Isolated Gastrocnemius Recession for Flexible Adult Acquired Flatfoot Deformity

Abstract

Category: Hindfoot; Midfoot/Forefoot Introduction/Purpose: Adult acquired flatfoot deformity (AAFD) frequently has an associated gastrocnemius contracture, which is a primary focus of most non-operative treatment protocols. When conservative measures fail, AAFD reconstruction often includes a gastrocnemius recession. Most reconstruction procedures involve a period of post-operative non-weight-bearing, which can be difficult for elderly patients. Beginning in 2011, patients with flexible AAFD patients and at risk of non-compliance with weight-bearing restrictions, were offered a staged approach with initial isolated gastrocnemius recession followed by reconstruction, if required. Gastrocnemius recession may allow passive correction of the deformity, improve orthotic fit and obviate the need reconstruction (Figure). The goal of this study was to retrospectively evaluate patient reported outcomes following an isolated gastrocnemius recession for flexible AAFD. Methods: A total of 49 patients met the inclusion criteria: isolated gastrocnemius recession for flexible AAFD, no previous ipsilateral surgery and >6 months follow-up. Of 49 eligible patients, 29 (31 feet) participated. Pre-operative and post-operative outcomes were compared for Foot and Ankle Ability Measure activities of daily living subscale (FAAM-ADL), visual analog scale (VAS), and the PROMIS Physical Function Short Form 10a (PROMIS PF SF 10a). Additionally, patients were asked about satisfaction, willingness to undergo the procedure again and whether orthotic provided better relief. Mean and standard deviation were compared using a two-tailed paired t-test with significance. Results: FAAM-ADL and PROMIS PF SF 10a significantly improved from 55.9 and 37.3 pre-operatively to 71.6 and 42.0 (p=0.01, p=0.046) respectively. 70% of patients were either satisfied or very satisfied, 67% would undergo the procedure again, and 64.5% of patients had improved relief with use of orthotics post-operatively. Conclusion: A staged approach with initial isolated gastrocnemius recession for the management of flexible AAFD in elderly patients can be effective. These results for patient recorded outcomes, patient satisfaction, willingness to undergo the procedure again and improvement in orthotic relief may guide the shared decision-making process with elderly patients when offered a reconstruction versus staged approach.