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Muscle, Ligaments and Tendons Journal

Musculotendinous equinus deformity correction: gastrocnemius or gastrosoleus release

Review article, 58 - 75
doi: 10.11138/mltj/2018.8.1.058
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Abstract
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Introduction: Equinus is a condition in which the upward bending motion of the ankle joint is limited.
Someone with equinus lacks the flexibility to bring the top of the foot toward the front of the leg. Equinus can occur in one or both feet. There are several possible causes for the limited range of ankle motion, this deformity of the foot may result from either musculotendinous forms, osseous forms, or combined forms. Congenital deformities and neuromuscular diseases are the main causes of musculotendinous equinus, and they will be the subject of our review.
Material and methods: Gastrocnemius release: An isolated gastrocnemius contracture (IGC) is often encountered in patients with foot and ankle pathology.
Gastrocnemius contracture has been reported as an isolated entity as well as a problem associated with several forefoot, midfoot, or hindfoot pathologies. The gastrocnemius recession is one the oldest orthopaedic procedures described in the literature. This procedure has been performed for many years for contracture associated with pediatric neuromuscular disorders, and now it is an effective and predictable method for the treatment of spastic and non-spastic gastrocnemius equinus deformities. Over the past decade, there has been an increase in use of this procedure in the adult population. In general, surgical procedures for the correction of any form of ankle equinus are more effective, with better long-term results, in patients who are more physically active. Physical activity
and state of health help to determine the surgical procedure and may indeed contraindicate surgical intervention. Once surgical correction has been elected, a surgical procedure aimed at correcting the specific condition may be chosen.
Gastrosoleus release: Many surgical procedures have been described for the correction of a gastrosoleus equinus deformity. Most of these techniques have been oriented to elongation of the Achilles tendon, but there are other kinds of operations, like selective neurectomy and anterior advancement of the Achilles tendon, for the spastic forms of gastrosoleus equinus only. A tenotomy of the Achilles tendon may be considered for correction of either spastic or non-spastic gastrocnemius- soleus contractures, but it should generally not be used for the correction of a gastrocnemius equinus deformity.
Discussion: Surgical procedures for the correction of equinus deformity by lengthening of the gastrocnemius or the gastrocnemius-soleus complex vary in terms of selectivity, stability, and range of correction.
Procedures for the correction of musculotendinous equinus deformity have different anatomical, biomechanical and clinical characteristics.
Level of evidence: Ia.

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