A gastrocnemius recession is a surgical procedure designed to lengthen the gastrocnemius muscle, one of the two major muscles that form the calf. This lengthening relieves chronic tension in the back of the lower leg, allowing the ankle to move more freely. The goal is to restore a more natural position and range of motion to the heel and foot, addressing pain and improving walking ability.
The Muscular Issue Requiring Recession
The gastrocnemius muscle, often called the “gastroc,” is the most superficial of the calf muscles. It joins with the deeper soleus muscle to form the Achilles tendon, which then attaches to the heel bone. Because the gastrocnemius crosses both the knee and ankle joints, its tightness can restrict ankle movement, particularly the ability to bend the foot upward toward the shin, known as dorsiflexion.
The primary condition this surgery addresses is an equinus deformity, where the limited dorsiflexion causes the foot to point downward. Equinus occurs when the calf muscles or Achilles tendon are too short or tight, preventing the foot from achieving a neutral position when the knee is straight. The standard measure for this issue is a dorsiflexion of less than 10 degrees with the knee extended.
This chronic tightness creates excessive strain on the foot and ankle, often leading to secondary conditions. For example, patients may experience chronic plantar fasciitis because the tight calf pulls on the heel bone and fascia underneath the foot. Other indications include midfoot overload syndromes, Achilles tendinopathy, and non-healing diabetic foot ulcers, as the procedure allows the heel to drop into a more natural position.
Surgical Techniques for Gastrocnemius Recession
The goal of a gastrocnemius recession is to lengthen the muscle-tendon unit by releasing the tight fascia that encases the muscle fibers. Surgeons have developed several techniques to achieve this lengthening, which vary mainly in the size of the incision and the visualization method used. All approaches are usually performed as outpatient procedures under general or regional anesthesia.
Open Approach
The traditional, or open, approach involves making a longer incision on the inner or back side of the calf. Through this opening, the surgeon carefully dissects between the gastrocnemius and soleus muscles to access the gastrocnemius aponeurosis, which is the broad, flat tendon sheet that connects the muscle. The surgeon then cuts this aponeurosis, allowing the muscle fibers to slide and lengthen naturally under the tension of the ankle joint.
Endoscopic Approach
A less invasive option is the endoscopic gastrocnemius recession, which uses a small camera and specialized instruments inserted through tiny incisions. The endoscope allows the surgeon to visualize the inside of the calf muscle and guide the cutting instrument. This technique allows the surgeon to precisely release the fascia through a small working channel created between the muscles, often leading to smaller scars and potentially faster initial recovery.
Some surgeons may also use percutaneous techniques, which involve extremely small puncture incisions, sometimes guided by ultrasound, to make a partial release of the gastrocnemius tendon or fascia. Regardless of the method, the surgeon tests the ankle’s range of motion during the procedure to ensure the desired lengthening has been achieved before closing the incisions with sutures.
Recovery and Potential Complications
The recovery process following a gastrocnemius recession is structured to protect the newly lengthened muscle and gradually restore strength and function. Immediately after surgery, the patient’s leg is immobilized in a cast, splint, or walking boot for a period that often ranges from two to six weeks to protect the surgical site. During this initial phase, patients are usually instructed to remain non-weight-bearing and use crutches or a knee scooter to avoid putting pressure on the healing calf.
Once the initial immobilization period is over, patients transition to a removable walking boot and begin a progressive weight-bearing protocol. The total healing process typically takes six to eight weeks, but a full return to normal activity can take several months, sometimes up to seven months for full physical activity. Physical therapy is a necessary part of the rehabilitation process, often starting around two weeks post-surgery, to rebuild calf strength and improve gait.
The procedure carries potential risks and complications, though it is generally effective for correcting calf tightness. Common concerns include infection at the surgical site, delayed wound healing, and the development of blood clots. A specific risk involves potential damage to the sural nerve, which runs along the back of the calf and provides sensation to the side of the foot.
There is also a risk of the muscle being over-lengthened, which could cause weakness in the calf, or under-lengthening, which may lead to the original symptoms persisting or recurring. Following the detailed physical therapy regimen is important to ensure the muscle heals correctly and achieves the optimal length, minimizing the chance of long-term complications.