Endoscopic Gastrocnemius Recession

  • Amol Saxena
  • Christopher W. DiGiovanniEmail author


Percutaneous techniques are becoming popular for treating many musculoskeletal conditions. Those developed for endoscopic carpal tunnel and plantar fascial release are currently among the most common. The reported benefits of endoscopic surgery include smaller incisions and shorter postoperative recovery time.1–3 Visualization with an endoscope may also decrease perioperative complications from scarring such as incisional irritation or neuritis, although the overall safety of these interventions has yet to be determined. An endoscopic means of gastrocnemius recession (EGR) has recently been popularized for correction of ankle equinus contracture as an alternative to formal open gastrocnemius release (OGR) or Achilles tendon lengthening.4–21 The OGR remains today’s gold standard for aponeurotic lengthening because of its proven record as a safe, rapid, and effective procedure. This open “slide,” however, can involve a large unsightly incision, which is particularly unpopular with young women, and can be associated with sural nerve scarring and neuritis.11,14,15,19,22 The EGR, an alternative percutaneous approach, has been sought in an effort to avoid those problems, but it has a significant learning curve, can be associated with poor visualization, and is somewhat instrument dependent.14,17 In consideration of its potential advantages and drawbacks, the authors have tried over the last several years to develop a safe and reliable endoscopic technique for gastrocnemius recession.


Sural Nerve Medial Gastrocnemius Ankle Dorsiflexion Lateral Gastrocnemius Plantar Fasciitis 
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  1. 1.
    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 30(2): 272–278, 2002PubMedGoogle Scholar
  2. 2.
    Mirza A, King E. Newer techniques of carpal tunnel release. Orthop Clin North Am 27: 355–371, 1996PubMedGoogle Scholar
  3. 3.
    Saxena A. Uniportal endoscopic plantar fasciotomy: a prospective study on athletic patients. Foot Ankle Int 25(12): 882–889, 2004PubMedGoogle Scholar
  4. 4.
    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 81A(4): 535–538, 1999Google Scholar
  5. 5.
    DiDomenico L, Adams H, Garehar, D. Endoscopic gastrocnemius recession for the treatment of gastrocnemius equinus. J Am Podiatr Med Assoc 95(4): 410–413, 2005PubMedGoogle Scholar
  6. 6.
    Hansen ST. Midfoot arthrodesis In: Wulker N, Stephens M, Cracchiolo A (eds.) Atlas of Foot and Ankle Surgery. St. Louis, MO, Mosby, p. 154, 1998Google 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. Lippincott Williams & Wilkins, Baltimore, MD, pp. 415–421, 2000Google Scholar
  8. 8.
    Laborde J. Tendon lengthenings for forefoot ulcers. Wounds 17(5): 122–130, 2005Google Scholar
  9. 9.
    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 85-A(8): 1436–45, 2003PubMedGoogle Scholar
  10. 10.
    Pinney S, Sangeorzan B, Hansen ST. Surgical anatomy of the gastrocnemius recession (Strayer procedure) Foot Ankle Int 25(4): 247–250, 2004PubMedGoogle Scholar
  11. 11.
    Pinney SJ, Hansen ST, Sangeorzan BJ. The effect on ankle dorsiflexion of gastrocnemius recession. Foot Ankle Int 23(1): 26–29, 2002PubMedGoogle Scholar
  12. 12.
    Poul J, Tuma J, Bajerova J. Video-assisted tenotomy of the triceps muscle of the calf in cerebral palsy patients. Acta Chir Orthop Traumatol Cech 72(3): 170–172, 2005PubMedGoogle Scholar
  13. 13.
    Saxena A. Endoscopic gastrocnemius tenotomy. J Foot Ankle Surg 41(1): 57–58, 2002CrossRefPubMedGoogle Scholar
  14. 14.
    Saxena A, Widtfeldt A. Endoscopic gastrocnemius recession: a preliminary report on 18 cases. J Foot Ankle Surg 43(5): 302–306, 2004CrossRefPubMedGoogle Scholar
  15. 15.
    Saxena A, Gollwitzer H, DiDomenico L, Widtfeldt A, Die endoskopische Verlängerungsoperation des Musculus gastrocnemius zur Behandlung des Gastrocnemius equinus (German) Z Orthop Unfall 145:1–6, 2007Google Scholar
  16. 16.
    Saxena A, DiGiovanni C. Ankle equinus and the athlete. In: Maffulli N, Almekinders M (eds.) The Achilles Tendon. Springer, New York, 2006Google Scholar
  17. 17.
    Sgarlato TE. Medial gastrocnemius tenotomy to assist in body posture balancing. J Foot Ankle Surg 37(6): 546–547, 1998CrossRefPubMedGoogle Scholar
  18. 18.
    Takao M, Ochi M, Shu N, Uchio Y, Naito K, Tobita M, Matsusaki M, Kawasaki K. A case of superficial peroneal nerve injury during ankle arthroscopy. Arthroscopy 17(4): 403–404, 2001CrossRefPubMedGoogle Scholar
  19. 19.
    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 24: 473–476, 2003PubMedGoogle Scholar
  20. 20.
    Trevino S, Gibbs M, Panchbhavi V. Evaluation of results of endoscopic gastrocnemius recession. Foot Ankle Int 26(5): 35–364, 2005Google Scholar
  21. 21.
    Trevino S, Panchbhavi V. Technique of endoscopic gastrocnemius recession: cadaveric study. Foot Ankle Surg 8: 45–47, 2002CrossRefGoogle Scholar
  22. 22.
    Tashjian R, Appel A, Banerjee R, DiGiovanni C. Endoscopic gastrocnemius recession: evaluation in a cadaver model. Foot Ankle Int 24: 607–613, 2003PubMedGoogle Scholar
  23. 23.
    Silverskiold N. Reduction of the uncrossed two-joints muscles of the leg to one-joint muscles in spastic conditions. Acta Chir Scand 56: 315–30, 1924Google Scholar
  24. 24.
    DiGiovanni C, Kuo R, Tejwani N, Price R, Hansen T, Cziernecki J, Sangeorzan B. Isolated gastrocnemius tightness. J Bone Joint Surg 84A(6): 962–970, 2002Google Scholar
  25. 25.
    Saxena A, Kim W. Ankle dorsiflexion in adolescent athletes. J Am Podiatr Assoc 93(4): 312–314, 2003Google Scholar
  26. 26.
    Webb J, Moonjani N, Radford M. Anatomy of the sural nerve and its relation to the Achilles tendon. Foot Ankle Int 21(6): 475–477, 2000PubMedGoogle Scholar
  27. 27.
    Barouk L, Barouk P. Techniques, results and comparison between the medial and lateral proximal gastrocnemius release. Presented at the International Spring Meeting, French Foot Society. Toulouse, France June 8–10, 2006Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Division of Foot and Ankle, Department of Orthopedic SurgeryBrown University Medical School, Rhode Island HospitalProvidenceUSA

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