Foot & Ankle International - July 2016 - (Page 782)

640612 FAIXXX10.1177/1071100716640612Foot & Ankle InternationalMorales-Muñoz et al research-article2016 Article Proximal Gastrocnemius Release in the Treatment of Mechanical Metatarsalgia Foot & Ankle International® 2016, Vol. 37(7) 782-789 © The Author(s) 2016 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1071100716640612 fai.sagepub.com Patricia Morales-Muñoz, MD, PhD1, Raúl De Los Santos Real, MD, PhD1, Patricia Barrio Sanz, MD1, Jose Luis Pérez, MD1, Jesús Varas Navas, MD1, and Javier Escalera Alonso, MD, PhD1 Abstract Background: Gastrocnemius shortening causes an equinus deformity that may clinically manifest in foot disorders, including metatarsalgia. We use this term to describe pain localized to the metatarsal heads. The purposes of this prospective study were to review the effect of medial gastrocnemius proximal release on ankle dorsiflexion and assess the outcome of this technique on pain and functional limitations in patients who have mechanical metatarsalgia and isolated gastrocnemius shortening. Methods: We prospectively followed a consecutive series of 78 feet in 52 patients with metatarsalgia who had an isolated gastrocnemius contracture assessed with the Silfverskiöld test. Surgical release was evaluated with visual analog scale (VAS) and American Orthopaedic Foot & Ankle Society (AOFAS) scales. Ankle dorsiflexion was measured at 1, 3, and 6 months postoperatively. Results: Preoperative values of VAS and AOFAS were 7.4 and 46.8, respectively. After 3 months postoperatively, the values were 3.0 and 81.7, and 6 months after surgery these values were 3.5 and 83.6. No patient worsened clinically. There were no major complications. Thirty-six patients (69.2%) were completely satisfied with the results of the surgery. Preoperatively, ankle dorsiflexion with the knee straight was −17.5 degrees, which improved to 2.5 degrees at 6 months postoperatively. Conclusion: We believe proximal medial gastrocnemius recession is an alternate procedure to treat selected patients with mechanical metatarsalgia and gastrocnemius shortening. It had acceptable morbidity and cosmetic results. Level of Evidence: Level IV, case series. Keywords: metatarsalgia, gastrocnemius, proximal release, shortening Introduction Gastrocnemius shortening is more prevalent in patients with foot pain than in the general population.12 This condition causes an equinus contracture of the ankle, which leads to excessive pressure and overload throughout the foot during gait.2,13,20,23,32,38 This can be manifested clinically with foot and ankle pathologies such as metatarsalgia, plantar fasciitis, diabetic foot ulcers, posterior tibial tendon insufficiency, Achilles tendonitis and claw toes.* Release of the gastrocnemius tendon is a potentially important component of treatment in patients with chronic foot and ankle problems aggravated or precipitated by a gastrocnemius contracture. Clinically it is important to distinguish whether the limitation in ankle dorsiflexion is the result from either tightness of the gastrocnemius-soleus complex or from an * References 1, 2, 4, 15, 17, 22, 24, 25, 27, 28, 37, 38. isolated tightness of the gastrocnemius muscle. This can be identified by the Silfverskiöld test33 in which the degree of ankle dorsiflexion is measured with the knee fully extended and with the knee flexed. An improvement in ankle dorsiflexion with the knee flexed is considered a positive test and indicative of an isolated gastrocnemius contracture. If the equinus posture does not improve with the knee flexion, then soleus is tight also. When the knee is extended, the gastrocnemius are completely stretched, and any shortening will cause a plantarflexion deformity at the anke.14,18,33 Gait 1 Foot and Ankle Unit, Orthopaedic Surgery, Infanta Sofia University Hospital, Madrid, Spain Corresponding Author: Patricia Morales-Muñoz, MD, PhD, Infanta Sofia University Hospital, Orthopaedic Surgery, Foot and Ankle Unit, Calle Jose Celestino Mutis 1. Portal 7. 6ºB, 28703 San Sebastian de Los Reyes (Madrid), Spain. Email: patrmorales@hotmail.com http://www.sagepub.com/journalsPermissions.nav http://fai.sagepub.com

Table of Contents for the Digital Edition of Foot & Ankle International - July 2016

TOC/TOC/Verso
Editorial Board
Advertiser Index
Long Term Follow-up of a Randomized Controlled Trial Comparing Scarf to Chevron Osteotomy in Hallux Valgus Correction
Clinical Outcome and Fusion Rate following Simultaneous Subtalar Fusion and Total Ankle Arthoplasty
Anterior Heterotopic Ossification at the Talar Neck After Total Ankle Arthroplasty
Secondary Arthrodesis After Total Ankle Arthroplasty
Functional Outcomes Following First Metatarsophalangeal Arthrodesis
Increased Reduction Clamp Force Associated With Syndesmotic Overcompression
Pain Threshold Tests in Patients With Heel Pain Syndrome
Long-term Results of Chronic Achilles Tendon Ruptures With V-Y Tendon Plasty and Fascia Turndown
Peroneal Tendon Abnormalities on Routine Magnetic Resonance Imaging of the Foot and Ankle
Incisura Morphology as a Risk Factor for Syndesmotic Malreduction
Total Arthroplasty of the Metatarsophalangeal Joint of the Hallux
Ankle Power and Endurance Outcomes Following Isolated Gastrocnemius Recession for Achilles Tendinopathy
Survey of Patient Insurance Status on Access to Specialty Foot and Ankle Care Under the Affordable Care Act
Proximal Gastrocnemius Release in the Treatment of Mechanical Metatarsalgia
Gastrocnemius Proximal Release in the Treatment of Mechanical Metatarsalgia: A Prospective Study of 78 Cases.
Response to "Letter Regarding: Gastrocnemius Proximal Release in the Treatment of Mechanical Metatarsalgia"
The Internal Brace for Midsubstance Achilles Ruptures
The Evolution of Patient Safety
Education Calendar
Foot & Ankle International - July 2016

Foot & Ankle International - July 2016