1
|
Escalada Barrado J, Saiz Modol C, Llombart Blanco R. Medial gastrocnemius proximal fasciotomy in patients with chronic plantar fasciitis: A systematic review. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023:S1888-4415(23)00191-1. [PMID: 37730117 DOI: 10.1016/j.recot.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/20/2023] [Accepted: 08/16/2023] [Indexed: 09/22/2023] Open
Abstract
INTRODUCTION Plantar fasciitis is the main cause of heel pain in middle-aged patients. In chronic cases, limited ankle dorsiflexion caused by isolated gastrocnemius contracture is considered the main risk factor for suffering it. Therefore, in recent years the number of patients operated on by proximal fasciotomy of the medial gastrocnemius (FPGM) has increased to treat chronic plantar fasciitis. MATERIAL AND METHODS Systematic review following the PRISMA guidelines. We have carried out a bibliographic search in Pubmed, Science Direct, Cochrane Library and Web of Science databases. One hundred and eighty-four articles were found. Data extraction was performed using the Covidence software, and a quality and risk of bias analysis of the included articles was performed based on the Cochrane risk of bias Tool 2.0. RESULTS Three articles were included in the review: two randomized clinical trials and one cohort study with a total of 138 patients. In the analyzed studies, patients after proximal fasciotomy of the medial gastrocnemius showed significant improvements in pain and in the AOFAS score with high levels of patient satisfaction. Increases in ankle dorsiflexion angle were found after 12 months of follow-up, with no loss of gastrocnemius strength. The complication rate was low and fewer occurred in the proximal fasciotomy compared to plantar fasciotomy. CONCLUSION Proximal fasciotomy of the medial gastrocnemius provides clinical benefit in patients with chronic plantar fasciitis, with a low probability of complications and high patient satisfaction.
Collapse
Affiliation(s)
| | - C Saiz Modol
- Departamento de Cirugía Ortopédica y Traumatología, Clínica Universidad de Navarra, Pamplona, España
| | - R Llombart Blanco
- Departamento de Cirugía Ortopédica y Traumatología, Clínica Universidad de Navarra, Pamplona, España.
| |
Collapse
|
2
|
Li Y, Wang Z, Gan Y, Jiao X, Xu C, Zhao J, Dai K. A Retrospective Comparative Study of Endoscopic Treatment of Gastrocnemius Contracture using the Modified Soft Tissue Release Kit. Medicina (B Aires) 2023; 59:medicina59030635. [PMID: 36984636 PMCID: PMC10058304 DOI: 10.3390/medicina59030635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/07/2023] [Accepted: 03/18/2023] [Indexed: 03/29/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Yiming Li
- Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
- Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Zengguang Wang
- Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
- Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Yaokai Gan
- Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
- Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
- Correspondence:
| | - Xin Jiao
- Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
- Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Chen Xu
- Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
- Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Jie Zhao
- Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
- Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Kerong Dai
- Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
- Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| |
Collapse
|
3
|
Bull PE, Thompson MJ, McGann M, Mendez G, Berlet GC, Olaniyan A. The Medial Gastrocnemius Recession, an Alternative Surgical Treatment for Isolated Gastrocnemius Contracture: A Cadaver Study With Discussion Emphasizing Variable Conjoint Tendon Anatomy. Foot Ankle Spec 2022:19386400221133410. [PMID: 36330662 DOI: 10.1177/19386400221133410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSION 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. LEVELS OF EVIDENCE Level V: Cadaver Study.
Collapse
Affiliation(s)
| | | | - Maria McGann
- Romano Orthopaedic Center, River Forest, Illinois
| | | | | | | |
Collapse
|
4
|
Koh DTS, Yeo W, Koo KOT, Singh IR, Yeo NEM. Radiofrequency Plantar Fascia Coblation With and Without Gastrocnemius Recession in the Management of Recalcitrant Plantar Fasciitis. Foot Ankle Int 2022; 43:1167-1173. [PMID: 35652744 DOI: 10.1177/10711007221091807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSION 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 OF EVIDENCE Level III, retrospective cohort study.
Collapse
Affiliation(s)
| | - William Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Kevin Oon Thien Koo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.,The Bone and Joint Centre, Mount Elizabeth Hospital, Singapore
| | | | | |
Collapse
|
5
|
Gamba C, Álvarez Gomez C, Martínez Zaragoza J, Leal Alexandre C, Bianco Adames D, Ginés-Cespedosa A. Proximal Medial Gastrocnemius Release. JBJS Essent Surg Tech 2022; 12:ST-D-20-00039. [DOI: 10.2106/jbjs.st.20.00039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
6
|
Manzi G, Bernasconi A, Lopez J, Brilhault J. Ankle dorsiflexion after isolated medial versus complete proximal gastrocnemius recession: A cadaveric study. Foot (Edinb) 2021; 49:101842. [PMID: 34687979 DOI: 10.1016/j.foot.2021.101842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 06/02/2021] [Accepted: 06/09/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Gastrocnemius recession has been described in the treatment of gastrocnemius contracture. The aims of this study were: (1) to assess the change in ankle dorsiflexion after isolated medial gastrocnemius recession performed according to L.S. Barouk's technique; (2) to compare ankle dorsiflexion after isolated medial head with complete proximal gastrocnemius recession. METHODS A cadaveric study was performed on 15 lower limb adult specimens. Isolated medial gastrocnemius head recession was initially performed, followed by an additional recession of the lateral gastrocnemius head. Ankle dorsiflexion torque was applied with 2 and 4 kg forces on second metatarsal head. Ankle dorsiflexion was measured with the knee both in extension and at 90° of flexion and values were recorded before surgery (T0), after medial head recession (T1) and after both heads recession (T2). Normality of data was assessed using the Shapiro-Wilk test, then measurements were compared in the three conditions with appropriate statistical tests. RESULTS After isolated medial gastrocnemius recession (Δ = T1-T0), ankle dorsiflexion assessed with the knee in extension significantly increased by 5° ± 3 (range, -2 to 10) with a 2-kg torque (p = 0.02) and by 4.5° ± 3 (range, -4 to 10) with a 4-kg torque (p = 0.04). No significant difference was observed with the knee flexed at 90° (p > 0.05 for all measurements). After both gastrocnemius heads recession (Δ = T2-T1), although a further increase in dorsiflexion was noticed, statistical significance was not reached neither with the knee in extension nor at 90° of flexion (p > 0.05 for all measurements). CONCLUSION In this study, isolated medial gastrocnemius head recession performed according to LS Barouk's technique was effective in improving ankle dorsiflexion, whereas the additional release of the lateral head did not produce any significant change. LEVEL OF EVIDENCE Level V, cadaveric study.
Collapse
Affiliation(s)
- Giovanni Manzi
- Service de Chirurgie Orthopédique, Centre Hospitalier Saint Joseph Saint Luc, Lyon, France.
| | - Alessio Bernasconi
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, London, United Kingdom; Orthopaedic and Traumatology Unit, Department of Public Health, "Federico II" Naples University, Naples, Italy
| | | | - Jean Brilhault
- Centre de Chirurgie Orthopédique & Traumatologique, C.H.R.U Tours, 37044, Tours Cedex, France; Faculté de Médecine de Tours, 10, Boulevard Tonnelé, 37032 Tours Cedex 1, France
| |
Collapse
|
7
|
Liyanarachi S, Hulleberg G, Foss OA. Is Gastrocnemius Tightness a Normal Finding in Children?: A Cross-Sectional Study of 204 Norwegian Schoolchildren. J Bone Joint Surg Am 2021; 103:1872-1879. [PMID: 34432740 DOI: 10.2106/jbjs.20.01273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Isolated gastrocnemius tightness has been associated with several foot conditions. We do not know whether gastrocnemius tightness is a normal finding in the developing child or whether tightness is associated with foot symptoms. Recurrent foot and leg pain is common in children, and more knowledge of gastrocnemius tightness is of interest. METHODS Passive ankle dorsiflexion was measured with the knee flexed and extended (Silfverskiöld test) in 204 Norwegian schoolchildren (408 feet). School classes from 4 different age groups were recruited (5 to 6 years, 8 to 9 years, 11 to 12 years, and 14 to 15 years). Footprints were also recorded in order to assess for any association between foot morphology and dorsiflexion results, specifically, gastrocnemius tightness. RESULTS Ankle dorsiflexion decreased with increasing age. The thresholds for equinus contracture were set at either ≤5° or ≤0° of ankle dorsiflexion when measured with the knee extended, and the Silfverskiöld test was considered to be positive when ankle dorsiflexion was reduced by ≥10° from the flexed knee position to the extended knee position. The rate of gastrocnemius tightness was 54.9% if the threshold was set at ≤5° and only 3.7% if the threshold was set at ≤0°. The data did not provide evidence of an association between dorsiflexion and footprints. CONCLUSIONS Ankle dorsiflexion decreased with increasing age in this population of schoolchildren, highlighting the importance of age-matched norms. A majority had a tight gastrocnemius when the ankle dorsiflexion threshold was set at ≤5°, indicating that isolated gastrocnemius tightness should not be interpreted as a pathological finding. LEVEL OF EVIDENCE Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Suki Liyanarachi
- St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Gunn Hulleberg
- St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Olav A Foss
- St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway.,Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| |
Collapse
|
8
|
A comparative study between isolated gastrocnemius tightness patients and controls by quantitative Gait analysis and baropodometry. Foot Ankle Surg 2021; 27:772-776. [PMID: 33153918 DOI: 10.1016/j.fas.2020.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 08/20/2020] [Accepted: 10/05/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Isolated gastrocnemius tightness (IGT) has been suggested as an etiologic factor in mechanical disorders of the foot and ankle without a clear pathophysiological mechanism in the literature. We hypothesized that restricted ankle dorsiflexion inducing increased forefoot pressure in IGT patients could be this pathophysiological mechanism. METHODS Case/control experimental observational investigation. Forty lower limbs in 20 asymptomatic IGT patients were included and compared to controls. Quantitative gait analyses coupled with dynamic baropodometry were used for comparison between groups. The primary outcome was maximum ankle dorsiflexion during stance phase. Secondary outcomes were knee flexion and forefoot pressure. RESULTS Maximum ankle dorsiflexion and maximum forefoot pressure were similar between groups. Increased knee flexion was found in the asymptomatic IGT group. CONCLUSIONS IGT induced compensatory knee flexion during stance phase, which probably prevents increased pressure on the forefoot by allowing ankle dorsiflexion. LEVEL OF EVIDENCE Level IV, Case/control experimental observational investigation.
Collapse
|
9
|
Gamba C, Serrano-Chinchilla P, Ares-Vidal J, Solano-Lopez A, Gonzalez-Lucena G, Ginés-Cespedosa A. Proximal Medial Gastrocnemius Release Versus Open Plantar Fasciotomy for the Surgical Treatment in Recalcitrant Plantar Fasciitis. Foot Ankle Int 2020; 41:267-274. [PMID: 31808359 DOI: 10.1177/1071100719891979] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Plantar fasciitis is a common cause of foot pain. If conservative treatment fails, there is no consensus as to the best surgical management for recalcitrant plantar fasciitis (RPF). The aim of this study was to compare the results obtained from proximal medial gastrocnemius release (PMGR) with those obtained from open plantar fasciotomy (OPF) in terms of pain, satisfaction, health-related quality of life, and American Orthopaedic Foot & Ankle Society (AOFAS) score. METHODS This is a prospective randomized trial conducted between 2012 and 2016. Patients with RPF for at least 9 months were included. Diagnosis was clinically made. The exclusion criteria were neuropathic heel pain; a history of previous foot fracture, surgery, or deformity; rheumatoid arthritis; or the need for long-term analgesic administration. After ruling out other conditions with magnetic resonance or ultrasound imaging, patients were randomized to be operated on with OPF or PMGR independently of the Silfverskjold test. Follow-up was carried out for up to 1 year. The AOFAS, visual analog scale (VAS) for pain, SF-36, and Likert scale for satisfaction were used to evaluate the results obtained. The analysis was done with 21 patients in the OPF group and 15 in the PMGR group. The demographic data (age, sex, body mass index, duration of symptoms, and positivity to the Silfverskjold test) of the groups were comparable. RESULTS No differences were found in terms of the AOFAS (P = .24), VAS (P = .14), or any item of the SF-36. Satisfaction was very good in 85.8% of the PMGR group and 89.5% of the OPF group (P = .27). Faster recovery was observed in the PMGR group. CONCLUSION OPF and PMGR provided good results for patients with RPF. Neither was superior to the other relative to pain, AOFAS score, satisfaction, or the SF-36. We recommend PMGR as the first option in RPF surgical management in order to avoid potential biomechanical complications related to OPF. LEVEL OF EVIDENCE Level I, therapeutic randomized controlled trial.
Collapse
Affiliation(s)
- Carlo Gamba
- Orthopaedic Department, Hospital del Mar, Universitat Autonoma Barcelona (UAB), Barcelona, Spain.,Orthopaedic Department, Hospital de la Santa Creu I Sant Pau, Universitat Autonoma Barcelona (UAB), Barcelona, Spain
| | | | - Jesus Ares-Vidal
- Department of Radiology and Radiodiagnostic, Hospital del Mar, Barcelona, Spain
| | | | - Gemma Gonzalez-Lucena
- Orthopaedic Department, Hospital del Mar, Universitat Autonoma Barcelona (UAB), Barcelona, Spain
| | - Alberto Ginés-Cespedosa
- Orthopaedic Department, Hospital del Mar, Universitat Autonoma Barcelona (UAB), Barcelona, Spain
| |
Collapse
|
10
|
Abstract
Metatarsalgia is a common foot disease with a multitude of causes. Proper identification of underlying diseases is mandatory to formulate an adequate treatment. Multiple surgical solutions are available to treat metatarsalgia. Only limited scientific evidence is available in the literature. However, most of the techniques used in the treatment of metatarsalgia seem to be reasonable with acceptable results.
Collapse
Affiliation(s)
- Georg Klammer
- Institute for Foot and Ankle Reconstruction, Kappelistrasse 7, 8002 Zurich, Switzerland
| | - Norman Espinosa
- Institute for Foot and Ankle Reconstruction, FussInsitut Zurich, Kappelistrasse 7, Zurich 8002, Switzerland.
| |
Collapse
|
11
|
Chan O, Malhotra K, Buraimoh O, Cullen N, Welck M, Goldberg A, Singh D. Gastrocnemius tightness: A population based observational study. Foot Ankle Surg 2019; 25:517-522. [PMID: 30321953 DOI: 10.1016/j.fas.2018.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 03/17/2018] [Accepted: 04/03/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Gastrocnemius tightness is believed to be associated with multiple musculoskeletal pathologies such as back pain, plantar fasciitis and metatarsalgia. Although surgical treatment of gastrocnemius tightness is gaining popularity the objective definition of a gastrocnemius contracture has not been determined. The aim of our study was therefore to quantify gastrocnemius tightness in a normal population. METHODS Adult participants with no obvious foot and ankle pathology were recruited. Gastrocnemius tightness was quantified using a weightbearing lunge test. Maximal ankle-foot dorsiflexion was measured on participants with the knee in full extension and flexed to 20° using a digital inclinometer. The ankle-foot dorsiflexion index or ADI (difference in ankle dorsiflexion with the knee extended and flexed) was calculated. The ADI values were plotted on a histogram to identify the distribution of values and were compared according to participant demographics. RESULTS 800 limbs from 400 participants were examined. There was a wide distribution of absolute values of maximal ankle-foot dorsiflexion ranging from 8 to 52°. The ADI ranged from 0 to19° and approximated to a normal distribution. The mean ADI was 6.04±3.49° and was positively correlated with age (r=0.132, P<0.001) and negatively correlated with physical activity (r=-0.88, P=0.015). CONCLUSION(S) Our study is the first to quantify gastrocnemius tightness in a large healthy adult population with differences observed by age and physical activity. We have defined an easy and reproducible weightbearing test that can be used in both research and clinical settings. The majority of the population have some degree of gastrocnemius tightness and values of ADI greater than 13° (>2 SD of the mean), as measured by the lunge test, may be considered abnormal.
Collapse
Affiliation(s)
- Oliver Chan
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Stanmore HA7 4LP, United Kingdom.
| | - Karan Malhotra
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Stanmore HA7 4LP, United Kingdom
| | - Olatunbosun Buraimoh
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Stanmore HA7 4LP, United Kingdom
| | - Nick Cullen
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Stanmore HA7 4LP, United Kingdom
| | - Matthew Welck
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Stanmore HA7 4LP, United Kingdom
| | - Andy Goldberg
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Stanmore HA7 4LP, United Kingdom
| | - Dishan Singh
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Stanmore HA7 4LP, United Kingdom
| |
Collapse
|
12
|
Gossett L, Gossett PC, Roberts J, Anderson J. Gastrocnemius Recession for the Treatment of Tibialis Anterior Tendinopathy. FOOT & ANKLE ORTHOPAEDICS 2019; 4:2473011419852940. [PMID: 35097331 PMCID: PMC8500391 DOI: 10.1177/2473011419852940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Leland Gossett
- Spectrum Health–Michigan State University Orthopaedic Surgery Residency, Grand Rapids, MI, USA
| | - P. Cameron Gossett
- Spectrum Health–Michigan State University Orthopaedic Surgery Residency, Grand Rapids, MI, USA
| | - Justin Roberts
- Orthopaedic Associates of Michigan, Grand Rapids, MI, USA
| | - John Anderson
- Orthopaedic Associates of Michigan, Grand Rapids, MI, USA
| |
Collapse
|
13
|
Abstract
The terminology ‘Morton’s neuroma’ may represent a simplification of the clinical condition as the problem may not be a benign tumour of the nerve, but neuropathic foot pain associated with the interdigital nerve. Foot and ankle pathomechanics leading to metatarsalgia, clinical examination and differential diagnosis of the condition and imaging of the condition, for differential diagnosis, are discussed. Nonoperative management is recommended initially. Physiotherapy, injections (local anaesthetic, steroid, alcohol), cryotherapy, radiofrequency ablation and shockwave therapy are discussed. Operative treatment is indicated after nonoperative management has failed. Neuroma excision has been reported to have good to excellent results in 80% of patients, but gastrocnemius release and osteotomies should be considered so as to address concomitant problems. Key factors in the success of surgery are correct diagnosis with recognition of all elements of the problem and optimal surgical technique.
Cite this article: EFORT Open Rev 2019;4:14-24. DOI: 10.1302/2058-5241.4.180025.
Collapse
|
14
|
Malhotra K, Chan O, Cullen S, Welck M, Goldberg AJ, Cullen N, Singh D. Prevalence of isolated gastrocnemius tightness in patients with foot and ankle pathology. Bone Joint J 2018; 100-B:945-952. [DOI: 10.1302/0301-620x.100b7.bjj-2017-1465.r1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Aims Gastrocnemius tightness predisposes to musculoskeletal pathology and may require surgical treatment. However, it is not clear what proportion of patients with foot and ankle pathology have clinically significant gastrocnemius tightness. The aim of this study was to compare the prevalence and degree of gastrocnemius tightness in a control group of patients with a group of patients with foot and ankle pathology. Patients and Methods This prospective, case-matched, observational study compared gastrocnemius tightness, as assessed by the lunge test, in a control group and a group with foot and ankle pathology. Gastrocnemius tightness was calculated as the difference in dorsiflexion of the ankle with the knee extended and flexed. Results A total of 291 controls were paired with 97 patients with foot and ankle pathology (FAP). The mean gastrocnemius tightness was 6.0° (sd 3.5) in controls and 8.0° (sd 5.7) in the FAP group (p < 0.001). Subgroup analysis showed a mean gastrocnemius tightness of 10.3° (sd 6.0) in patients with forefoot pathology versus 6.9° (sd 5.3) in patients with other pathology (p = 0.008). A total of 12 patients (37.5%) with forefoot pathology had gastrocnemius tightness of > two standard deviations of the control group (> 13°). Conclusion Gastrocnemius tightness of > 13° may be considered abnormal. Most patients with foot and ankle pathology do not have abnormal degrees of gastrocnemius tightness compared with controls, but it is present in over a third of patients with forefoot pathology. Cite this article: Bone Joint J 2018;100-B:945–52.
Collapse
Affiliation(s)
- K. Malhotra
- Foot and Ankle Unit, Royal National Orthopaedic
Hospital, Stanmore, UK
| | - O. Chan
- Foot and Ankle Unit, Royal National Orthopaedic
Hospital, Stanmore, UK
| | - S. Cullen
- University College London Medical School, London, UK
| | - M. Welck
- Foot and Ankle Unit, Royal National Orthopaedic
Hospital, Stanmore, UK
| | - A. J. Goldberg
- Foot and Ankle Unit, Royal National Orthopaedic
Hospital, Stanmore, UK
| | - N. Cullen
- Foot and Ankle Unit, Royal National Orthopaedic
Hospital, Stanmore, UK
| | - D. Singh
- Foot and Ankle Unit, Royal National Orthopaedic
Hospital, Stanmore, UK
| |
Collapse
|
15
|
Abstract
Metatarsalgia is a common cause of plantar forefoot pain. Causes of metatarsalgia include foot anatomy, gait mechanics, and foot and ankle deformity. One specific cause, mechanical metatarsalgia, occurs because of gastrocnemius muscle contracture, which overloads the forefoot. Muscular imbalance of the gastrocnemius complex alters gait mechanics, which increases recruitment of the toe extensor musculature, thereby altering forefoot pressure. Patients with concomitant metatarsalgia and gastrocnemius contracture demonstrate ankle equinus and a positive Silfverskiold test. Nonoperative therapeutic modalities are mainstays of treatment. In patients in whom these treatments fail to provide metatarsalgia symptomatic relief, gastrocnemius muscle lengthening is a therapeutic option.
Collapse
Affiliation(s)
- Rose E Cortina
- Department of Orthopedic surgery, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - Brandon L Morris
- Department of Orthopedic surgery, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
| | - Bryan G Vopat
- Department of Orthopedic surgery, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
| |
Collapse
|
16
|
Abstract
Endoscopically assisted procedures have been established to provide the surgeon with minimally invasive techniques to address common Achilles conditions. Modifications to some of these techniques as well as improvements in instrumentation have allowed these procedures to provide similar clinical results to the traditional open surgeries while reducing wound complications and accelerating patient's recoveries. The available literature on these techniques reports consistently good outcomes with few complications, making them appealing for surgeons to adopt.
Collapse
|
17
|
Abstract
BACKGROUND Rheumatoid arthritis is a chronic disease affecting multiple joints of the body. More than 90% of patients affected by rheumatoid arthritis develop foot or ankle pain over the course of their disease. The purpose of the current study was to report ankle dorsiflexion in rheumatoid arthritis patients as well as a control group utilizing a validated measurement instrument. METHODS Using a previously validated device, 70 patients presenting with rheumatoid arthritis and 70 controls were measured for ankle range motion and isolated gastrocnemius contractures. Clinical and goniometer measurement of ankle range of motion was also performed. RESULTS The rheumatoid arthritis group had a mean dorsiflexion of 12.3 degrees compared to a mean of 17.3 degrees in the control group ( P < .05). The difference in dorsiflexion was significantly less utilizing a goniometer than using the validated device, which may be due to measurement technique and external landmarks ( P < .05). CONCLUSION Patients with rheumatoid arthritis had less ankle dorsiflexion than the control group. The clinical significance of this study is that it provides evidence that patients with rheumatoid arthritis have decreased ankle dorsiflexion even despite a lack of foot and ankle pain. In light of the high lifetime incidence of foot and ankle pain in these patients, this study provides some evidence that the decreased ankle dorsiflexion may be a contributing factor in foot and ankle pain, but further studies are needed. LEVEL OF EVIDENCE Level II, prospective cohort study.
Collapse
Affiliation(s)
| | - Adam Green
- 2 Michigan State University College of Osteopathic Medicine, East Lansing, MI, USA
| |
Collapse
|
18
|
Phillips RD. A Response to "A Novel Treatment Approach to Over-Pronation Dysfunction: A Follow-Up". J Am Podiatr Med Assoc 2017; 107:573-575. [PMID: 29252014 DOI: 10.7547/17-053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Robert D. Phillips
- Department of Podiatry, Orlando Veterans Affairs Medical Center, 13800 Veterans Way, Orlando, FL 32827. (E-mail: )
| |
Collapse
|