Isolated Gastrocnemius Recession for Treatment of Insertional Achilles Tendinopathy: A Pilot Study.
BACKGROUND
Many surgeries exist for treatment of insertional Achilles tendinopathy. Another surgical option to consider is an isolated gastrocnemius recession. Recent studies have demonstrated the success of a gastrocnemius recession for noninsertional Achilles tendinitis. We hypothesize that an isolated gastrocnemius recession can be a successful, effective, and less invasive surgery for patients with chronic insertional Achilles tendinopathy.


METHODS
This article presents a retrospective review of one surgeon's results of 11 patients (2010-2012), with an average age of 59 years who presented with chronic insertional Achilles tendinopathy. Gastrocnemius recessions, either endoscopic or open, were performed after an average of 6.2 months of conservative treatment. All patients' radiographs were reviewed preoperatively for any calcaneal spurs and divided into groups accordingly. Average follow-up time postoperatively was 13.8 months. Plantarflexion strength, equinus deformity, as well as the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot instrument was assessed.


RESULTS
In all, 10/11 (91%) patients had high patient satisfaction, pain relief, no residual equinus deformity, loss in muscle strength and returned to regular activities successfully at 1-year follow up. All patients and groups had significant improvement in AOFAS scores. The median postoperative AOFAS score was 94.8. All patients and patient groups had significant improvement pre- to postoperatively. Patients without spurs appear to do better than patients with spurs. One patient developed recurrence of insertional heel pain and equinus deformity. Other complications included 2 sural nerve parasthesias, which resolved.


CONCLUSIONS
An isolated gastrocnemius recession for chronic insertional Achilles tendinopathy can provide high satisfaction, pain relief, and a faster recovery period with few or no complications.


METHODS
Therapeutic, Level IV: Case series.
UnityPoint Health-St Lukes Hospital, UnityPoint Clinic-Podiatry, Sioux City, Iowa (VKT)Foot and Ankle Center of Nebraska, P.C., Omaha, Nebraska (RMG)Podiatric Medicine and Surgery Residency, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (CL).
Valerie K
VK
Tallerico
UnityPoint Health-St Lukes Hospital, UnityPoint Clinic-Podiatry, Sioux City, Iowa (VKT)Foot and Ankle Center of Nebraska, P.C., Omaha, Nebraska (RMG)Podiatric Medicine and Surgery Residency, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (CL) robert.m.greenhagen@gmail.com.
Robert M
RM
Greenhagen
UnityPoint Health-St Lukes Hospital, UnityPoint Clinic-Podiatry, Sioux City, Iowa (VKT)Foot and Ankle Center of Nebraska, P.C., Omaha, Nebraska (RMG)Podiatric Medicine and Surgery Residency, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (CL).
Clinton
C
Lowery
D000125:Achilles Tendon / Q000601:surgery*; D000328:Adult; D000368:Aged; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000601:surgery*; D019637:Orthopedic Procedures / Q000379:methods*; D017060:Patient Satisfaction; D010865:Pilot Projects; D012189:Retrospective Studies; D052256:Tendinopathy; D016896:Treatment Outcome
Achilles tendinitis; equinus; gastrocnemius recession; heel pain; insertional