Influence of Interventions on the Sural Complex like the Gastrocnemius Recession on the Calf Strength

Category: Ankle; Hindfoot; Midfoot/Forefoot; Other Introduction/Purpose: Increasing evidence has shown that gastrocnemius tightness is related to various types of foot and ankle pathology. The recession and lengthening of the gastrocnemius has become an important ancillary procedure in many reconstructive operations, such as hallux valgus, pes plano-valgus and total ankle arthroplasty surgery. Additionally, isolated Gastrocnemius Recession is also performed alone to treat plantarfasciitis, achillestendinosis, metatarsalgia and diabetic forefoot ulceration. The reports about the clinical results are encouraging, but evident data about the resulting strength of the treated muscle is lacking. Methods: This study was designed to measure calf-strength of every patient before and after Gastrocnemius Tenotomy, Gastrocnemius Recession, Achillestendon lengthening. The data was taken before surgery and one year post-op. A Leonardo Mechanograph GRFP was used to measure calf-strength with bended and extended knee on both sites. 85 patients were measured before surgery. 58 of these patients underwent a intervention on the sural complex. The interventions included Gastrocnemius Tenotomy, Gastrocnemius Recession, Achillestendon lengthening combined with different types of foot and ankle reconstruction. Results: The results show that the calf strength decreased overall significantly. The force on the operated site decreases significantly with bended and extended knee. However, contralatrel forces diminish in the same dimension. The decrease in force was mainly related to the force during knee extension. There was no significant force difference postoperatively between ipsi- and contralateral. Conclusion: Apparently, a surgical intervention on the foot seems to cause a weakening of the flexor muscles on both lower legs. Not surprisingly, the greater reduction in strength is during knee extension. Apparently, however, the loss of strength on the operated foot is compensated, so that ultimately there is the same strength on both side.

Effect of the additional first ray osteotomy on hindfoot alignment after calcaneal osteotomy for the correction of mild-to-moderate adult type pes plano-valgus

Purpose: To determine the effect of the additional first ray osteotomy on hindfoot alignment for the correction of pes plano-valgus. Methods: Data obtained from 37 consecutive patients recruited from 2006 to 2014 who underwent medial displacement calcaneal osteotomy (MDCO) alone (group H) or MDCO followed by medial cuneiform opening wedge osteotomy (MCOWO) (group HF) with a minimum 1-year follow-up were reviewed retrospectively. The mean follow-up periods were 34 and 32 months. Results: Degree of decrease of Talonavicular coverage angle (TNCA) via surgery or postoperative TNCA on standing foot AP radiographs were not significantly different between group H and HF ( p = 0.287). The calcaneal pitch angle and medial cuneiform height on the standing foot lateral radiographs was significantly increased after operation in group HF ( p = 0.01), there was a significant difference with group H as well ( p = 0.033). In group HF, the Meary’s angle was significantly decreased after operation, a significant difference compared to group H ( p = 0.009). Hindfoot alignment angle on the hindfoot alignment view was decreased after operation in both groups but was not significantly different between both groups ( p = 0.410). Hindfoot alignment ratio was also increased after the operation in both groups, but was not different between two groups ( p = 0.783). Conclusion: The additional first ray osteotomy using MCOWO had no correctional power for hindfoot correction, although it caused improvement in some radiographic parameters.

Surgical correction of hallux valgus complicated with adult-type pes plano-valgus

Purpose: To investigate the efficiency of simultaneous correction of moderate to severe hallux valgus deformity and adult-type pes planus. Methods: Twenty cases of moderate to severe hallux valgus complicated with adult-type pes planus in 19 consecutive patients (15 (79%) women, 4 (11%) men; mean age: 44.50 ± 17.13 years, mean follow-up duration: 31.30 ± 17.02 months) were included. Medial calcaneal sliding osteotomy was performed to correct hindfoot valgus, whereas treatments of hallux valgus were case dependent. Results: The mean postoperative hallux valgus angle, intermetatarsal angle, hindfoot alignment angle, and hindfoot alignment ratio were 8.40 ± 5.29°, 4.20 ± 2.54°, 3.09 ± 2.92º and 0.41 ± 0.17, respectively. Although a hallux varus deformity occurred as a postoperative complication in one case (5%), there were no cases of postoperative recurrence. Conclusion: Simultaneous correction of hallux valgus and pes plano-valgus using medial calcaneal sliding osteotomy is an effective technique that reduces recurrence of hallux valgus and increases satisfaction in patients with moderate to severe hallux valgus deformity complicated with adult-type pes planus accompanying hindfoot valgus.