By: 25 October 2011

John G. Anderson, et al.
Current Orthopaedics Practice. May/June 2010. Vol. 21. No. 3. Pp. 251-257

Sometimes surgeons discover things serendipitously. For example, surgically lengthening the gastrocnemius muscle in patients with diabetes helps heal foot ulcers. That discovery pointed out the association between abnormal foot positioning, altered biomechanics, and foot pain all linked to a tight calf muscle.

Surgeons then started looking at patients with chronic, persistent foot pain. They tried lengthening the gastrocnemius muscle and found good outcomes. As a result, more studies have been done to look at the effect of gastrocnemius lengthening on the ankle joint, foot arch, position of the hindfoot, and joint range of motion.

Specific diagnoses have now been treated using the gastrocnemius lengthening procedure. Conditions such as plantar fasciitis, metatarsalgia, fallen arches, foot arthritis, and tendon problems have all responded well to gastrocnemius lengthening.

In this article, surgeons from Michigan State University review the results of the studies done so far using this technique for foot and ankle problems. They also present their own treatment approach to gastrocnemius contracture.

They recognise that an inflexible gastrocnemius muscle can pull so hard on the bones that it deforms the natural shape of the foot and ankle. Their method is to evaluate patients and place them in a management group based on symptoms, diagnosis, and biomechanical structures present at the time of the exam.

For example, type 1 contracture refers to patients who have a weakened ligamentous support of the arches. The diagnosis is often plantar fasciitis, metatarsalgia, Achilles pain, or painful arches. Type 2 gastrocnemius contracture describes a patient with a collapsed forefoot and/or bunion.

Type 3 contracture results in a collapse of the midfoot with midfoot arthritis. Type 4 is a collapse of the hindfoot affecting the spring ligament in the middle arch of the foot. And type 5 is a tilted ankle linked with deltoid ligament problems and ankle arthritis. Each type is featured in the article with either a photograph of the foot and ankle or corresponding X-ray.

By releasing the gastrocnemius muscle and its tendon, the foot and ankle can return to a more normal midline position. Release of pull on the bony structures makes it possible to restore normal arch shape, structure, and function. They suggest that arch collapse in its more advanced stages can’t be restored without the gastrocnemius release procedure.

The authors point out that there are a few downsides to the procedure. It can cause some calf weakness but this is only temporary. The gastrocnemius is a large muscle that can quickly recover.

Damage to the sural nerve is also possible. The patient will also have an unsightly scar because it is done with an open incision.

Future studies will be done in the area of gastrocnemius lengthening. The focus will be two-fold: 1) accomplishing the operation endoscopically with a very small incision and 2) finding out what types of foot problems can best benefit by this procedure.