Efficacy of pedobarographic analysis to evaluate proximal medial gastrocnemius recession in patients with gastrocnemius tightness and metatarsalgia

Purpose: Proximal medial gastrocnemius recession (PMGR) is a surgical procedure performed in patients with gastrocnemius tightness (GT). The purpose of this study is to evaluate the efficacy of pedobarographic analysis on PMGR in patients with GT and metatarsalgia.

Methods: This prospective study included 52 patients diagnosed with GT treated surgically with PMGR and 49 non-operated upon patients (control group). A total of 55 PMGRs (three bilateral) were performed as an isolated or combined procedure in the treatment group. Passive ankle dorsiflexion with knee flexion and extension was evaluated in all patients. In addition, pedobarographic analysis was performed before and after surgery.

Results: Median preoperative ankle dorsiflexion was -10.0° (equinus) with extended knee and 10.0° with flexed knee and postoperative differences in median ankle dorsiflexion was 12.5° (extended knee) (p = 0.000) and 5.0° (flexed knee) (p = 0.002). After the PMGR, the median area of the contact surface (-3.0 cm2) (p = 0.009), the maximum (-13,239.0 Pa) (p = 0.019) and mean pressure (-2,942.0 Pa) and the forefoot force (-70.0 N) (p = 0.000) decreased. An increase in hindfoot force (20.0 N), hindfoot bearing time (4.0 ms) (p = 0.005), and forefoot bearing time (1.0 ms) was also observed.

Conclusions: Pedobarographic analysis is an efficient tool to evaluate surgical procedures that assess metatarsal overload. PMGR is an effective surgical procedure to improve passive ankle range of motion and decrease forefoot plantar overload.

CITATION  Int Orthop. 2017 Nov;41(11):2281-2287. doi: 10.1007/s00264-017-3621-0. Epub 2017 Aug 31