Minimal Invasive Mid-Calf Gastrocnemius Recession: Safety and Efficacy Analysis

CATEGORY: Midfoot/Forefoot INTRODUCTION/PURPOSE: Limited ankle dorsiflexion associated with an isolated gastrocnemius contracture is one of the key impairments present in some chronic foot and ankle pathologies. The Baumann procedure consists of a gastrocnemius recession through an incision along the proximal medial calf performed in the interval between the gastrocnemius and soleus fascia. The advantages of the technique is that isolates the lengthening to the gastrocnemius muscle and preserves muscle strength. It is performed in supine decubitus, making unnecessary to switch position of the patient. We performed it in a minimally invasive fashion through a 4 cm approach. Our purpose was to evaluate the functional results and satisfaction of patients after performing a release of the gastrocnemius through the Baumann minimally invasive procedure in different foot and ankle pathologies. METHODS: 34 patients (37 procedures) whom presented with forefoot or midfoot or rearfoot pathologies that were suspected to be associated with gastrocnemius contracture between 2015 and 2017 were retrospectively evaluated (Table 1). All patient demographic information; such as age, sex, diagnosis and date of surgical, was retrieved from clinical charts. Patients included were to have an isolated gastrocnemius contracture as determined by a positive Silfverskiold test. Patients underwent Bauman gastrocnemius recession alone or in combination with other procedures according to each patient´s primary diagnosis. A supervised physical therapy program that consisted on stretching and flexibility of the posterior chain, was started as soon as possible depending on the underlying pathology, when possible, during the first postoperative week. RESULTS: Thirty-seven procedures belonging to thirty-four patients were included in this investigation. The mean age of the patients was 47.13 years (range 26-78 years). The mean follow-up was 21.6 months (range 7-42 months). The average initial amount of ankle dorsiflexion measured was 108 (range 95 to 120) degrees. After gastrocnemius muscle recession, the average ankle dorsiflexion measured was 91 (range 84 to 95) degrees. Therefore, an overall improvement of 17 degrees was obtained. There were significant differences in the dorsiflexion angle measured pre and post-surgery (p < 0.05). 88.9% of the patients were satisfied and would undergo the same surgery if necessary. 91.7% would recommend the procedure to a friend or family member. CONCLUSION: There exists reasonably convincing evidence to support the use of gastrocnemius recession as a therapeutic intervention for isolated foot pain associated with an overload syndrome, justifying a grade of recommendation B. It is our perspective that the Bauman procedure offers a chance to lengthen the musculotendinous unit in a predictable manner, through a small incision avoiding the potential risks of over lengthening the gastrocnemius-soleus complex.