Gastrocnemius Recession Research Articles

Outcomes of Isolated Open Gastrocnemius Recession for the Treatment of Chronic Insertional Achilles Tendinopathy: A Retrospective Cohort Study.

Insertional Achilles tendinopathy (IAT) is a common condition causing pain and dysfunction. Patients with diabetes, hyperlipidemia, hypothyroidism, and obesity are at increased risk of developing IAT. These comorbidities also carry an increased risk of wound healing complications following surgery. Therefore, there is a need for alternative management strategies for this high-risk patient population. This study investigated the potential role of isolated GR in patients with chronic IAT. This study is a single-institution retrospective review of adult patients who underwent isolated GR to address chronic IAT with a minimum 1-year follow-up. Demographics, complications, radiographic findings, and preoperative and postoperative patient-reported outcome scores (PROs) were collected. The primary outcome was improvement in PROMIS scores from preoperative to postoperative. Secondary outcomes were complication and reoperation rates. Sixteen patients underwent open GR with a mean follow-up of 2.7 years. Postoperative PROMIS domain scores improved significantly from preoperative scores for physical function, pain interference, pain intensity, and global physical function. Two patients (13%) underwent reoperation (open calcaneal exostectomy and tendon debridement) at a mean time of 7 months from gastrocnemius recession. One patient developed a postoperative hematoma that resolved with conservative management. This single-institution series reports on a small cohort of patients with chronic IAT treated with open GR. We found significant improvement in patient-reported outcomes. Rates of complication and reoperation were low. This study supports the potential use of isolated gastrocnemius recession in IAT patients who, because of age or medical comorbidities, may benefit from a less invasive surgery and faster rehabilitation. Level III, retrospective case control study.

Isolated Gastrocnemius Contraction and Gastroc Recession Surgery in Case of Planter Fasciitis: A Systemic Review and Meta-Analysis.

The current systematic and meta-static review aimed to analyze the correlation between isolated gastrocnemius contracture and plantar fasciitis and the effectiveness of gastroc recession surgery in the treatment of plantar fasciitis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to conduct this meta-analysis. A literature search was carried out on the following databases, including Google Scholar, PubMed, EMBASE, and the Cochrane databases with the appropriate medical subject headings (MeSH) to identify the eligible articles. A total of 13 studies were included in this meta-analysis. In this study, there is a significant difference in chronic plantar fasciitis outcome when comparing experimental and control (RR: 0.02; 95% CI: 0.01 to 0.05; P < 0.001; I2 = 29%). There is a significant difference in pain scale outcome when comparing pre-treatment and post-treatment (RR: 3.25; 95% CI 1.44 to 7.32; P = 0.004 < 0.01; I2 = 0%). A significant difference in VAS scale outcome when comparing pre-treatment and post-treatment (RR: 2.58; 95% CI 1.52 to 4.38; P = 0.0004 < 0.01; I2 = 0%). In conclusion, the current systematic review and meta-analysis of gastrocnemius recession and proximal medial gastrocnemius release and other treatment measures for plantar fasciitis suggests that the improvement of ankle dorsiflexion, reduction in pain, and patient satisfaction are almost similar in all the treatment measures. Among the five treatment measures, gastrocnemius recession remains the best, followed by proximal medial gastrocnemius release.

Factors Associated With Poor Patient-Reported Outcomes in Isolated Gastrocnemius Recession for Heel Pain.

Gastrocnemius recession is commonly performed for a variety of pathologies of the foot and ankle, yet studies characterizing risk factors associated with patient-reported outcomes are limited. In this cohort study, patient outcomes were compared against the general population for PROMIS scores with correlation analysis comparing demographics and comorbidities. Our primary goal in this study is to identify risk factors associated with poor patient-reported outcomes following isolated gastrocnemius recession for patients with plantar fasciitis or insertional Achilles tendinopathy. A total of 189 patients met inclusion criteria. The open Strayer method was preferred. However, if the myotendinous junction could not be adequately visualized without expanding the excision, then a Baumann procedure was performed. The decision between the two did not depend on preoperative contracture. Patient demographics and visual analog scale (VAS) scores were obtained via the electronic medical record. Telephone interviews were completed to collect postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) and Foot Function Index (FFI) scores. The data were analyzed using the type 3 SS analysis of variance test to identify individual patient factors associated with reduced PROMIS, FFI, and VAS scores. No demographic variables were found to be significantly associated with postoperative complications. Patients who reported tobacco use at the time of surgery had significantly decreased postoperative PROMIS physical function (P = .01), PROMIS pain interference (P < .05), total FFI scores (P < .0001), and each individual FFI component score. Patients undergoing their first foot and ankle surgeries reported numerous significant postoperative outcomes, including decreased PROMIS pain interference (P = .03), higher PROMIS depression (P = .04), and lower FFI pain scores (P = .04). Hypertension was significantly associated with an increased FFI disability score (P = .03) and, along with body mass index (BMI) >30 (P < .05) and peripheral neuropathy (P = .03), significantly higher FFI activity limitation scores (P = .01). Pre- and postoperative VAS scores demonstrated improvement in patient-reported pain from a mean of 5.53 to 2.11, respectively (P < .001). We found in this cohort that numerous patient factors were independently associated with differences in patient-reported outcomes following a Strayer gastrocnemius recession performed for plantar fasciitis or insertional Achilles tendinopathy. These factors include, but are not limited to, tobacco use, prior foot and ankle surgeries, and BMI. This study strengthens previous reports demonstrating the efficacy of isolated gastrocnemius recession and elucidates variables that may affect patient-reported outcomes. Level III, retrospective cohort study.

Cavovarus deformity of one foot with planovalgus deformity of the contralateral foot (Wind-swept heels): A case report

Normal alignment of the arches and adequate stability is essential for the foot to function correctly. Pes planus and pes cavus are fairly common foot deformities, but it is uncommon to see both in the same patient simultaneously. This study aimed to describe the clinical presentation and prognosis of an uncommon combination of bilateral foot abnormalities named “windswept heels” resembling windswept knees. A 43-year-old female employee experienced frequent pain in her right foot and swelling and pain in her left foot, mainly when walking barefoot. She had a severe cavovarus deformity of the right foot with pressure callosities on the lateral side, clawing of the toes, and a positive Coleman’s block test. With the loss of the medial arch, severe heel valgus, and forefoot abduction, the left foot developed a planovalgus deformity. The left foot’s talus-first metatarsal angle and the right foot’s calcaneal inclination angle increased on weight-bearing radiographs. The left foot underwent staged surgical treatments, including medial sliding calcaneal osteotomy, gastrocnemius recession, and cotton osteotomy. For the right foot, lateral sliding calcaneal osteotomy, plantar fasciotomy, and peroneus longus tendon transfer. The American Orthopaedics Foot and Ankle Society Score (AOFAS) was used to measure the clinical and functional outcomes. At 1 year, her AOFAS scale was 85 compared to 59 before surgery. Since this presentation resembles the windswept knee deformity, we propose calling this disorder windswept heel deformity.

PROMIS Scores for Plantar Fasciitis Before and After Gastrocnemius Recession.

There has been an established relationship between increased loading on the Achilles tendon and tension on the plantar fascia. This supports the idea that either tight gastrocnemius and soleus muscles or contractures of the Achilles tendon are risk factors for plantar fasciitis. Gastrocnemius recession has gained popularity as a viable surgical intervention for cases of chronic plantar fasciitis due to isolated gastrocnemius contracture. To our knowledge, this is the first study to investigate Patient-Reported Outcome Measurement Information Systems (PROMIS) scores in patients with plantar fasciitis before and after gastrocnemius recession. The Electronic Medical Record was queried for medical record numbers associated with Current Procedural Terminology code 27687 (gastrocnemius recession). Our study included all patients with a preoperative diagnosis of chronic plantar fasciitis with treatment via isolated gastrocnemius recession with 1-year minimum follow-up. Forty-one patients were included in our study. Patient variables were collected via chart review. Preoperative and postoperative PROMIS scores were collected in the clinic. We followed up 41 patients with a median age of 48 years (interquartile range [IQR] 38-55) and median body mass index of 29.02 (IQR 29.02-38.74) for 1 year post surgery. Preoperative and postoperative PROMIS scores improved for physical function from 39.3 to 44.5 (P = .0005) and for pain interference from 62.8 to 56.5 (P = .0001). PROMIS depression scores were not significantly different (P = .6727). Visual analog scale (VAS) scores significantly decreased from 7.05 to 1.71 (P < .0001). In this case series, we found the gastrocnemius recession to be an effective option for patients with refractory pain in plantar fasciitis. Our PROMIS and VAS data confirm this procedure's utility and highlight its ability to significantly decrease pain and improve physical function in patients with chronic plantar fasciitis, although final median scores did not reach normative standards for the population, suggesting some residual pain and/or dysfunction was, on average, present. Based on the results of this study, the authors conclude that gastrocnemius recession is a reasonable treatment option for chronic plantar fasciitis patients who fail nonoperative management. Level III, retrospective cohort study.

A Retrospective Comparative Study of Endoscopic Treatment of Gastrocnemius Contracture using the Modified Soft Tissue Release Kit

Background and Objectives: This study aimed to evaluate the effectiveness and safety of endoscopic gastrocnemius recession using the self-developed Modified Soft Tissue Release Kit. Materials and Methods: This retrospective review followed up 22 patients (34 feet) who underwent endoscopic surgery and 20 patients (30 feet) who received open surgery between January 2020 and January 2022. The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the maximum ankle dorsiflexion angle were evaluated preoperatively and at the last follow-up. Postoperative complications were recorded. Patient satisfaction was surveyed at the last follow-up. The comparison between quantitative data was analyzed with the Wilcoxon signed-rank test. The comparison between qualitative data was analyzed with the chi-square test. Results: There was no significant difference in the baseline characteristics between the two groups. The AOFAS score in the endoscopic group increased from 50 (18) points preoperatively to 90 (13) points at the last follow-up; the maximum ankle dorsiflexion angle increased from -7.7 (2.8) degrees to 10.6 (3.6) degrees. The AOFAS score in the open group improved from 47 (15) points preoperatively to 90 (18) points at the last follow-up; the maximum ankle dorsiflexion angle increased from -7.6 (4.0) degrees to 10.7 (3.3) degrees. The change values of the AOFAS scores in the endoscopic and open groups were 39 (15) and 40.5 (11) points, respectively, and there was no significant difference between them. The change values of the maximum ankle dorsiflexion angles in the endoscopic and open groups were 19.5 (4.3) and 19.1 (4.9) degrees, respectively, and there was no significant difference between them. There were no complications, such as sural nerve injury, in both groups. There was no significant difference between the two groups in satisfaction with the surgical outcome. Conclusions: Endoscopic gastrocnemius recession using the Modified Soft Tissue Release Kit can significantly improve the foot function with significant mid-term efficacy and high safety.

Retrospective Comparison of Isolated Haglund's Deformity Surgery Versus Combined With Gastrocnemius Recession

Insertional Achilles tendonitis is a common pathology treated by foot and ankle surgeons that may require surgical intervention. Literature has shown good outcomes following detachment and reattachment of the Achilles for removal of the exostosis. However, there is minimal literature showing the impact of adding a gastrocnemius recession to the Haglund's resection. The goal of the present study was to retrospectively review the outcomes of an isolated Haglund's resection versus a Haglund's resection combined with a gastrocnemius recession. A retrospective chart review of 54 operative extremities was performed: 29 with isolated Haglund's resection and 25 with a Strayer gastrocnemius recession. We found similar decreases in pain between the 2 groups, 6.1 to 1.5 and 6.8 to 1.8 in the isolated Haglund's and Strayer's group, respectively. We found decreased postoperative Achilles rupture and reoperation rates in the Strayer group but this did not reach statistical significance. We found a statistically significant decreased rate of wound healing complications in the Strayer group, 4% in the Strayer group and 24% in the isolated procedure. In conclusion, adding a Strayer to a Haglund's resection was found to have a statistically significant decrease in wound complications. We recommend future randomized controlled studies to compare the use of a Strayer procedure on postoperative complications.

Endoscopic calcaneoplasty with gastrocnemius recession for Haglund's syndrome: Is it safe and effective? Results from a retrospective case series

BackgroundEndoscopic calcaneoplasty (ECP) and gastrocnemius recession (GR) are procedures that have been described to effectively treat Haglund’s deformity and insertional Achilles tendinopathy respectively. The purpose of our manuscript is to evaluate the efficacy and safety of ECP and GR with immediate weightbearing for the treatment of Haglund’s deformity with mild to moderate insertional Achilles tendinopathy. MethodsWe performed ECP coupled with GR on 14 patients with an average age of 52 years. All patients demonstrated < 50% tendinous degeneration on MRI. All were allowed weightbearing as tolerated in a CAM boot within the first post-operative week. AOFAS scores and plain film radiographic findings were collected pre-operatively and post-operatively. ResultsThe radiographic exam of the Fowler-Philip angle significantly improved from an average 60.1–40.7° (p < 0.001). The AOFAS ankle/hindfoot score significantly improved from an average 54.7–91.4 (p < 0.001). The average return to work was 7.5 weeks. There were two cases of temporary sural nerve paresthesia, and two cases of delayed wound healing. ConclusionsThis is the first mid-term study evaluating the outcomes of ECP with GR. The results of our study suggest that ECP with GR followed by immediate weightbearing is a safe and effective procedure for the treatment of Haglund’s deformity and mild to moderate insertional Achilles tendinopathy.

Bilateral talocalcaneal tarsal coalition with flatfeet treated with single-stage coalition resection and calcaneal lengthening osteotomy: A case report

A coalition is a bridge connecting osseous structures. Tarsal coalitions typically involve talocalcaneal and calcaneonavicular joints. As a result, patients might present with pain and/or rigid flatfoot deformity. We outline a case of bilateral middle facets talocalcaneal tarsal coalition with rigid flatfeet who was treated with resection combined with flatfoot reconstruction. the patient was an 11-year-old Saudi girl who had progressive bilateral flatfoot for which non-operative treatment failed. A single-stage middle facet talocalcaneal coalition resection with concomitant Evans calcaneal lengthening osteotomy and gastrocnemius recession was performed. Postoperatively, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle midfoot score was measured, and the patient had a score of 90/100. The outcome was satisfactory, and the other foot was operated on 6 months later, with the same procedure and outcome (AOFAS: 90/100). Six years of follow-up showed no recurrence and a satisfactory lifestyle with no activity limitation. We aimed to highlight the AOFAS score 6 years after resecting the coalitions while reconstructing the foot in a single-staged procedure.

Tibiopedal Motion Following Tendo-Achilles Lengthening or Gastrocnemius Recession in Total Ankle Replacement: A Comparative Cohort Study.

End-stage ankle arthritis is a debilitating condition often necessitating total ankle replacement (TAR). Tendo-Achilles lengthening (TAL) and gastrocnemius recession (GR) are commonly performed with TAR to improve ankle dorsiflexion (DF). No studies to date have radiographically analyzed tibiopedal motion to guide surgical management. The purpose of this study is to determine the effect of a TAL or GR during TAR on radiographic tibiopedal range of motion (ROM). A retrospective review of a prospectively maintained database was conducted followed by a propensity score-matched analysis of 110 patients who underwent TAL (n = 26), GR (n = 29), or no lengthening procedure (n = 55) with TAR. Minimum of 1-year ROM radiographic follow-up was required. Exclusion criteria included (1) calcaneal osteotomies, (2) simultaneous or previous hindfoot or midfoot arthrodesis, (3) prior ankle arthrodesis, or (4) revision TAR. Demographic data were extracted from the TAR database. Radiographic assessment included tibiopedal dorsiflexion (DF) and plantarflexion (PF). DF improved by 2.8 degrees (P = .0286) and by 6.0 degrees (P < .0001) in the TAL and GR cohorts, respectively, with no difference in the control group (+0.7 degrees, P = .3764). PF was decreased by 4.5 degrees (P = .0152) and by 7.2 degrees (P = .0002) in the TAL and GR cohorts, respectively, with no difference in the control group (-0.2 degrees, P = .8546). Minimal differences were observed for total arc of motion for all 3 groups (control 0.5 degrees, GR -1.2 degrees, TAL -1.7 degrees), all of which were nonsignificant (all P > .05). There was no between-group difference in the change in overall arc of motion between the groups (P = .3599). GR resulted in a greater increase in DF (6.0 vs 2.8 degrees; P = .1074), with a reciprocal greater decrease in PF (7.2 vs 4.5 degrees; P = .2416) compared with the TAL cohort. Both TAL and GR increased postoperative DF; however, this was accompanied by a reciprocal loss in PF. Minimal differences were observed for total arc of motion. Patients should be counseled that concomitant procedures performed to increase DF will do so at the expense of PF. Level III, retrospective review of prospectively collected data.

The Medial Gastrocnemius Recession, an Alternative Surgical Treatment for Isolated Gastrocnemius Contracture: A Cadaver Study With Discussion Emphasizing Variable Conjoint Tendon Anatomy.

Gastrocnemius recession is a popular procedure utilized to treat chronic conditions related to isolated gastrocnemius contracture (IGC). Recent anatomical research detailing variable gastrocsoleus tendon morphology has raised important questions regarding the safety of some traditional recession procedures. Alternative gastrocnemius recession strategies may produce comparable dorsiflexion improvement results while avoiding the surgical risk related to conjoint tendon anatomical variability. Ten matched cadaver pairs were randomized to receive either a medial gastrocnemius recession (MGR) procedure or a gastrocnemius intramuscular recession "Baumann" procedure. Postoperative dorsiflexion improvement was measured and then compared between groups. Detailed postoperative surgical dissections were performed to assess structures at risk, conjoint tendon morphology, and anatomical symmetry. Medial gastrocnemius recession and Baumann procedures were equally effective at producing significant increases in passive ankle dorsiflexion. No sural nerve injuries were observed. Thirty-five percent of specimens showed direct muscular fusion of at least a portion of the distal gastrocnemius muscular tissue to the adjacent soleus. The MGR procedure produced comparable dorsiflexion improvement results to the Baumann procedure in our cadaver model. Surgeons must account for certain conjoint tendon anatomical variants when surgically treating IGC as traditional recession methods risk tendo-Achilles overlengthening. Level V: Cadaver Study.

Isolated Gastrocnemius Recession for Progressive Collapsing Foot Deformity.

Progressive collapsing foot deformity (PCFD) is frequently associated with a gastrocnemius contracture. Surgical treatment of PCFD often includes a gastrocnemius recession in addition to other corrective procedures, which typically requires a period of restricted weight bearing postoperatively. Isolated gastrocnemius recession may allow passive correction of the deformity, improve orthotic fit, and obviate the need for full reconstruction and restricted weight bearing. The goal of this study was to evaluate patient-reported outcomes after an isolated gastrocnemius recession for flexible PCFD in patients anticipated to have difficulty with postoperative restricted weight bearing. A total of 47 patients met the inclusion criteria: isolated gastrocnemius recession for flexible PCFD, no previous ipsilateral surgery, and more than 6 months of follow-up. Of 47 eligible patients, 29 (31 feet) participated. Available preoperative and postoperative patient-reported outcomes were gathered, including the Foot and Ankle Ability Measure Activities of Daily Living, visual analog scale, and the Patient-Reported Outcome Measurement Information System Physical Function Short Form 10a. In addition, patients were asked about satisfaction, willingness to undergo the procedure again, and whether orthotics provided better relief. At a mean of 5.1 (range, 0.6 to 9.0) years postoperatively, median Foot and Ankle Ability Measure Activities of Daily Living was 82.1, mean Patient-Reported Outcome Measurement Information System Physical Function Short Form 10a was 44.2, and median visual analog scale was 10 (of 100). Sixty-nine percent of patients were either satisfied or very satisfied, 69% would undergo the procedure again, and 62% reported improved relief with use of orthotics postoperatively. Among the 47 eligible patients, there were 5 (11%) subsequent flatfoot reconstructions. Isolated gastrocnemius recession for the management of flexible PCFD can be effective as this procedure demonstrated good outcomes scores with high procedural satisfaction and 11% of patients proceeding to subsequent flatfoot reconstruction. This alternative approach may be of particular value for patients anticipated to have difficulty with postoperative weight-bearing restrictions. :IV.

Radiographic Changes in Tibiotalar Motion Following Achilles Tendon Lengthening and Gastrocnemius Recession in Total Ankle Arthroplasty: A Comparative Cohort Study

Category: Ankle; Hindfoot Introduction/Purpose: End-stage ankle osteoarthritis is a debilitating condition that often results in limited tibiotalar range of motion. Total ankle replacement (TAR) preserves ankle range of motion and improves the patient's functionality. Tendo-Achilles lengthening (TAL) and gastrocnemius recession (GR) are concomitant procedures often performed with TAR to improve tibiotalar dorsiflexion. The purpose of this study is to determine the effect of a TAL and GR during TAR on radiographic range of motion compared to a control group without a lengthening procedure. Methods: A retrospective review of a prospectively maintained TAR database was conducted from November 2015 - June 2020 at a single academic institution. All surgeries were performed by fellowship-trained foot and ankle surgeons. Inclusion criteria included greater than18 years of age and a minimum of one-year radiographic follow-up with both preoperative and postoperative weight-bearing, range of motion radiographs. Exclusion criteria included concomitant 1) calcaneal osteotomies, 2) hindfoot or midfoot arthrodesis, 3) prior ankle arthrodesis, or 4) revision total ankle arthroplasty. A total of seventy-five patients (TAL, n = 40; GR, n = 35) were included with a control group of seventy-five consecutive patients who underwent TAR without a lengthening procedure. Demographic and clinical data were extracted from the TAR database. Preoperative and postoperative radiographic assessment included a measurement of dorsiflexion and plantarflexion. All measurements were performed by two members of the research team. Results: A total of 150 patients were included in this study: TAL: n = 35, GR: n = 40, Control: n = 75. Dorsiflexion significantly improved by 3.4° (p=0.0053) and by 6.7° (p &lt; 0.0001) in the TAL and GR cohorts respectively with no significant difference in the control group (+1.3°, p=0.0857). Plantarflexion was significantly decreased by 3.6° (p=0.0378) and by 6.6° (p=0.0002) in the TAL and GR cohorts respectively with no significant difference in the control group (+0.3°, p=0.7863). The total arc of motion did not change significantly for any of the three groups postoperative (control 1.63°, GR 0.05°, TAL -0.20°; all p&gt;0.05). There were no significant between-group differences in the change in overall arc of motion between the groups (p=0.3913). Compared to TAL group, GR resulted in a greater increase in dorsiflexion (6.7° versus 3.4°; p=0.0459) with a reciprocal, albeit non-significant, greater decrease in plantarflexion (6.8° versus 3.6°; p=0.1598). Conclusion: Both TAL and GR significantly increased postoperative dorsiflexion; however, this was accompanied by a reciprocal significant loss in plantarflexion. GR resulted in double the improvement in dorsiflexion and loss in plantarflexion compared to TAL. The total arc of motion did not significantly change for the control, GR, or TAL cohorts. Patients should be counselled that their preoperative range of motion (ROM) will dictate their postoperative ROM, and that concomitant procedures performed to achieve an increase in dorsiflexion will do so at the expense of plantarflexion.

Five-Year Minimum Patient-Reported Outcomes Following Isolated Gastrocnemius Recession for Plantar Fasciitis and Achilles Tendinopathy

Category: Hindfoot; Other Introduction/Purpose: Plantar fasciitis and Achilles tendinopathy are common foot and ankle overuse conditions encountered in clinical practice. Treatment modalities for these diagnoses vary however, isolated gastrocnemius recession may be a viable treatment option for these conditions when conservative management has failed. There is little published on the long-term outcomes of this procedure with very few studies able to report on the five-year reported outcomes in these patients. Here, we assess patient-reported outcome in those with a minimum of five-year follow up that underwent isolated gastrocnemius resection for the above indications. Methods: A retrospective analysis of patients that underwent gastrocnemius recession at our facility from 2011 to 2018 was conducted. Patients were selected if they underwent an isolated gastrocnemius recession specifically due to Achilles tendinopathy or plantar fasciitis. Patients were excluded if they had a history of musculoskeletal disorders of a history of previous recession. Basic patient demographics, chronic use of fluoroquinolones and NSAIDs, duration of symptoms, presence of rheumatoid arthritis, history of previous foot and ankle operations, and surgical complications were all recorded. To evaluate outcomes, we utilized Foot Function Index (FFI) scores as well as the Patient Reported Outcomes Measurement Information System (PROMIS) survey. Results: A total of 141 patients met inclusion criteria with all individuals completing both the PROMIS survey and 115 completing the FFI survey. The average time point at which outcomes were collected was 6.6 years postoperatively. Postoperative PROMIS scores for physical function, pain interference, and depression were all within one standard deviation of the reference population. The average PROMIS physical function, pain interference, and depression scores for this population was 45.67, 50.87, and 41.20, respectively. The mean FFI scores were 28.58 for pain, 36.11 for disability, 21.11 for activity limitation with an average total FFI of 31.40. Six patients developed surgical site infection, 36 patients reported postoperative symptoms of sural neuropathy with 12 reporting complete resolution of the neuropathy, and four patients required revisional surgery. Conclusion: With the limited data regarding the long-term outcomes of gastrocnemius recession, we sought to explore patient- reported outcomes in terms of pain, disability, physical function, depression, and pain interference. Our results prove that gastrocnemius recessions for Achilles tendinopathy and plantar fasciitis can lead to long term satisfaction for patients and can expect relatively low complication rates during the process. Additionally, the high retention rate of patients answering all required patient surveys further strengthens the findings reported here.

Comparison Between Corrective Osteotomies and Arthroereisis in Management of Symptomatic Flexible Pes Planovalgus in Young Adolescents: A Prospective Randomised Controlled Study

Category: Hindfoot Introduction/Purpose: Flexible pes planovalgus is a common deformity in young adolescents. It can interfere with daily activities and athletic participation. If conservative treatment fails, operative intervention is justified. Operative interventions include lateral column lengthening alone, multiple osteotomies (medial translation calcaneal osteotomy, lateral column lengthening, and Cotton osteotomies), and arthroereisis. All these options can be combined with gastrocnemius recession, excision of accessory navicular, or other soft tissue procedures. Arthroereisis is a highly controversial procedure with a great debate regarding indications, safety and clinical outcome. The literature comparing corrective osteotomies to arthroereisis in young adolescents is deficient and non conclusive. This study was done to compare the clinical and radiological outcome of multiple corrective osteotomies to arthroereisis in young adolescents. Methods: This prospective randomized controlled study included 40 feet (20 feet in each group) in 25 patients with flexible pes planovalgus deformity in patients aged 10 to 13 years, after failure of conservative treatment. Exclusion criteria included generalised ligamentous laxity, neurogenic disorders, and rigid deformity. Cases with severe talonavicular uncoverage (angle more than 40 degrees) were excluded as this might be a contraindication to arthroereisis. Group 1 underwent correction by multiple osteotomies (medial translation calcaneal osteotomy, lateral column lengthening, and Cotton osteotomies) and group 2 underwent arthroereisis using a titanium subtalar spacer. Gastrocnemius recession and resection of painful accessory navicular were done if indicated in both groups, but no other soft tissue procedures were used. Clinical outcome was assessed using AOFAS, FAAM scores and subjective patient satisfaction. Radiological assessment included lateral talocalcaneal angle, anteroposterior and lateral talus first metatarsal angle, talonavicular coverage angle, and calcaneal pitch angle. Results: The mean follow up in group 1 was 29 months (12-43 months) compared to 25 months (12-41 months) in group 2. Preoperatively, there was no statistically significant difference between the two groups regarding patient demographics, clinical scores, or radiological measurements. Clinically, 18 patients were satisfied in group 1, compared to 17 patients in group 2. The mean AOFAS score improved significantly from 73 (62-90) to 91(73-100) in group 1 and from 73(62-90) to 89(73-100) in group 2. FAAM score improved significantly from 76%(68-87) to 95.75%(74-100) in group 1, and from 73%(62-86) to 91%(71-98) in group 2. The difference between the two groups was not statistically significant. All radiological measurements improved significantly in both groups without a statistically significant difference between the two groups. Arthroereisis implant was not removed in any patient. Conclusion: Clinical and radiological outcome of arthroereisis is comparable to corrective osteotomies in young adolescents with symptomatic pes planovalgus deformity and can be a valid option in management of these cases, but long term follow up is needed. Also, consensus regarding the perfect age, implant removal, and the degree of talonavicular uncoverage that can be corrected by arthroereisis need further studies.

Is Patient Resilience a Predictor of Postoperative Success Following Total Ankle Arthroplasty?

Category: Ankle Arthritis; Ankle; Other Introduction/Purpose: Resilience is defined as the ability to adapt well to adversity or a significant source of stress, such as surgery. The Brief Resilience Scale (BRS) is a commonly used 6-item Likert scoring system that has been validated in adult musculoskeletal literature. Prior studies have demonstrated that patients with higher resilience are successful at managing their perioperative circumstances leading to better functional outcomes postoperatively. However, no literature exists in patients who have undergone total ankle arthroplasty (TAA). The purpose of this study is to investigate whether patient resilience is a predictor of subjective and functional outcomes after TAA. We hypothesize that patients with higher resilience will have significantly improved pain, function, and satisfaction compared to patients with lower resilience. Methods: This was a single institute, cross-sectional survey of patients who underwent primary TAA by one of four fellowship trained Foot and Ankle surgeons prior to June 2020. Concomitant procedures performed were tendoachilles lengthening or gastrocnemius recession, and/or medial malleolar osteotomy. Patients with pre- and postoperative visual analog scale (VAS) and Foot and Ankle Ability Measure (FAAM) scores were included. Patients without completed pre- or postoperative pain or functional scores or those who underwent revision arthroplasty and/or additional procedures other than those previously mentioned were excluded. A telephone survey was performed to obtain the included patients' BRS scores and satisfaction. Statistical analysis was performed to compare outcomes in patients with either low, normal, or high resilience. Parametric continuous data was compared using T-tests while nonparametric data was compared using Mann-Whitney tests. Chi-square or Fisher's Exact tests were performed to compare categorical data. Stats were done using R Studio (Vienna, Austria). Results: A total of 65 patients were included. Patients were defined as having low, normal, or high resilience based on a BRS score of &lt; 3, 3-4.30, and &gt; 4.3, respectively. There was a total of 25, 38, and 2 patients in the low, normal, and high resilience groups, respectively. The high resilience group was excluded from statistical analysis secondary to low patient count. When comparing outcomes after TAA in patients with normal versus low resilience, we found no statistically significant difference in VAS pain scores, FAAM functional scores, or satisfaction (Table 1). Specifically, there was no statistically significant difference in postoperative VAS pain scores (p=0.422) or the change in scores from pre- to postop (p=0.773). Likewise, there was no statistically significant difference in postoperative FAAM scores (p=0.588) or the change in scores from pre- to postop (p=0.647). Over 84% of patients in both groups were either very satisfied or satisfied. Conclusion: To our knowledge, this is the first study investigating the effect of patients' resilience on outcomes following TAA. We were unable to prove that patients with higher resilience have significantly improved outcomes compared to those with lower resilience. Despite this, patients in all 3 cohorts (low, normal, and high resilience) on average experienced decreased pain and improved function postoperatively. In addition, the vast majority of patients were either very satisfied or satisfied with the surgery. Future studies should aim to increase the sample size as this may lead to results more consistent with previous orthopaedic literature regarding resilience.

Routine Postoperative Aspirin for VTE Chemoprophylaxis in Primary Total Ankle Arthroplasty

Category: Ankle Arthritis; Ankle; Other Introduction/Purpose: The use of low-dose aspirin for postoperative venous thromboembolism (VTE) chemoprophylaxis has been widely studied and validated in adult reconstruction surgery with little to no reported adverse reactions. In total ankle arthroplasty (TAA) literature, low-molecular-weight heparin (LMWH) has been the predominant chemoprophylactic agent used, despite little evidence supporting it. To date, no studies have assessed the role of aspirin for VTE chemoprophylaxis after total ankle arthroplasty and no formalized clinical practice guideline exists. The purpose of this study was to evaluate outcomes of a large consecutive series of patients undergoing primary TAA at a single institution, in relation to routine postoperative aspirin administration. Methods: A prospective telephone survey and retrospective chart review was performed of patients undergoing primary TAA at a single institution by two fellowship trained foot and ankle surgeons. All patients were prescribed oral aspirin 81 mg BID for at least 2 weeks postoperatively, (or while weight-bearing was restricted). The primary outcome variable was postoperative development of deep vein thrombosis (DVT), pulmonary embolism (PE), or VTE related mortality within 3 months postoperatively. Venous ultrasounds were also queried. The secondary outcome variable was assessment of aspirin related adverse reaction including delayed wound healing and gastrointestinal (GI) bleeding. Patients with a history of bleeding disorder or history of prior VTE requiring non-Aspirin VTE chemoprophylaxis were excluded. Results: There were 217 patients included for retrospective review, and 81 patients completed the telephone survey (34% response rate). Concomitant procedures included gastrocnemius recession (104), teno-Achilles lengthening (20), ligament repair (17), tendon repair (3), tendon transfer (12), and plantar fasciectomy (1). The cohort included 119 males (54.8%), with a mean age 62.6 +/- 10.3 years (range 24 to 88), and mean BMI 30.6 +/- 5.6 (range 21.3 to 52.6). There were no GI bleeding or VTE events, yet 46/217 (21.2%) cases of delayed wound healing. Eleven patients underwent venous ultrasounds that all were negative. Sex (p=0.458), age (p=0.443), and BMI (p=0.335) were not associated with delayed wound healing, but current/former smoking status trended toward significant association (p=0.077). Time to weight-bearing was mostly bi-modal, between 1.5-3.5 weeks (37.8%) or 5.5-7.5 weeks (45.1%). Time to weight-bearing approached significance with delayed wound healing (p=0.05), which may represent surgeon intervention to promote healing. Conclusion: This study demonstrates effective use of aspirin in preventing VTE events after primary TAA in patients without risk factors for VTE and PE, which is cheaper and more widely available all around the world. Further randomized controlled studies may better elucidate any role of aspirin with regards to delayed wound healing, which had an an approximate incidence of 20% in our cohort. Limitations of the study include those inherent to a retrospective review, such as lack of a control group.

The Role of the Plantaris in Intramuscular Gastrocnemius Equinus Correction

Equinus deformity is a common cause of foot and ankle pathology. The purpose of our study was to evaluate the role of the plantaris in equinus. Secondary aims were to describe the role of the plantaris in intramuscular gastrocnemius recession and to determine the prevalence of the plantaris in our patient population. We measured ankle dorsiflexion during the steps of a Baumann-type intramuscular gastrocnemius recession. Eighty-nine patients were enrolled in our study. Fourteen of 89 (15.7%) patients did not have a plantaris. A mean dorsiflexion of 9 (interquartile range 6-12)° was obtained after transection of the plantaris tendon and an additional mean 8 (interquartile range 5-10)° was obtained after recession of the gastrocnemius aponeurosis. There was a strong positive correlation (rs = 0.842) of dorsiflexion increase after plantaris transection and dorsiflexion increase after gastrocnemius recession (p < .00). Linear regression showed that for every one-degree of dorsiflexion increase with plantaris transection, there was a predicted dorsiflexion increase of 0.69° with gastrocnemius recession. These results indicate that the plantaris is a component of equinus deformity.

Triceps Surae Lengthening in Foot and Ankle Trauma: A Survey of OTA and AOFAS Members.

Background:The prevalence, indications, and preferred methods for gastrocnemius recession and tendo-Achilles lengthening—grouped as triceps surae lengthening (TSL) procedures—in foot and ankle trauma are supported by a scarcity of clinical evidence. We hypothesize that injury, practice environment, and training heritage are significantly associated with probability of performing adjunctive TSL in the operative management of foot and ankle trauma.Methods:A survey was distributed to members of the American Orthopaedic Foot & Ankle Society and the Orthopaedic Trauma Association. Participants rated how likely they would be to perform TSL at initial management, definitive fixation, and after weightbearing in the presence and absence of a positive Silfverskiöld test in 10 clinical scenarios of closed foot and ankle trauma.Results:A total of 258 surgeons with median 14 years’ experience responded. Eighty-five percent reported foot and ankle fellowship training, 24% reported traumatology fellowship training, 13% both, and 4% no fellowship. Ninety-nine percent reported performing TSL with a median 25 TSL procedures per year, 72% open gastrocnemius recession, and 17% percutaneous tendo-Achilles lengthening). Across all scenarios, we observed low overall 8% probability with fair agreement (κ = 0.246) of performing TSL (range, 1% at initial management of an unstable Weber B bimalleolar ankle fracture with negative contralateral Silfverskiöld test to 29% at definitive fixation of tongue-type calcaneus fracture with positive contralateral Silfverskiöld test). Silfverskiöld testing significantly influenced TSL probability at all time points. University of Washington training (β = 1.5, P = .007) but not trauma vs foot fellowship training, years in practice, academic practice, urban setting, or facility trauma designation were significantly associated with likelihood of performing TSL.Conclusion:Orthopaedic traumatology and foot and ankle surgeons report similar indications, methods, and low perceived propensity to use TSL in the management of foot and ankle trauma. We found that graduates of 1 fellowship training site were more likely to perform TSL in the setting of acute trauma potentially indicating the need for better scientific data to support this practice.Level of Evidence:Level V, therapeutic.

Radiofrequency Plantar Fascia Coblation With and Without Gastrocnemius Recession in the Management of Recalcitrant Plantar Fasciitis.

Plantar fasciitis is the most common cause of plantar heel pain. Although most are self-limiting, recalcitrant conditions can be debilitating, significantly reducing patient's quality of life. A myriad of surgical procedures are available for the treatment of recalcitrant plantar fasciitis (RPF) with little consensus on best practice. This purpose of this study was to assess the efficacy of radiofrequency coblation with and without gastrocnemius release on the surgical management of RPF. Between June 2013 and June 2019, a total of 128 patients with RPF and tight gastrocnemius were treated surgically. Presence of tight gastrocnemius was assessed clinically by a positive Silfverskiold test. Group A (n = 73) consisted of patients who underwent radiofrequency coblation alone; group B (n = 55) consisted of patients who underwent radiofrequency coblation and endoscopic gastrocnemius recession. The primary outcome measure was visual analog scale (VAS) score. Secondary outcome measures included (1) American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score; (2) physical (PCS) and mental component summaries (MCS) of the 36-Item Short Form Health Survey; (3) overall assessment of improvement, expectation fulfilment, and satisfaction; and (4) complication rates. Both groups reported significant improvement in VAS, AOFAS, and PCS scores postoperatively at 6 and 24 months. Group B (radiofrequency coblation with gastrocnemius recession) was associated with better VAS at both 6 months (3.0 ± 2.9 vs 1.7 ± 2.6, P < .05) and 24 months postoperatively (1.9 ± 3.1 vs 0.8 ± 2.0, P < .05) compared with group A (radiofrequency coblation without gastrocnemius recession). At 24 months postoperatively, no differences were found in AOFAS, PCS, MCS scores, expectation fulfilment, or overall satisfaction. No wound complications were reported in either group. One patient (group B) has persistent symptoms consistent with tarsal tunnel syndrome. In this retrospective cohort comparative study, treatment of RPF with radiofrequency coblation alone was associated with slightly inferior results than radiofrequency coblation combined with endoscopic gastrocnemius recession in terms of pain relief without an increase in complication rates. However, at 2 years, we did not find a significant difference in other measures of outcome. Level III, retrospective cohort study.