Do You Need a Gastrocnemius Recession?

Gastrocnemius recession is also beneficial for patients with spastic diplegic cerebral palsy, a neurological condition that mainly impacts the legs and causes muscle stiffness and tightness in the calves.

Tight calf muscles, especially the gastrocnemius muscle, can deeply impact your ability to walk and move. For some people, stretching, physical therapy, orthotics and other solutions can provide a fix, whereas others only find relief with surgery. If this sounds familiar, read on to better understand your options.

• Introduction to Gastrocnemius Recession

• Understanding the Role of the Gastrocnemius Muscle

• The Role of the Gastrocnemius Tendon

• Signs You May Need a Gastrocnemius Recession

• How Doctors Evaluate Calf Muscle Tightness

• Non-Surgical Options Before Considering Surgery

• When Surgery Becomes the Best Option

• How To Prepare for a Gastrocnemius Recession

• Potential Complications

• What to Expect from Recovery

Introduction to Gastrocnemius Recession

Gastrocnemius recession is a surgical procedure designed to address conditions such as flatfoot, chronic Achilles tendonitis, and equinus, commonly known as toe walking. This procedure involves lengthening the gastrocnemius muscle, one of the two primary muscles in the calf, to improve flexibility and reduce pain.

The main goal of gastrocnemius recession surgery is to allow the heel to shift downward into a more natural position, thereby enhancing ankle dorsiflexion. This improved range of motion can significantly alleviate pain and improve overall mobility. Often, this surgery is considered an alternative to Percutaneous Tendo-Achilles Lengthening, offering a different approach to achieving similar outcomes.

One of the advanced techniques used in this surgery is the endoscopic approach. This minimally invasive method involves making small incisions in the skin and using a thin tube called a cannula to access and lengthen the gastrocnemius muscle. This approach reduces recovery time and minimizes scarring.

Gastrocnemius recession is commonly performed to treat various foot and ankle conditions, including plantar fasciitis, Achilles tendonitis, and flatfoot. The procedure is typically done on an outpatient basis, allowing patients to return home the same day. Post-surgery, patients may need to wear a cast or walking boot to protect the foot and ankle while they heal.

Physical therapy plays a crucial role in recovery, helping to rebuild calf strength and improve range of motion. The success of the procedure depends on several factors, including the severity of the condition being treated and the patient’s overall health. With proper care and rehabilitation, most patients experience significant improvements in pain and mobility.

Understanding the Role of the Gastrocnemius Muscle

The gastrocnemius muscle is one of the two main muscles in your calf (the other is called the soleus). It starts in the back of your femur (thigh bone) and ends in your Achilles tendon which connects to your heel bone. Since this muscle crosses both your knee and your ankle joint, it plays a critical role in most movements like walking, running, jumping, and even just standing up. If this muscle gets too tight, it can limit movements across these joints and can even limit your ability to flex your foot upwards. When your body tries to compensate for this tightness, it can lead to other problems like foot pain, toe walking, flat foot, plantar fasciitis, arthritis, and Achilles tendon issues.

Preserving muscle fibers during surgical procedures is crucial to avoid complications such as increased postoperative pain and other issues.

The Role of the Gastrocnemius Tendon

The gastrocnemius tendon is a vital structure that connects the gastrocnemius muscle to the heel bone. This tendon plays a crucial role in ankle movement, allowing for the flexion and extension of the foot. When the gastrocnemius tendon becomes tight, a condition known as gastrocnemius contracture, it can lead to restricted ankle dorsiflexion and significant pain.

Gastrocnemius recession surgery involves lengthening the gastrocnemius tendon to improve ankle mobility and reduce discomfort. This procedure targets the tendon to alleviate tightness and restore a more natural range of motion. The soleus muscle, the other major muscle in the calf, works in conjunction with the gastrocnemius muscle to control foot movement, making the balance between these muscles essential for proper function.

The gastrocnemius tendon is surrounded by a layer of connective tissue called fascia, which can become inflamed and painful in cases of tendonitis. During surgery, the sural nerve, which runs through the calf, must be carefully navigated to avoid injury. The complexity of the gastrocnemius tendon requires meticulous attention during surgery to ensure optimal outcomes.

Using endoscopic techniques can help minimize damage to surrounding tissues and promote faster healing. The gastrocnemius tendon plays a critical role in maintaining balance and stability, so its function must be carefully considered during surgery. Proper surgical technique and post-operative care are essential for a successful recovery and long-term relief from pain.

Signs You May Need a Gastrocnemius Recession

Not everyone who has calf pain or tightness needs surgery, but there are some clear signs that you would benefit from a gastrocnemius recession surgery, including:

• Heel pain: If you have heel pain, especially related to plantar fasciitis and it hasn’t responded to other treatments.

• Persistent calf tightness or Achilles pain: If you have ongoing tightness in the back of your lower leg despite regularly stretching.

• Inability to flex your foot: If you are unable to flex your foot upwards while keeping your heel on the ground.

• Midfoot collapse or arch fatigue: If you have flattening of your arch, or feel discomfort in your arch when walking or running.

• If you have started toe walking: If you walk on your toes due to your inability to flex your foot upwards.

• Difficulty walking uphill or up stairs: If you are having a hard time climbing stairs or walking uphill.

If any of these sound familiar and are affecting your ability to walk or do daily activities and other treatments haven’t helped, then as a patient, gastrocnemius recession may be worth discussing with an orthopedic surgeon.

How Doctors Evaluate Calf Muscle Tightness

Doctors can evaluate your issues in several ways, which often starts with a physical exam. They will likely use a test called the Silfverskiöld test. This test helps doctors figure out whether the tightness is isolated only to the gastrocnemius muscle or if it also involves other structures like the soleus muscle or Achilles tendon. It is important to keep the knee extended during the test to properly assess the gastrocnemius muscle.

Here’s how the Silfverskiöld test works:

Your doctor will check how far your foot can dorsiflex (flex upward) while your knee is bent and then again with your knee straight. If you are able to flex it further when your knee is bent, this usually means the gastrocnemius muscle is the main issue. Variations in the length of the gastrocnemius muscle can affect the test results and subsequent treatment decisions. This distinction is important because gastrocnemius recession targets that specific muscle only. It would not fix issues with the Achilles tendon or the soleus.

Imaging (like X-rays, CT scan or MRI) are usually not needed unless there are concerns about other issues in the foot or ankle. Your doctor might use imaging if they want to rule out other causes of pain or impaired function before recommending surgery.

Non-Surgical Options Before Considering Surgery

Before deciding to proceed with surgery, most doctors will recommend non-invasive options. These may include:

• Physical therapy, particularly ones focused on gastrocnemius stretching exercises

• Night splints or braces that gently stretch the calf overnight; a splint may also be used postoperatively to support healing

• Orthotics or heel lifts to reduce strain on the Achilles and plantar fascia

• Manual therapy or massage to release tightness

• Dry needling or other advanced physical therapy techniques

For many people, especially those with milder tightness, these options can provide lasting relief without needing surgery.

When Surgery Becomes the Best Option

Surgery is usually recommended after a trial of a few months of conservative treatments without seeing any improvement. Surgery is also considered earlier if the tightness is severe and is significantly impacting function, causing deformity, or causing ongoing pain and disability.

Anesthesia is administered to the patient before the surgical incision is made, ensuring that the procedure is pain-free and the patient is comfortable.

Gastrocnemius recession surgery involves lengthening the gastrocnemius muscle by cutting and releasing part of it or its surrounding connective tissues. The goal of this surgery is to increase your ability to flex the foot upwards without causing issues with strength or stability.

This surgery is relatively low risk, especially when performed by an experienced foot and ankle surgeon on an otherwise healthy person. Complications are uncommon but can include infection, nerve irritation, or overlengthening (which may cause some calf muscle weakness).

How To Prepare for a Gastrocnemius Recession

Preparing for a gastrocnemius recession involves several essential steps that help ensure a smooth and successful surgery. Before the procedure, patients will typically have a preoperative evaluation with their orthopedic surgeon to discuss their medical history, current medications, and any relevant allergies. It is crucial to disclose all information accurately to ensure patient safety.

In terms of dietary instructions, patients may receive specific guidelines from their surgeon regarding fasting the night before surgery. It is essential to follow these instructions closely. Additionally, patients may be advised to temporarily stop certain medications or supplements that can interfere with the surgical process or increase bleeding risks. It is essential to communicate openly with the surgical team, follow their instructions diligently, and address any concerns or questions before the scheduled procedure.

Potential Complications

As with any surgical procedure, there are potential complications associated with gastrocnemius recession surgery. These can include infection, bleeding, and damage to surrounding tissues such as the sural nerve, a sensory nerve that runs down the back of the leg and provides feeling to the outer foot and ankle. Patients may experience pain, swelling, and bruising after the procedure, which can be managed with medication and rest.

In some cases, patients may require additional procedures, such as physical therapy or orthotics, to achieve optimal outcomes. The use of endoscopic techniques can help minimize the risk of complications and promote faster healing. Patients should be carefully evaluated before surgery to ensure that they are suitable candidates for the procedure.

The procedure should only be performed by a qualified surgeon with experience in gastrocnemius recession surgery. Following post-operative instructions carefully is crucial to minimize the risk of complications and promote optimal healing. In rare cases, patients may experience weakness or numbness in the foot or ankle after the procedure, which can be managed with physical therapy and rehabilitation.

Overall, the potential complications associated with gastrocnemius recession surgery are relatively rare, and the procedure is generally considered safe and effective. With proper surgical technique and diligent post-operative care, most patients experience significant improvements in pain and mobility, leading to a better quality of life.

What to Expect from Recovery

Most patients have a straightforward recovery from gastrocnemius recession with few complications. Recovery from gastrocnemius recession surgery can generally take six to eight weeks.

Immediate post-op: You may be placed in a walking boot and allowed to bear weight almost right away, depending on your surgeon’s protocol. Incisions will be closed and bandaged, and a postoperative shoe may be used depending on the patient's needs.

First 2 weeks: Focus is on wound healing and gentle ankle range-of-motion exercises.

Weeks 2–6: Physical therapy begins, often emphasizing stretching, balance, and working on returning to walking normally.

Weeks 6–12: Strengthening exercises are introduced. Most people can return to low-impact activities like walking, swimming, or cycling during this phase.

3–6 months: A full return to sports or even high-impact activity is usually possible.

Most patients report significant relief from pain, improved ability to walk and run after they have healed. Stretching will still be important even after surgery to maintain your gains in flexibility.

How to Find Out More

Gastrocnemius recession can be a life-changing surgery for people with chronic calf tightness and related foot problems. If you are struggling with pain in the foot or ankle due to an issue with the gastrocnemius muscles in the calf, gastrocnemius recession may help. Get moving again and schedule an appointment with our Resurgens physicians today!