Endoscopic Gastrocnemius Recession (egr) Technique

Equinus is probably the most unrecognized, and untreated pathological condition affecting the human lower extremity. Numerous forefoot pathological symptoms are attributed to its devastating biomechanical forces, yet there is a large segment of foot and ankle surgeons who simply do not address the condition concurrently with other surgical intervention. It is the author’s opinion this relegation of equinus to the “surgical back burner” is largely due to the techniques previously available to the treating surgeon in addition to how they were trained. Essentially, prior to the advent of minimally invasive, endoscopic surgical techniques, the surgeon was left with one of several choices. First, a percutaneous Achilles tendon lengthening could be performed, which was less invasive than an open Achilles tendon lengthening, but still hampered with a long recovery period associated with the cutting of this major tendon, and an assured loss of one grade of muscle strength. Another approach would be for the surgeon to address the problematic equinus with an open Gastrocnemius recession, with something like a Vulpius or Strayer technique. These techniques are traumatic, and not suited to concurrent performance with other forefoot surgical techniques because of patient positioning on the operating room table, and the added length of intraoperative time associated with an “open” gastroc procedure. As technology and surgical techniques improve, the surgeon’s job becomes easier, and the ultimate surgical outcome for the patient improves. This is indeed the case with Endoscopic Gastrocnemius Recession (EGR). Once a surgeon becomes trained in the EGR technique, he will recognize and appreciate the presence of deforming biomechanical forces from equines. In addition, the use of this technique will only improve patient outcomes, but decrease post-operative morbidity associated with other forefoot surgical procedures that many times will resolve without surgery after the equinus deformity is addressed. While a conservative philosophy in surgery is always admired, nothing can be considered truly “conservative” if only part of a patient’s problem is being addressed. There is nothing conservative about surgically treating severe hallux valgus with a distal metaphyseal osteotomy , when there is a high intermetatarsal angle, the apex of the deformity is proximal, and there is severe equinus present.