Gastrocnemius Lengthening (Recession)

The calf is made up of two muscles, the gastrocnemius and soleus muscles. The gastrocnemius is the larger muscle. It has two separate heads that that attach the thighbone (femur) to the heel (calcaneus). The gastrocnemius and soleus join at the base of the heel to form the Achilles tendon.

The gastrocnemius allows the knees and feet to flex and it powers the ability to push off the foot.  When the muscle is tight, the ankle’s movement becomes restricted, causing excessive force on the foot and ankle. A number of painful conditions can develop over time if the condition is not resolved.  Achilles tendon issues and plantar fasciitis have been linked to this condition. Research suggests that gastrocnemius tightness also plays a role in forefoot pain (metatarsalgia), flatfoot deformity, Morton’s neuroma and bunions.

PROCEDURE

There are numerous ways to lengthen the gastrocnemius. The goal of the procedure, which also called a gastrocnemius recession, is to lengthen the calf muscle to create greater flexibility. In our technique, the fascia, or encasing tissue of the muscle, is divided to allow the muscle to gain one to two centimeters in length without damaging the muscle fibers. This will increase the range of motion at the ankle by an average of ten degrees when the knee is extended.  As a result, the pressure on the foot and ankle is eased, removing the cause of symptoms and pain.

In most cases, this procedure will be recommended for a patient who has had significant pain that does not respond to stretching exercises and other conservative treatments.  Gastrocnemius lengthening is most commonly recommended for patients with severe cases of plantar fasciitis or Achilles tendonitis.

For certain conditions, gastrocnemius recession is recommended in conjunction with a larger surgery. For example, tight calf muscles can be a factor in some bunion and flatfoot corrective surgeries.  Incorporating gastrocnemius recession into a larger surgery does not significantly impact pain levels or the recovery process.

Gastrocnemius surgery is done in an ambulatory setting. The patient can go home a few hours after the surgery. The procedure is brief, less than an hour, and is performed while the patient is under light anesthesia.

During the procedure, the surgeon will make a small, two to three inch incision in the inner calf, about halfway between the knee and ankle. The muscle is lengthened, and stitched on the inside and on the surface. Patients may walk immediately after the surgery when it is done in isolation. For more complex surgeries, a patient may need crutches for a few days and a walking boot for two to three weeks. In both instances, however, a splint is worn while sleeping for six weeks after surgery.

In most cases, the calf muscle will feel stretched or tight for just a few weeks. The stretching that begins shortly after surgery may be uncomfortable.  Discomfort can be managed with non-opioid, over the counter pain medication.

RISKS

There are two small nerves that sit along the gastrocnemius muscle that may be stretched during the procedure. When you stretch the muscle, occasionally the nerves are stretched as well. This can cause a passing sensation of numbness or tingling. Based on studies, this complication occurs in about 5% of cases and resolves within six to eight weeks. There is a much smaller risk of infection, bleeding, and blood clot.

Patients with a history of neuropathy or neuritis may be at a higher risk of developing complications.

There are some surgical techniques for gastrocnemius lengthening that can lead to weakness. However, the technique used by ONS surgeons does not create any noticeable muscle weakness.