Tobin T. Eckel,Scott B. Shawen

In recent years, there seems to be a trend toward performing large numbers of gastrocnemius recessions for a variety of pathological conditions of the foot and ankle. Whether it be as part of a complex flat or cavus foot reconstruction or to improve dorsiflexion, to offload forefoot pressures when treating diabetic ulcers, or, in the case of this paper, to decrease tension across the Achilles to treat tendinopathy, there is no doubt that the gastrocnemius recession has emerged as a vital tool in the armamentarium of the foot and ankle surgeon. While there are several case series that demonstrate promising results with regard to pain relief after gastrocnemius recession for Achilles tendinopathy, the literature has not been as defined regarding the effect on plantar-flexion strength postoperatively. Some of these limitations include small sample size, retrospective study designs with no preoperative strength-testing for comparison, and gastrocnemius recession procedures performed in conjunction with other major reconstructive procedures, making it difficult to determine what effect the recession would have in isolation.

The present study does an admirable job of quantifying the pain relief, strength, and function following a gastrocnemius recession. The results are very encouraging with regard to reducing pain and improving patient-reported satisfaction. The results of strength-testing and self-reported sports function may be a little less promising; however, this comes as no surprise. We believe that this procedure is so effective because by lengthening the gastrocnemius, the muscle is weakened. In the case of tendinopathy, this muscle-weakening reduces the stress across the degenerative portion of the tendon, and with other pathological processes, it reduces the deforming force of the gastrocnemius-soleus complex. The decrease in calf circumference postoperatively seems to support this assumption.