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Article history: Background: Gastrocnemius recession (GR) has been introduced for treatment of forefoot overload
Received 18 October 2016 syndrome (FOS). We questioned if GR leads to an altered forefoot load and weakness of plantarexors in
Received in revised form 29 January 2017 those patients.
Accepted 2 March 2017
Methods: 26 patients suffering from FOS and gastrocnemius tightness underwent GR. A strength power
Available online xxx
analysis of plantar exors and a pedobarography was performed. Clinical outcome was measured by Foot
Function Index (FFI).
Keywords:
Results: Plantarexors are impaired about 40% six weeks and around 10% 24 weeks following GR
Gastrocnemius tightness
Gastrocnemius recession
compared to the contralateral side. Patients experienced a pain relief and an improvement of ankle
Forefoot overload syndrome dorsiexion from 2 to 15 . An increased contact time of the heel (15%) and a shift of metatarsal plantar
Muscle strength pressure from lateral to medial could be demonstrated.
Conclusions: This study suggests that GR leads to pain reduction by an increase in heel contact time and a
shift of gait line to medial in patients with a FOS. Despite, a temporary impairment of muscle strength has
to be considered.
2017 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.fas.2017.03.014
1268-7731/ 2017 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.
Please cite this article in press as: H. Schmal, et al., Gastrocnemius recession leads to medial shift of gait line, impairment of muscle strength
and improved dorsal extension in forefoot overload syndrome, Foot Ankle Surg (2017), http://dx.doi.org/10.1016/j.fas.2017.03.014
G Model
FAS 1035 No. of Pages 5
2.3. Clinical assessmentFoot Function Index After a follow-up of 24 weeks all 26 patients (26 feet)
completed the FFI. The clinical score improved from preoperatively
The German Foot Function Index (FFI) was used to measure 38.4 points (SD 26.5) to postoperatively 29.9 points (SD 19.5).
function and pain pre- and 6 month postoperatively. The FFI is a The subscale function noted preoperative 12.9 points (SD 26.9)
reliable and valid questionnaire for self-assessment of pain and compared to postoperative 16.8 points (SD 19.1). The subscale
disability in patients with foot complaints [11]. In contrast to the pain improved signicantly (p = 0.04) from preoperative
English version, the German FFI is not limited to rheumatoid arthritis 25.5 points (SD 28.3) to postoperative 13.1 points (SD 20.6)
related limitations but evaluated for general foot and ankle disorders. (Fig. 1).
Dorsiexion ROM was measured in full knee extension pre- and Preoperatively the average ankle dorsiexion in fully extended
6 months postoperatively using a goniometer. To prevent excessive knee position was 2 (SD 3.25). After a follow-up of 6 weeks the
dorsiexion due to pathological motion the examiner put the average ROM of the ankle joint improved signicantly to 16
subtalar joint in a neutral position. Following the correct examina- (SD 7.4) (p < 0.05) and remained 15 (SD 4.8) (p = 0.01) after a
tion technique the visual goniometer is a reliable and reproducible follow-up period of 24 weeks (Fig. 2).
method [12].
3.3. Gait analysispedobarography
2.5. Gait analysispedobarography
Comparing the plantar peak pressure before and 6 months after
The plantar pressure distribution was measured on a 1.2 10 m operation (heel, hallux, rst metatarsal head, and fth metatarsal
walkway with integrated pressure plate (Emed-M, 38 cm 42 cm, head) a shift of plantar peak pressure from the lateral to medial
Please cite this article in press as: H. Schmal, et al., Gastrocnemius recession leads to medial shift of gait line, impairment of muscle strength
and improved dorsal extension in forefoot overload syndrome, Foot Ankle Surg (2017), http://dx.doi.org/10.1016/j.fas.2017.03.014
G Model
FAS 1035 No. of Pages 5
Fig. 1. Function and pain was assessed by Foot Function Index (FFI) before and after
gastrocnemius recession (24 weeks). Asterisks indicates statistically signicance
(* = p < 0.05). Fig. 4. The contact time (heel, midfoot, forefoot, toes) was measured on the Con-
Trex Multi-Joint-System 6 and 24 weeks following gastrocnemius recession. A
signicant increase of contact time was detected below the heel. Asterisks indicates
statistically signicance (* = p < 0.05).
Fig. 3. Peak torque of plantar exors of the ankle joint was measured on the Con-
Trex Multi-Joint-System 6 and 24 weeks following gastrocnemius recession. A
signicant increase of plantar peak pressure below the rst metatarsal head and a Fig. 5. The means for the intra-individual side-to-side differences in maximum
signicant decrease below the fth metatarsal head was assessed following strength of the plantar exors (concentric, eccentric, isometric mode) as percent of
gastrocnemius recession. Asterisks indicates statistically signicance (* = p < 0.05) the non-operated limb following 6 and 24 weeks are shown. Asterisks indicates
(MH = metatarsal head). statistically signicance (* = p < 0.05).
Please cite this article in press as: H. Schmal, et al., Gastrocnemius recession leads to medial shift of gait line, impairment of muscle strength
and improved dorsal extension in forefoot overload syndrome, Foot Ankle Surg (2017), http://dx.doi.org/10.1016/j.fas.2017.03.014
G Model
FAS 1035 No. of Pages 5
Please cite this article in press as: H. Schmal, et al., Gastrocnemius recession leads to medial shift of gait line, impairment of muscle strength
and improved dorsal extension in forefoot overload syndrome, Foot Ankle Surg (2017), http://dx.doi.org/10.1016/j.fas.2017.03.014
G Model
FAS 1035 No. of Pages 5
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Please cite this article in press as: H. Schmal, et al., Gastrocnemius recession leads to medial shift of gait line, impairment of muscle strength
and improved dorsal extension in forefoot overload syndrome, Foot Ankle Surg (2017), http://dx.doi.org/10.1016/j.fas.2017.03.014