Post-Operative Weight Bearing Protocol Following Endoscopic Gastrocnemius Recession
Early protected weight bearing is recommended following endoscopic gastrocnemius recession, with patients typically able to bear weight immediately after surgery with appropriate protection. This approach allows for faster recovery while maintaining the integrity of the surgical site.
Weight Bearing Protocol
Immediate Post-Operative Period (0-2 weeks)
- Immediate protected weight bearing is recommended as tolerated with appropriate protection
- Use of assistive devices (crutches or walker) to ensure proper gait pattern
- Weight bearing should only be allowed if:
- Patient maintains correct gait pattern
- No pain occurs during or shortly after walking
- No increase in swelling or temperature at the surgical site
Early Post-Operative Period (2-4 weeks)
- Progressive weight bearing as tolerated
- Transition from assistive devices to full weight bearing based on:
- Pain levels
- Wound healing status
- Ability to maintain proper gait mechanics
- Use of a protective device that allows controlled mobilization
Intermediate Post-Operative Period (4-8 weeks)
- Full weight bearing typically achieved
- Patients can usually perform a single-leg heel raise by approximately 13 weeks post-surgery 1
Evidence-Based Rationale
Research demonstrates that endoscopic gastrocnemius recession has significant advantages over open techniques, including:
- Lower overall complication rate (7.5% for endoscopic vs. higher rates for open procedures) 2
- Significantly fewer wound complications (1.0% for endoscopic) 2
- Lower incidence of sural nerve injury (3.0% for endoscopic) 2
The endoscopic approach allows for earlier weight bearing due to:
- Smaller incisions
- Less soft tissue disruption
- Reduced risk of wound complications (2.6% for endoscopic vs. 26.8% for open procedures) 3
Functional Outcomes and Expectations
Patients can expect:
- Significant improvement in ankle dorsiflexion (average improvement from -0.8° preoperatively to 11.0° postoperatively) 4
- Reduction in pain scores (from 7/10 to 3/10 on VAS) 4
- Improved functional outcomes as measured by SF-36 and Foot Function Index 4
Common Complications to Monitor
- Plantarflexion weakness (3.1-3.5% of cases) 2, 4
- Sural nerve dysesthesia (3.0-3.4% of cases) 2, 4
- Wound complications (rare with endoscopic technique)
Return to Activities
- Most patients can return to activities of daily living within 6-8 weeks
- Return to sports or high-impact activities should be individualized based on:
- Resolution of pain
- Recovery of strength
- Achievement of functional milestones (including single-leg heel raise)
- Full recovery with return to all activities typically occurs by 3-6 months post-surgery 5
Clinical Pearls
- Ensure proper gait mechanics before advancing weight bearing status
- Monitor for signs of sural nerve irritation or injury
- Progressive strengthening exercises should be initiated once full weight bearing is achieved
- Patient education regarding realistic expectations for recovery timeline is essential
- Regular follow-up is important to monitor progress and adjust rehabilitation as needed