title: Proximal Gastrocnemius Release in the Treatment of Mechanical Metatarsalgia.
abstract: BACKGROUND
  Gastrocnemius shortening causes an equinus deformity that may clinically manifest in foot disorders, including metatarsalgia. We use this term to describe pain localized to the metatarsal heads. The purposes of this prospective study were to review the effect of medial gastrocnemius proximal release on ankle dorsiflexion and assess the outcome of this technique on pain and functional limitations in patients who have mechanical metatarsalgia and isolated gastrocnemius shortening.
  
  
  METHODS
  We prospectively followed a consecutive series of 78 feet in 52 patients with metatarsalgia who had an isolated gastrocnemius contracture assessed with the Silfverskiöld test. Surgical release was evaluated with visual analog scale (VAS) and American Orthopaedic Foot & Ankle Society (AOFAS) scales. Ankle dorsiflexion was measured at 1, 3, and 6 months postoperatively.
  
  
  RESULTS
  Preoperative values of VAS and AOFAS were 7.4 and 46.8, respectively. After 3 months postoperatively, the values were 3.0 and 81.7, and 6 months after surgery these values were 3.5 and 83.6. No patient worsened clinically. There were no major complications. Thirty-six patients (69.2%) were completely satisfied with the results of the surgery. Preoperatively, ankle dorsiflexion with the knee straight was -17.5 degrees, which improved to 2.5 degrees at 6 months postoperatively.
  
  
  CONCLUSIONS
  We believe proximal medial gastrocnemius recession is an alternate procedure to treat selected patients with mechanical metatarsalgia and gastrocnemius shortening. It had acceptable morbidity and cosmetic results.
  
  
  METHODS
  Level IV, case series.
authors.affiliation: Foot and Ankle Unit, Orthopaedic Surgery, Infanta Sofia University Hospital, Madrid, Spain patrmorales@hotmail.com.
authors.forename: Patricia
authors.initials: P
authors.lastname: Morales-Muñoz
authors.affiliation: Foot and Ankle Unit, Orthopaedic Surgery, Infanta Sofia University Hospital, Madrid, Spain.
authors.forename: Raúl
authors.initials: R
authors.lastname: De Los Santos Real
authors.affiliation: Foot and Ankle Unit, Orthopaedic Surgery, Infanta Sofia University Hospital, Madrid, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: Barrio Sanz
authors.affiliation: Foot and Ankle Unit, Orthopaedic Surgery, Infanta Sofia University Hospital, Madrid, Spain.
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Pérez
authors.affiliation: Foot and Ankle Unit, Orthopaedic Surgery, Infanta Sofia University Hospital, Madrid, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Varas Navas
authors.affiliation: Foot and Ankle Unit, Orthopaedic Surgery, Infanta Sofia University Hospital, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Escalera Alonso
mesh_terms: D003286:Contracture / Q000503:physiopathology*; D004863:Equinus Deformity / Q000601:surgery*; D005534:Foot Diseases / Q000601:surgery*; D006801:Humans; D008682:Metatarsal Bones / Q000601:surgery*; D037061:Metatarsalgia / Q000503:physiopathology / Q000601:surgery*; D018482:Muscle, Skeletal / Q000503:physiopathology / Q000601:surgery*; D019637:Orthopedic Procedures / Q000379:methods*; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology*; D016896:Treatment Outcome; D064232:Visual Analog Scale
keywords: gastrocnemius; metatarsalgia; proximal release; shortening