Gastrocnemius Recession as an Alternative to Midfoot Arthrodesis for Painful Midfoot Arthritis.

Arthrodesis has been described as the gold standard of treatment for midfoot degenerative joint disease (DJD) but has also been associated with nonunion, increased tourniquet times, technical difficulty, and a long postoperative non-weightbearing period. Although it is postulated that a contracted gastrocnemius may cause midfoot pain, there are no reports of using the procedure as a primary treatment for midfoot DJD. The purpose of this study was to determine whether gastrocnemius recession resolved midfoot pain from osteoarthritis and eliminated the need for midfoot arthrodesis. Eleven patients with symptomatic midfoot osteoarthritis and gastrocnemius equinus elected to have a modified Baker gastrocnemius recession as an alternative to a recommended midfoot arthrodesis. Patients were kept non-weightbearing for 2 weeks, transitioned to protected weightbearing in a controlled ankle motion walking boot at weeks 3 to 4, and were allowed to ambulate without restriction in regular shoes at 4 weeks. Preoperative American Orthopedic Foot & Ankle Society (AOFAS) midfoot scores were compared with postoperative scores. Eight (72.7%) of the 11 patients responded to the postoperative survey (n = 8). The mean AOFAS midfoot score improved by 44.63 ± 20.9 points (mean ± standard deviation) (range 18 to 76) or 107% (p < .01). All subjects reported sustained improvement since the preoperative evaluation, with a mean time to follow-up of 28 ± 9.9 months (range 12 to 40). None of the patients surveyed underwent subsequent arthrodesis of the midfoot. The results of this investigation indicate that gastrocnemius recession is an effective treatment to relive symptomatic midfoot osteoarthritis. Foot and ankle surgeons may consider this procedure before performing midfoot arthrodesis to treat this pathology.