Surgical correction of soft-tissue ankle equinus contracture

Soft-tissue ankle equinus contracture is an important component of numerous foot and ankle deformities. In high-risk patients who have multiple co-morbidities, procedure selection and careful surgical technique are paramount to increase the likelihood of postoperative success. This article discusses the indications for percutaneous Achilles tendon lengthening, open gastrocnemius recession, and endoscopic gastrocnemius recession, and provides a detailed description of each surgical technique with pearls to avoid intra-perative and postoperative complications specific to the high-risk patient. Thorough knowledge of each of these techniques will aide the foot and ankle surgeon in appropriate peri-operative management of equinus deformity in a complex patient population.