Featured Lecture

Endoscopic Gastrocnemius Recession

by Lawrence DiDomencico, DPM

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Equinus takes the rap for so many deformities/abnormalities of the foot. From Collapsing Pes Plano Valgus and Hypermobility of the 1st Ray to Flexor Stabilization and Charcot Osteoarthropathy, everyone points their finger in the direction of equinus. Yet quite commonly, the problem is overlooked when addressing some of these deformities surgically.

Dr. DiDomenico introduces us to a relatively simple approach to equinus using an endoscopic technique. Podiatric surgeons should be comfortable with traditional open approaches, including the Vulpius, Strayer, and Gastroc Slide, before attempting the endoscopic approach that Dr. DiDomenico describes.

Some of the advantages of this new technique include better cosmesis, direct visualization and early return to function. The lecture reviews some of the classic radiographic findings seen in the equinus foot. The various forms of equinus are discussed, along with the limited conservative approaches to the problem.

We learn that 1 cm of gastrocnemius gapping yields 10º - 15º of increased ankle sagittal plane flexibility. The result is a 27% reduction in peak plantar pressures. This is certainly something to be mindful of when attempting to salvage the diabetic foot. Dr. DiDomenico expertly describes the technique, alerts us to the pitfalls, and goes through a few case studies.

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