery has been shown to increase function and dorsiflexion range of motion, but the impact on force production is unknown. PURPOSE: To determine the effect of gastrocnemius recession surgery on function and force production. METHODS: 7 legs with IGC (51 years, 83.78 kg, 1.69 m) and 23 control legs (48 years, 74.19 kg, 1.72 m) performed isometric plantarflexion at maximum ankle dorsiflexion with full knee extension. Subjects with IGC were tested pre- and 3 months post-surgery at their maximum ankle dorsiflexion angle. The Foot and Ankle Ability Measures (FAAM) questionnaire was used to evaluate function. Passive ankle dorsiflexion range of motion (PROM) was measured with the knee in full extension using a bi-plane goniometer. RESULTS: Post-surgery, subjects with IGC had significantly (p < 0.01) increased self reported function (91% vs. 59%) and global rating (86% vs. 48%) scores, but these were slightly lower than scores reported by control subjects. PROM significantly (p < 0.001) increased post-surgery from 0° to 13°, and was not different from control subjects (14°). There was a 10% increase in isometric plantarflexion strength post-surgery, however significant (p < 0.05) weakness persisted compared to control subjects (∼ 35%). CONCLUSION: Gastrocnemius recession surgery is a beneficial treatment option for patients with IGC. Increased function, dorsiflexion range of motion, and plantarflexion strength were observed post-surgery. Although improvements were noted following gastrocnemius recession, subjects were still weaker than controls and therefore may benefit from organized post-surgical rehabilitation. Supported in part by Synthes, Inc. and NIHR01AR040408.