Equinus deformity refers to a condition where the foot is limited in its ability to move upwards (dorsiflexion), due to a tight gastrocnemius muscle. This limitation can lead to various secondary complications, including Achilles tendinosis, flatfoot, knee hyperextension, and even lower back pain. Non-surgical treatments such as stretching, physical therapy, and the use of orthotics are often attempted, but for many patients, these measures are not sufficient.
For individuals suffering from gastrocnemius equinus, particularly those who have not responded to nonoperative treatments, surgery may be necessary. One effective surgical approach is the gastrocnemius recession procedure. This procedure aims to release the tight gastrocnemius muscle, improving the range of motion in the ankle and alleviating the symptoms associated with equinus deformity. Endoscopic gastrocnemius recession (EGR) has emerged as a minimally invasive alternative to traditional open surgery.
What Is Endoscopic Gastrocnemius Recession (EGR)?
Endoscopic gastrocnemius recession involves using small incisions and a camera to guide the surgeon as they release the gastrocnemius muscle. Compared to traditional open surgery, this technique offers several benefits, including smaller scars, less post-operative pain, and a quicker recovery.
The procedure is typically performed on patients who have a history of failed non-surgical interventions. In the case of children and adolescents, it is particularly beneficial for those who are still growing and need a minimally invasive solution that will allow for continued physical development. EGR has proven to be effective in increasing ankle dorsiflexion (the ability to point the toes upwards), which in turn improves overall function and mobility.
Why Choose EGR for Equinus Deformity?
There are several advantages to the endoscopic approach over traditional open surgery:
- Minimally Invasive: Only small incisions are needed, which reduces scarring and leads to faster healing.
- Reduced Risk of Nerve Injury: By using a camera for guidance, the surgeon can avoid damaging nerves that might otherwise be at risk in open surgery.
- Faster Recovery: Most patients can bear weight on their feet soon after the procedure, with a quicker return to normal activity.
- Less Pain: Because of the smaller incisions and reduced tissue disruption, patients generally experience less post-operative pain.
The Procedure: What to Expect
- Preparation and Anesthesia: The procedure is performed under general or regional anesthesia. The patient is positioned comfortably, and a tourniquet is applied to create a bloodless field for the surgery.
- Incision and Portal Creation: A small 1 cm incision is made on the medial side of the calf. The surgeon uses this portal to insert an endoscope (a thin tube with a camera) to visualize the gastrocnemius muscle and surrounding tissues.
- Releasing the Aponeurosis: The gastrocnemius aponeurosis (the connective tissue surrounding the muscle) is carefully released, which allows for the muscle to stretch. The surgeon uses a hook blade to gradually cut through the aponeurosis, ensuring that only the necessary tissue is removed to achieve the desired ankle dorsiflexion.
- Checking for Nerve Injury: The sural nerve, located near the surgical site, is carefully monitored throughout the procedure to ensure it is not damaged. The surgeon will always confirm the location of the nerve before making any cuts.
- Closure and Recovery: After the muscle has been released, the incision is closed with a few stitches. A splint is applied to keep the foot in the correct position for healing. Most patients are able to walk again within a few weeks, although they are advised to avoid high-impact activities for a few months.
Results and Benefits of EGR
In a study involving pediatric patients, EGR was shown to significantly improve ankle dorsiflexion, with an average increase of 15° in range of motion. Postoperative follow-ups demonstrated that the procedure was not only effective in improving mobility but also in relieving pain associated with equinus deformity.
Patients reported a marked improvement in their ability to engage in daily activities and sports. The majority of individuals in the study were able to return to their normal routine within one to two months, with minimal pain or weakness in the affected leg.
Complications and Considerations
As with any surgery, there are risks involved with EGR, although they are minimal. The most common complications include:
- Sural Nerve Dysesthesia: Some patients may experience numbness or tingling in the foot or leg, though this is usually temporary.
- Weakness in Plantar Flexion: A small number of patients report weakness in the calf muscle following surgery. This can often be managed with physical therapy to strengthen the muscle.
- Wound Healing Issues: While rare, some patients may experience issues with the incision site, such as scarring or infection.
However, the overall complication rate is low, and the benefits of improved range of motion and pain relief far outweigh these potential risks.
Is EGR Right for You?
Endoscopic gastrocnemius recession is suitable for individuals who have a tight gastrocnemius muscle that has not responded to nonoperative treatments. It is particularly beneficial for those who suffer from equinus deformity and its associated symptoms, such as foot pain and difficulty walking. If you have a history of failed treatments and are looking for a minimally invasive solution, EGR may be the right option for you.
If you are considering this procedure, it’s essential to consult with a skilled orthopedic surgeon who specializes in foot and ankle conditions. They will evaluate your specific condition and determine whether EGR is the most appropriate treatment for you.
Conclusion
Endoscopic gastrocnemius recession offers an effective, minimally invasive solution for patients suffering from gastrocnemius equinus. By improving ankle dorsiflexion and alleviating pain, it enables patients to return to a more active lifestyle. The procedure has demonstrated excellent results with a low complication rate, making it an ideal option for those who have not found relief through nonoperative treatments.
