Gastroc RECESSION:
Incision of ONLY the deep portion of the investing fascia of the gastroc muscle belly, allowing for a controlled lengthening of the gastroc muscle. This effectively weakens the action of the gastroc to allow more dorsiflexion.
Gastroc SLIDE:
Aponeurosis/tendon between gastroc and soleus is completely transected, allowing gastroc to “slide” more proximally and then scar back down onto soleus and Achilles. This effectively weakens the action of the gastroc to allow more dorsiflexion.
NOTE:
Both surgeries reduce tightness in gastrocnemius, however the Gastroc SLIDE is a more aggressive surgery than the Gastroc RECESSION. Gastroc Recession is the cutting of ONLY the deep layer of the fascia surrounding the gastroc to allow for subtle lengthening, but does not affect the continuity of the gastroc tendon attaching to the Soleus/Achilles. The sural nerve may be affected during this procedure; usually it is just stretched and will recover.
For a good description with diagrams/images describing the differences between these procedures, see this article. They use the term GIAR for what I call a “Recession” and Modified Strayer for what I call a “Slide.”
Tight gastrocnemius predisposes to forefoot overload and midfoot instability. Excessive pressure on fore/midfoot leads to sagging 1st TMT and/or NC joint (can result in hypermobile 1st ray), Posterior Tib tendon failure, calc. valgus and abducted forefoot. Toe extensors overwork to assist dorsiflexion (extensor overdrive) causing claw toes. Gastrocnemius tightness may be a factor in subtle cavus foot, caused by peroneus longus overdrive and plantarflexed 1st ray. It is usually the primary cause of plantar fasciitis and probably Achilles’ tendinosis.
Patient testimonials and experiences with gastroc release procedures.
Pre-op Assessment
–Gait training with device. Usually don’t tolerate much weight on foot at first. Warn patient that surgery site is painful for the first few days, feels like a strong kick to the calf. Usually feel quite a bit better by 4th day post-op.
If bilateral, patient will need walker and/or w/c.
–Exercise training—prepare for post op exercises—will begin gentle AROM on day 4.
Measure range of ankle dorsiflexion knee straight, knee bent. Measure height of navicular from floor in normal stance.
Patient will not have full strength of gastroc for several months.
Post-op
CAM boot. WBAT 1st POD. Walking (protected by CAM boot) is advantageous in prevention of scar contracture.
–Toe pumps/curls
–Foot intrinsics: MTP flexion with DIP/PIP extension, toe add/abd.
–Light isometrics in cast/splint.
1st 24-48 hours after surgery are the most painful.
–On 4-5th POD, may start gentle AROM ankle, STJ (remove CAM boot for exercise).
AROM: gentle, 4-5th POD
PROM: no
Stretch: no
Resistance: no
3-6 weeks
CAM off during day. Walking in regular shoes during the day. CAM on at night to maintain position in neutral until 6 weeks post-op.
–Gentle gastroc stretch using towel.
–Beginning strengthening with lightweight theraband all motions.
–Sitting arch lifts.
–Instruct patient in beginning scar massage/ transverse friction massage (may benefit from Silipos).
AROM: yes
Stretch: gentle
Resistance: light
6-12 weeks
Measure range of motion.
Practice normal weight loading of foot in stance and gait.
Stretching: Stair-step stretch, foot positioned with heel only off edge of stair. Standing “runner’s type” gastroc.stretch if patient can position foot in subtalar neutral only (don’t allow foot to be pronated in stretch).
Strengthening: Theraband gastroc-soleus, Post. Tib., Peroneals, Tib Ant with toes relaxed.
Progress to single leg stance activities: static balance, standing heel lifts, arch lifts, etc. Eccentric strengthening. Assess hips, quads.
8 week functional eval (SLS heel raise, squat, balance, reach)
Progressive conditioning.
Impact, plyometrics as tolerated
14 week functional eval (jump, hop, step)
AROM: yes
Stretch: as tol
Resistance: as tol
12 weeks
F.U visit with M.D.
Functional strength/ROM eval.
Measure height of navicular from floor.
