Is gastroc (gastrocnemius) recession effective for relieving retrocalcaneal pain?

Gastrocnemius Recession for Retrocalcaneal Pain Relief

Gastrocnemius recession is an effective surgical intervention for relieving retrocalcaneal pain in patients who have failed conservative management for 6-8 weeks.

Conservative Management First

Before considering gastrocnemius recession, a structured conservative approach should be attempted:

1. Activity Modification and Rest

   • Avoid activities that exacerbate pain
   • Use open-backed shoes to reduce pressure on posterior heel 1
   • Limit standing/walking on uneven surfaces 1

2. Pain and Swelling Management

   • NSAIDs for pain and inflammation control 1
   • Ice therapy (20-30 minutes, 3-4 times daily) 1
   • Compression wraps for swelling 1

3. Supportive Measures

   • Heel lifts or orthotic devices to reduce stress on the affected area 1
   • AFO (ankle-foot orthosis) with stretching regimen - shown to have 88% success rate in avoiding surgery 2
   • Proper footwear with adequate support 1

4. Physical Therapy

   • Eccentric strengthening exercises for the Achilles tendon 1
   • Stretching of the gastrocnemius-soleus complex 1
   • Manual mobilization combined with exercise therapy 1

5. Injection Therapy

   • Corticosteroid injections around (not into) the tendon 1
   • Ultrasound-guided intrasheath anesthetic injections 1

Surgical Intervention: Gastrocnemius Recession

When conservative measures fail after 6-8 weeks, surgical options should be considered:

Evidence for Gastrocnemius Recession

• Grade B evidence ("fair") exists supporting gastrocnemius recession for treatment of foot pain due to midfoot/forefoot overload syndrome 3
• Some supportive data (Grade Cf) for treating non-insertional Achilles tendinopathy 3
• Can effectively address retrocalcaneal pain by reducing tension on the posterior heel 3

Alternative Surgical Options

• Endoscopic decompression of retrocalcaneal bursae with excision of bony spurs shows good outcomes (AOFAS scores improved from 57.92 to 89.08 points) 4
• Partial calcaneal ostectomy for retrocalcaneal bursitis allows return to desired activity level within 6 months 5
• Achilles detachment and reattachment using a standard midline approach has a low reoperation rate of 4.0% 6

Patient Selection Factors

Gastrocnemius recession may be particularly beneficial for:

1. Patients with limited ankle dorsiflexion due to tight gastrocnemius muscle
2. Those with retrocalcaneal pain unresponsive to conservative treatment
3. Patients with midfoot/forefoot overload syndrome

Important Considerations

• Tendon Degeneration: Patients with degenerative changes in the Achilles tendon have poorer outcomes in terms of subjective satisfaction 4
• Smoking: Smokers show significantly less improvement with conservative treatment 2
• Exostosis Size and Type: Patients with exostosis less than 1 cm and Types I and III exostoses show less improvement with conservative treatment 2

Surgical Technique

The gastrocnemius recession involves:

1. Partial or complete release of the gastrocnemius muscle
2. Various techniques exist for muscle-tendon unit release along the length of the calf
3. All techniques share the common goal of addressing the gastrocnemius as the primary plantarflexor of the ankle

Recovery Expectations

• Return to light work: 2 weeks for mild cases, 3-6 weeks for more severe cases 1
• Full return to former activities: 6-8 weeks depending on injury severity 1
• Complete treatment duration typically requires at least 12 weeks 1

Conclusion

For patients with retrocalcaneal pain that persists despite comprehensive conservative management, gastrocnemius recession offers an effective surgical solution with good outcomes. The procedure addresses the underlying biomechanical cause of retrocalcaneal pain by reducing tension on the posterior heel structures.