Ankle Equinus and Endoscopic Gastrocnemius Recession

  • Amol Saxena
  • Christopher Di GiovanniEmail author


Ankle equinus, with contracture of the Achilles tendon, may have a negative effect on foot and ankle function and morphology in the long term if left unevaluated and untreated. The gastrocnemius-soleus complex easily overpowers the other musculotendinous units and ligamentous constraints in the foot when pathologically tight. This can cause ulceration, midfoot breakdown, ankle pathology, and potential gait derangement1–20 (Fig. 26.1). With repetitive contact between the ground and the foot any structure responsible for abnormal loading across the foot during the gait cycle, most often the Achilles tendon, hastens foot breakdown.


Achilles Tendon Sural Nerve Ankle Dorsiflexion Achilles Tendinopathy Athletic Individual 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Armstrong D, Stacpoole-Shea S, Nguyen H, Harkless L. Lengthening of the achilles tendon in diabetic patients who are at high risk for ulceration of the foot. J Bone Joint Surg. 1999;81A:535–538.Google Scholar
  2. 2.
    Barry D, Sabacinski K, Habershaw G, Giurini J, Chrzan J. Tendo achilles procedures for chronic ulcerations in diabetic patients with transmetatarsal amputations. J Am Podiatr Assoc. 1993;83:96–100.Google Scholar
  3. 3.
    DiGiovanni C, Kuo R, Tejwani N, Price R, Hansen T, Cziernecki J, Sangeorzan B. Isolated gastrocnemius tightness. J Bone Joint Surg. 2002;84 A:962–970.Google Scholar
  4. 4.
    Downey M. Ankle equinus. In: McGlamry E, ed. Comprehensive Textbook of Foot Surgery. 2nd ed. Baltimore, MD: Williams & Wilkins; 2002:716–720.Google Scholar
  5. 5.
    Downey M. Ankle equinus. In: McGlamry E, ed. Comprehensive Textbook of Foot Surgery. 1st ed. Baltimore, MD: Williams & Wilkins; 1987:368–401.Google Scholar
  6. 6.
    Grant W, Sullivan R, Sonenshine D, Adam M, Slusser J, Carson K, Vinik A. Electron microscopic investigation of the effects of diabetes mellitus on the Achilles tendon. J Foot Ankle Surg. 1997;36:272–278.CrossRefGoogle Scholar
  7. 7.
    Hansen ST. Tendon transfers and muscle balancing techniques. Achilles tendon lengthening. In: Hansen S, ed. Functional Reconstruction of the Foot and Ankle. Baltimore, MD: Lippincott Williams & Wilkins; 2000:415–421.Google Scholar
  8. 8.
    Hansen ST. Midfoot arthrodesis. In: Wulker N, Stephens M, Cracchiolo A, eds. Atlas of Foot and Ankle Surgery. St. Louis, MO: Mosby; 1998:154.Google Scholar
  9. 9.
    Hastings M, Mueller M, Sinacore D, Salsich G, Engsberg J, Johnson J. Effects of a tendo-Achilles lengthening procedure on muscle function and gait characteristics in a patient with diabetes mellitus. J Orthop Sports Phys Ther. 2000;30:85–90.Google Scholar
  10. 10.
    Hibbs R. Muscle bound feet. NY Med J. 1914;17C:798–808.Google Scholar
  11. 11.
    Kaufman K, Brodine S, Shaffer R, Johnson C, Cullison T. The effect of foot structure and range of motion on musculoskeletal overuse injuries. Am J Sports Med. 1999;27:585–593.Google Scholar
  12. 12.
    Lin S, Lee T, Wapner K. Plantar forefoot ulceration with equinus deformity of the ankle in diabetic patients: the effect of tendo-Achilles lengthening and total contact casting. Orthop. 1996;19:465–75.Google Scholar
  13. 13.
    Mueller M, Sinacore D, Hastings M, Johnson J. The effect of Achilles tendon lengthening on neuropathic plantar ulcers: a randomized clinical trial. J Bone Joint Surg. 2003;85-A:1436–1445.Google Scholar
  14. 14.
    Orendurff M, Aiona M, Dorociak R, Pierce R. Length and force of the gastrocnemius and soleus during gait following tendo Achilles lengthenings in children with equinus. Gait Posture. 2002;15:130–135.CrossRefGoogle Scholar
  15. 15.
    Pinney SJ, Hansen ST, Sangeorzan BJ. The effect on ankle dorsiflexion of Gastrocnemius Recession. Foot Ankle Int. 2002;23:26–29.Google Scholar
  16. 16.
    Saxena A, Widtfeldt A. Endoscopic gastrocnemius recession: a preliminary report on 18 cases. J Foot Ankle Surg. 2004;43:302–306.CrossRefGoogle Scholar
  17. 17.
    Sgarlato T, Morgan J, Shane H, Frenkenberg A. Tendo Achilles lengthening and it’s effect on foot disorders. J Am Podiatr Assoc. 1975;65:849–871.Google Scholar
  18. 18.
    Sgarlato TE. Medial Gastrocnemius Tenotomy to assist in body posture balancing. J Foot Ankle Surg. 1998;37:546–547.CrossRefGoogle Scholar
  19. 19.
    Tabrizi P, McIntyre W, Quesnel M, Howard A. Limited ankle dorsiflexion predisposes to injuries of the ankle in children. J Bone Joint Surg. 2000;82-B:1103–1106.CrossRefGoogle Scholar
  20. 20.
    Wulker N. Triple arthrodesis. In: Wulker N, Stephens M, Cracchiolo A, eds. Atlas of Foot and Ankle Surgery. St. Louis, MO: Mosby; 1998:262.Google Scholar
  21. 21.
    Grady J, Saxena A. The effects of stretching on gastrocnemius equinus. J Foot Ankle Surg. 1991;30:465–469.Google Scholar
  22. 22.
    Kannus P. Etiology and pathophysiology of chronic tendon disorders in sports. Scand J Med Sci Sports. 1997;7:78–85.CrossRefGoogle Scholar
  23. 23.
    Kannus P, Jozsa L, Natri A, Jarvinen M. Effects of training, immobilization and remobilization on tendons. Scand J Med Sci Sports. 1997;7:67–71.CrossRefGoogle Scholar
  24. 24.
    Schepsis A, Leach R. Surgical management of achilles tendonitis. Am J Sports Med. 1987;15:308–315.PubMedCrossRefGoogle Scholar
  25. 25.
    Weber M, Niemann M, Lanz R, Muller T. Non-operative treatment of acute rupture of the Achilles tendon: results of a new protocol and comparison with operative treatment. Am J Sports Med. 2003;31:685–691.Google Scholar
  26. 26.
    Silverskiold N. Reduction of the uncrossed two-joints muscles of the leg to one-joint muscles in spastic conditions. Acta Chir Scand. 1924;56:315–330.Google Scholar
  27. 27.
    Van Gheluwe B, Kirby KA, Roosen P, Phillips RD. Reliability and accuracy of biomechanical measurements of the lower extremities. J Am Podiatr Med Assoc. 2002;92:317–326.Google Scholar
  28. 28.
    Saxena A, Kim W. Ankle dorsiflexion in adolescent athletes. J Am Podiatr Assoc. 2003;93: 312–314.Google Scholar
  29. 29.
    Saxena A. Retrospective review of 91 surgeries for chronic Achilles pathology. J Am Pod Med Assoc. 2003;93:283–291.Google Scholar
  30. 30.
    Saxena A. Results of achilles tendon surgery in elite and sub-elite track athletes. 2003;24:712–720.Google Scholar
  31. 31.
    Schepsis A, Wagner C, Leach RE. Surgical management of Achilles tendon overuse injuries. Am J Sports Med. 1994;22:611–619.CrossRefGoogle Scholar
  32. 32.
    Nelen G, Martens M, Burssens A. Surgical treatment of chronic Achilles tendonitis. Am J Sports Med. 1989;17:754–759.CrossRefGoogle Scholar
  33. 33.
    Alfredson H, Pietila T, Jonsson P, Lorentzon R. Heavy-load eccentric training for the treatment of chronic Achilles tendinosis. Am J Sports Med. 1998;26:360–366.Google Scholar
  34. 34.
    Koman L, Brashear A, Rosenfeld S, Chamber H, Russman B, Rang M, Root L, Ferrari E, Garcia de Yebenes rous J, Smith B, Turkel C, Wall J, Molloy P. Botulinum toxin Type A neuromuscular blockade in the treatment of equinus foot deformity in cerebral palsy: a multi-center open-label clinical trial. Pediatrics. 2001;108:1062–1071.CrossRefGoogle Scholar
  35. 35.
    Delpech J. Tenotomie du tendon d’Achille. In: Chirurg Clin de Montpellier: ou observations et reflexions tirees des travaux de chirurgie clinique cette ecole. Paris: Gabon; 1823:147–231.Google Scholar
  36. 36.
    Stromeyer G. Beitragge zur operativen Orthopädik oder Erfahrungen über die Subcutane Durchscheidung verkurzter Muskein und deren Sehnen. Hanover, NH: Helwing; 1838.Google Scholar
  37. 37.
    Hoke M. An operation for correction of extremely relaxed feet. J Bone Joint Surg. 1931;13(A):773–783.Google Scholar
  38. 38.
    Delp S, Zajac F. Force- and moment-generating capacity of lower-extremity muscles before and after tendon lengthening. Clin Orthop. 1992;284:247–259.Google Scholar
  39. 39.
    Strayer LM. Gastrocnemius recession: a five-year report of cases. J Bone Joint Surg. 1958;40:1019–1030.Google Scholar
  40. 40.
    Pinney S, Sangeorzan B, Hansen S. Surgical anatomy of the Gastrocnemius recession (Strayer procedure). Foot Ankle Int. 2004;25:247–250.Google Scholar
  41. 41.
    Vulpius O, Stoffel A. In: Orthopädische Operationslehre. Stuttgart, Germany: Ferdinand Ecke; 1913:29–31.Google Scholar
  42. 42.
    Vulpiani M, Guzzini M, Ferretti A. Operative treatment of chronic Achilles tendinopathy. Int Orthop. 2003;27:307–310.CrossRefGoogle Scholar
  43. 43.
    Costa M, Donnell S, Tucker K. Long-term outcome of tendon lengthening for chronic Achilles tendon pain. Foot Ankle Int. 2006;27:672–676.Google Scholar
  44. 44.
    DiGiovanni C. Proximal gastrocnemius recession (Personal Communication). 2005.Google Scholar
  45. 45.
    Maffulli N, Tallon C, Wong J, Lim K, Bleakney R. Early weightbearing and ankle mobilization after open repair of acute midsubstance tears of the achilles tendon. Am J Sports Med. 2003;31:692–700.Google Scholar
  46. 46.
    Mandelbaum BR, Myerson MS, Forster R. Achilles tendon ruptures: a new method of repair, early range of motion, and functional rehabilitation. Am J Sports Med. 1995;23:392–395.PubMedCrossRefGoogle Scholar
  47. 47.
    Cannon L, Hackney R. Operative shortening of the elongated defunctioned Tendoachilles following previous rupture. J Royal Nav Med Serv. 2003;89:139–141.Google Scholar
  48. 48.
    Carmont M, Maffulli N. Z Shortening of healed Achilles tendon rupture: a technical note. Foot Ankle Int. 2009;30:704–707.CrossRefGoogle Scholar
  49. 49.
    Cottrell W, Pearsall A, Hollis M. Simultaneous tears of the Achilles tendon and the medial head of the Gastrocnemius muscle. Orthopedics. 2002;25:685–687.Google Scholar
  50. 50.
    Gilbert T, Bullis B, Griffiths H. Tennis calf or tennis leg. Orthopedics. 1996;19:179–182.Google Scholar
  51. 51.
    Webb J, Moonjani N, Radford M. Anatomy of the Sural Nerve and its relation to the Achilles Tendon. Foot Ankle Int. 2000;21:475–477.Google Scholar
  52. 52.
    Leversedge F, Casey P, Seiler J, Xerogeanes J. Endoscopically assisted fasciotomy: description of technique and in-vitro assessment of lower-leg compartment decompression. Am J Sports Med. 2002;30:272–278.Google Scholar
  53. 53.
    Saxena A. Endoscopic gastrocnemius tenotomy. J Foot Ankle Surg. 2002;41:57–58.CrossRefGoogle Scholar
  54. 54.
    Tashjian RZ, Appel AJ, Banerjee R, DiGiovanni CW. Anatomic study of the gastrocnemius-soleus junction and its relationship to the sural nerve. Foot Ankle Int. 2003;24:473–476.Google Scholar
  55. 55.
    Saxena A, Gollwitzer H, DiDomenico L, Widtfeldt A. Endoscopic Gastrocnemius Recession: a midterm report on 54 cases. Z Orthop Unfall. 2007; 145(4): 499–504.Google Scholar

Copyright information

© Springer London 2010

Authors and Affiliations

  1. 1.Brown University Medical SchoolProvidenceUSA

Personalised recommendations