Management of Metatarsalgia and Equinus Contracture: Gastrocnemius Recession, Percutaneous Tendoachilles Lengthening, and Diaphyseal Metatarsal Shortening Osteotomy
Rachel J. Shakked
Maxwell C. Alley Jr.
Christopher Johnson
Andrew J. Rosenbaum
Gastrocnemius Recession
Instruments/equipment
Long-handled scalpel
Vaginal speculum
Right-angle retractors
Positioning
The patient is positioned supine, with the leg in neutral or slightly externally rotated position.
Surgical procedure
The author’s preferred technique is a modified Strayer recession of the gastrocnemius (Figure 3-1).1
Identify the contour of the gastrocnemius muscle along the medial aspect of the lower leg (Figure 3-2).
A 3- to 4-cm longitudinal incision is made, medially centered over the musculotendinous junction as determined by visual inspection.
Identify the fascia and incise in line with the skin incision.
The musculotendinous junction should be visualized. Use blunt dissection to dissect the gastrocnemius fascia anterior and posterior to the gastrocnemius muscle just proximal to the musculotendinous junction.
Large right-angle retractors can be utilized for visualization.
Figure 3-1. Cartoon depiction of the Strayer procedure demonstrating the location of the incision across the gastrocnemius fascia. Reprinted from Hsu RY, VanValkenburg S, Tanriover A, et al. Surgical techniques of gastrocnemius lengthening. Foot Ankle Clin. 2014;19(4):745-765. Copyright © 2014 Elsevier. With permission.
Identify the sural nerve, which is typically midline and may be adherent to the posterior aspect of the gastrocnemius fascia. A small elevator can be used to gently sweep the nerve and its adventitial tissue away from the fascia.
The plantaris tendon is tenotomized.
A vaginal speculum can be used for optimal exposure (Figure 3-3). It is inserted to expose the gastrocnemius fascia and to protect the sural nerve.
Figure 3-2. The incision is marked at the junction of the contoured gastrocnemius muscle and the most proximal portion of the Achilles tendon. Reprinted from Hsu RY, VanValkenburg S, Tanriover A, et al. Surgical techniques of gastrocnemius lengthening. Foot Ankle Clin. 2014;19(4):745-765. Copyright © 2014 Elsevier. With permission.
Next, a long-handled scalpel or Mayo scissors can be used to incise the fascia from medial to lateral in line with the speculum (Figures 3-4 and 3-5). While performing this technique, an assistant holds the ankle in gentle dorsiflexion with the knee extended.Related posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
