Gastrocnemius Recession Procedure
What and where is the gastrocnemius muscle?
On the back of the calf, there are two muscles: the soleus, which is the deeper muscle, and the gastrocnemius, which is the more superficial muscle. The two muscles combine to form a conjoined tendon and eventually become the Achilles tendon, which attaches at the back of the heel.
A tight gastrocnemius muscle can cause many problems. This muscle itself may be tight and short; another scenario would be having a very large muscle which disproportionately overpowers the foot. This can cause heel pain and plantar fasciitis.
It is "all connected": the calf muscle (including the gastrocnemius), the Achilles tendon, the heel bone, and the plantar fascia are all part of a single chain. And in many cases, it is a tight gastrocnemius causing the etiology and/or cause of the problem.
What is the purpose of a gastrocnemius recession procedure?
The goal is to lengthen this muscle-tendon complex. By doing this, we can decrease the tension within this whole chain from the calf to the plantar fascia. For example, because of the way they are all interconnected, a tight calf muscle can cause plantar fasciitis; by lengthening this complex there is less tension transferred to the plantar fascia and therefore less pain. It is always part of the goal of treating plantar fasciitis to stretch out the gastrocnemius muscle, and when this is not enough, the gastroc release and gastroc recession is very effective.
This procedure can be a very effective treatment for plantar fasciitis and Achilles tendon problems. It can also be effective for treating midfoot and forefoot problems due to a tight calf muscle. This can include compression and arthritis on the top of the midfoot, or other problems in the forefoot such as marked early heel off and therefore rapid forefoot weight transfer.
What are some of the indications for this procedure?
Some the typical treatments for plantar fasciitis include stretching the calf muscle, using a night splint, massage and physical therapy. If these techniques do not allow for adequate stretching and lengthening of the gastrocnemius, then surgery is often appropriate.
Another scenario is when there is a very large, muscular calf from an anatomical standpoint. In some cases, there can be adequate flexibility, but the muscle is still overpowering the foot and the plantar fascia. These are cases where the gastrocnemius recession can also be effective.
An incision is made either on the inside of the midportion of the calf or the posterior aspect of the calf. This allows access to the gastrocnemius muscle-tendon junctional area. The tendon in this area is identified and surrounding tissues are protected. The tendon is surgically released and lengthened in a controlled manner at this location. It is directly adjacent to the muscle, which allows for rapid healing. The wound is flushed, irrigated and inspected. Deep sutures are used to help close this, along with the skin closure.
Post procedure details
A cast boot is utilized for the first several weeks after surgery. This helps to protect the surgical site from excessive motion and strain, which allows for healing and also helps ensure that there is slight tension on the tendon, so it heals in the correct length and position. It is also helpful to utilize a night splint after surgery for approximately two months post-op.
Keep the incision site clean and dry until there is adequate skin and wound healing, this timeframe varies but it is typically 2–3 weeks. The long-term post-procedure surgical site and scar often heals quite nicely, although it is possible to have some depression of the skin at the scar site. Note that in some cases this is combined with other procedures that may take longer to heal or require a different type of cast protection. It is possible to feel decreased strength and/or weakness of the calf muscle for the first six months after surgery.
Potential complications with surgery
As with any surgery, there is the potential for a wound that takes a long time to heal or becomes infected. It is possible to have nerve damage and numbness at the incision site or further down into the leg and foot. Because there is a cast, there is also a potential for a clot or deep venous thrombosis. We sometimes recommend taking aspirin after surgery.
- Can I still exercise after the surgery site is all healed? Yes you can. It is possible to have some decreased strength and/or weakness of the calf afterward. Occasionally, patients will have a temporary gait alteration or limp that typically resolves within 6–12 months after surgery.
- When can I drive a car after surgery? If it is your left foot, you should be able to drive within a week after surgery, if it is a standalone procedure. If it is your right foot, you would want to wait several weeks after surgery before driving a car.