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.
Do you have more questions?
Q. What is Endoscopic Gastrocnemius Recession (EGR)?
A. Endoscopic Gastrocnemius Recession (EGR) is a minimally invasive surgical procedure to treat gastrocnemius equinus, a condition where the Achilles tendon is too tight, restricting ankle movement. The surgery involves releasing the tight gastrocnemius muscle using a small incision and a camera.
Q. How is Endoscopic Gastrocnemius Recession performed?
A. The procedure is performed by making a small incision, inserting an endoscope (camera), and using specialized tools to release the gastrocnemius muscle’s connective tissue, improving ankle dorsiflexion and alleviating pain.
Q. What conditions does Endoscopic Gastrocnemius Recession treat?
A. EGR is primarily used to treat equinus deformity caused by a tight gastrocnemius muscle, which can lead to conditions like Achilles tendinitis, plantar fasciitis, and flatfoot, particularly in patients who have not responded to conservative treatments.
Q. What are the advantages of Endoscopic Gastrocnemius Recession over traditional open surgery?
A. The advantages include smaller incisions, reduced scarring, less post-operative pain, quicker recovery times, and a lower risk of nerve injury, making it an attractive option for many patients.
Q. How long is the recovery time after Endoscopic Gastrocnemius Recession?
A. Recovery typically takes a few weeks, with most patients able to return to normal activities within 1 to 2 months, though high-impact activities may need to be avoided for up to 3 months to ensure proper healing.
Q. Are there any risks or complications associated with Endoscopic Gastrocnemius Recession?
A. Risks are minimal but may include nerve irritation (especially to the sural nerve), weakness in plantar flexion (foot pointing down), and temporary numbness or tingling in the foot. These complications are generally temporary and manageable.
Q. What are the expected results of Endoscopic Gastrocnemius Recession?
A. The procedure typically results in improved ankle dorsiflexion (the ability to point the toes upward), reduced pain, and better mobility, allowing patients to engage in daily activities and sports with greater ease.
Q. Is Endoscopic Gastrocnemius Recession suitable for everyone with tight Achilles tendons?
A. EGR is suitable for patients with gastrocnemius equinus who have not found relief through nonoperative treatments. It is particularly beneficial for children or adolescents still growing, as it allows continued physical development without significant tissue disruption.
Q. Can Endoscopic Gastrocnemius Recession be performed on both legs at the same time?
A. While it is possible to perform the procedure on both legs simultaneously, it is generally recommended to treat one leg at a time to allow for proper healing and minimize the risk of complications.
Q. Will I experience pain after Endoscopic Gastrocnemius Recession?
A. Some mild discomfort or soreness is expected after surgery, but this is typically well-managed with pain medications. Most patients experience significant pain relief once the procedure heals.
Q. Can Endoscopic Gastrocnemius Recession be combined with other foot or ankle surgeries?
A. Yes, the procedure can be combined with other surgeries, such as Achilles tendon repair or bunion correction, if necessary, to address multiple issues in the foot and ankle during a single operation.
Q. How long will I need to stay off my foot after Endoscopic Gastrocnemius Recession?
A. Most patients are advised to avoid weight-bearing for the first few days to weeks after surgery. Crutches or a walking boot are often used to assist with movement during the early recovery phase.
Q. What should I expect during the first few days after Endoscopic Gastrocnemius Recession?
A. You may experience swelling and mild discomfort around the surgical site. Elevating the foot, applying ice, and following post-operative care instructions are crucial to manage swelling and promote healing.
Q. How soon can I return to driving after Endoscopic Gastrocnemius Recession?
A. Most patients can return to driving after they have regained sufficient ankle mobility and strength, typically after 2 to 4 weeks, depending on the healing process and whether surgery was on the dominant leg.
Q. Is physical therapy necessary after Endoscopic Gastrocnemius Recession?
A. Yes, physical therapy is often recommended to help restore strength, range of motion, and function in the ankle. It also helps to prevent stiffness and ensure optimal recovery after the procedure.
Dr. Mo Athar
