Isolated Gastrocnemius Recession for Progressive Collapsing Foot Deformity

Area of Science:

• Orthopedics
• Podiatry
• Foot and Ankle Surgery

Background:

• Progressive collapsing foot deformity (PCFD) is often linked to gastrocnemius contracture.
• Standard surgical treatment for PCFD involves gastrocnemius recession alongside other procedures, necessitating restricted weight-bearing post-surgery.
• Isolated gastrocnemius recession offers a potential alternative to correct deformity, improve orthotic fit, and avoid extensive surgery and prolonged weight-bearing restrictions.

Purpose of the Study:

• To evaluate patient-reported outcomes following isolated gastrocnemius recession for flexible PCFD.
• To assess the effectiveness of this procedure in patients who may have difficulty with postoperative weight-bearing restrictions.

Main Methods:

• A retrospective study included 47 patients with flexible PCFD who underwent isolated gastrocnemius recession.
• Preoperative and postoperative patient-reported outcomes were collected, including the Foot and Ankle Ability Measure (FAAM), visual analog scale (VAS), and Patient-Reported Outcome Measurement Information System (PROMIS) Physical Function Short Form 10a.
• Patient satisfaction, willingness to repeat the procedure, and the impact on orthotic relief were also assessed.

Main Results:

• At a mean follow-up of 5.1 years, the median FAAM score was 82.1, and the mean PROMIS Physical Function score was 44.2.
• The median VAS pain score was 10 (out of 100).
• Sixty-nine percent of patients reported satisfaction or high satisfaction, 69% would undergo the procedure again, and 62% experienced improved relief with orthotics.

Conclusions:

• Isolated gastrocnemius recession is an effective treatment for flexible PCFD, yielding favorable outcome scores and high patient satisfaction.
• This approach may be particularly beneficial for patients facing challenges with postoperative weight-bearing limitations.
• Only 11% of eligible patients required subsequent flatfoot reconstruction, suggesting the efficacy of isolated recession.