Review Question - QID 5896

Chronic plantar foot pain with a gastrocnemius contracture as evidenced by the results of the Silverskjold test is best treated with a gastrocnemius recession.

A gastrocnemius equinus contracture causes increased forefoot strike during gait, leading to increased tension on plantar structures including the plantar fascia. This has been implicated in progressive arch collapse, Achilles tendinopathy, plantar fasciitis, neuromas, and metatarsalgia. The Silverskjold test can differentiate an isolated gastrocnemius contracture from a tendoachilles contracture. Gastrocnemius contracture is diagnosed if the ankle dorsiflexion is <10 degrees with the knee in extension, but improves with knee flexion.

Maskill et. al. retrospectively reviewed 29 patients who underwent isolated gastroc recession for chronic foot pain in the setting of isolated gastrocnemius contracture with 6 month minimum follow up. At final follow up they noted 93% of patients were satisfied with their outcome and would recommend the procedure to a friend.

Anderson et. al. reviewed the impact of gastrocnemius contracture on midfoot arch collapse and as a cause of other painful foot and ankle conditions. They report that gastrocnemius recession can successfully treat patients with neuropathic plantar ulcers, isolated foot pain associated with arch collapse, and noninsertional Achilles tendinopathy.

Incorrect Answers:
2. A Silverskold test that remains unchanged with knee extension or flexion is suggestive of a tendoachilles contracture which would not be helped by gastroc recession.
3. Failure of physical therapy alone is not an indication for surgery. The patient can also try orthotics or injections.
4,5. Posterior tibial tendon dysfunction is a cause of pes planovalgus which can be seen clinically as a "too many toes" sign. This is not an indication for gastroc recession.