What Is Gastrocnemius Contracture
Sometimes one or both of these calf muscles can become too tense, which can lead to what is called an equine contracture or deformity. When this happens, it usually becomes difficult to move the foot in an upward direction, also known as dorsal flexion restriction. This anatomical problem can lead to impaired gait and lead to various problems over time, including: chronic pain, ulceration, or other types of mechanical degradation of the foot or ankle. A gastrocnemius release prolongs the gastrocnemius tendon. This is done to increase the flexibility of the calf muscle, which can reduce pressure at the front of the foot, improve function and reduce deformity. Prior to the operation, patients with isolated gastrocnemius contracture showed a significant increase in maximum knee bending angles and knee bending moments during median posture. There was no difference in the maximum dorsal bending angle of the ankle or in the maximum plantar bending moment. The gastrocnemius recession did not change the kinematics and kinetics of walking after surgery. The joint kinematic strategies used to compensate for isolated gastrocnemial contracture varied little from one CSI participant; Most used a bent knee strategy, while one participant used a reduced ankle spine flexion strategy. Instead of walking on tiptoe, most people naturally and unconsciously compensate for an underlying equinus by developing greater (excessive) upward movement in other nearby joints, such as transverse tarsal joints. Many gastrocnemius contractures are subtle and patients are often asymptomatic. However, when this problem occurs over time, it often leads to significant and progressive metatarsal compensation, which leads to repeated overloading of various bone structures and soft tissues of the foot, both when standing and walking. The presence of such a disease can therefore predispose to the development of certain foot diseases such as plantar fasciitis, acquired deformity of the adult flat foot, metatarsalgia or Achilles tendon disease.
Surgery cannot be recommended if you can achieve adequate range of motion and flexibility with conservative treatment (stretching). It should also be avoided if there are contractures of several tendons in the leg and not only in the stomach. Equine contractures are the inability to bring the foot into a neutral position (a right angle to the lower leg), either due to tension of the muscles and/or tendons in the calf, scarring of the ankle capsule and other retained structures, or a bone spur at the front of the ankle that restricts normal ankle movement. It is named after horses (horses) that essentially walk “on their toes”. Some postoperative walking mechanisms were unchanged; However, the mechanics of walking were not similar between patients with isolated non-spastic gastrocnemius contracture and healthy control participants. Surgical interventions in patients with isolated gastrocnemius contracture do not appear to cause negative gait adjustments; However, patients may benefit from gait rehabilitation after recession, as inappropriate walking patterns persist after the operation. The gastrocnemius (gastroc) and soleus are two muscles that make up the calf. The gastroc is the larger and more superficial of the two muscles. The soleus is a deeper muscle in the lower part of the leg. The stomach tendon connects to the soleus tendon to form the Achilles tendon. Background: Several studies report gastrocnemius tendon recession as a surgical treatment for foot and ankle pain associated with isolated gastrocnemius contracture. Few report the range of motion of the ankle with a validated counter or control group.
All previous studies reporting measurements with a validated device were small. Will prolonging the gastrocnemius affect my strength or ability to walk? This procedure will lead to some weaknesses, but most patients will not notice it. Some patients may have subtle lameness, but this usually resolves within six months of surgery. Lower limb kinematics and kinetics were studied in 6 clinically diagnosed patients with isolated gastrocnemius contracture before and after operative recession, compared to 33 healthy control participants. Gastrocnemius equinus contracture (Figure 1) occurs when a feeling of tightness in the outer calf muscle (gastrocnemius) results in limited dorsal flexion of the ankle joint (movement through the ankle joint itself). To compensate for this tightness and for the foot to be placed on the ground, compensatory movement often occurs in the joint in front of the ankle, the transverse torsal joint, which consists of the heel-toicular joint and the calcaneal cuboid joints (Figure 2) (Figure 2). The characteristic of gastrocnemius equinus contracture is that it corrects itself (that is, the movement of the ankle becomes full) when the knee is bent because the pressure is taken from the gastrocnemius muscle because it adheres above the knee joint. Isolated gastrocnemius contracture limits ankle dorsal flexion with full knee extension and can be problematic during middle gait posture when 10° dorsal flexion and full knee extension are required. Meanwhile, patients with isolated gastrocnemius contracture may have impaired kinematics and/or kinetics. While conservative management cannot resolve painful foot pathologies associated with isolated non-spastic gastrocnemius contracture, gastrocnemius recession surgery has been suggested to release contracture and improve function and strength. However, there are no published reports on lower limb kinematics and kinetics in the population of isolated non-spastic gastrocnemius contractures.
The evaluation of changes in the mechanics of walking is necessary to study the effects of this possible surgical intervention. In general, it is believed that isolated gastrocnemius contracture develops from one of the many causes: calf muscle contracture or “equinus” can occur due to isolated oppression of the gastrocnemius muscle, or the result of tension in these two muscles together, and it is important to distinguish these two causes, since the treatment to solve the problem and avoid long-term consequences can vary greatly. Although physiotherapy, stretching exercises and even daily splints can sometimes be effective in preventing or relieving this condition, the problem often remains refractory to such management and surgery may be necessary to release these tissues in a way that can restore normal upward ankle/foot movement (dorsal flexion). If the problem is limited to the tightness of the gastrocnemius tendon, surgery to release this contracture is called gastrocnemius recession or “wandering” procedure. If indicated, surgery can be very effective in resolving a patient`s various clinical conditions associated with the tension of that muscle and not responding to non-surgical treatment. Before considering surgery, a regular calf stretching program (with a right knee, as shown in Figure 3) should be recommended for at least a few months, as this non-surgical measure can lead to the resolution of symptoms in many cases. The largest calf muscles are called gastrocnemius and soleus. The gastrocnemius is the larger and longer of the two that arises above the knee joint before connecting the soleus below in a way that naturally makes the gastrocnemius more susceptible to oppression in humans. When these muscles run together to form the foot, they eventually connect to form a tendon called the Achilles tendon, which fits into the heel. The main function of this “gastroc-soleal complex” in humans is to control movement through the ankle joint and flex the foot to promote repellent force.
Your foot and ankle orthopedic surgeon may recommend this surgery if you have stomach tightness that has not improved with stretching exercises. This procedure can be combined with other rebuilding procedures or performed by yourself. In the first two weeks after surgery, the patient is usually immobilized in a splint or boot. It is important to keep the ankle in an appropriate position while the tendon heals. A spasmodic sensation in the back of the calf is normal. Gentle movement and stretching exercises begin as soon as the ankle is removed from the splint/boot. The schedule may vary depending on the other procedures performed. Your surgeon may perform this surgery through several different incisions. Most often, a small incision is made on the inside of the leg. Sometimes an incision is used directly at the back of the calf, or even an endoscopic incision of about 1/2 inch.
Once the stomach tendon is identified, it is separated from the underlying muscular abdomen of the Solee and then cut directly. Once the tendon is released, the ankle is bent upwards and an increased range of motion is detected intraoperatively. Conclusion: Patients with foot and ankle pain had less ankle spine flexion than the control group. This is the largest study to date with a validated meter and a control group and supports the results of previous authors. Why are my calf muscles tense? Most often, a tense calf muscle is an inherited problem that causes problems later in life. .