I spoke to a patient on the phone this week who told me he had a gastrocnemius recession surgery for heel pain. Huh? This is a surgery that involves lengthening the calf muscle for a tight calf, which is like saying your car pulls to the left when you drive so we should lengthen the left axle. This surgery, therefore, makes my list for the top 10 dumbest and most dangerous things a surgeon can do to an unsuspecting patient. Let me explain.
What Is Gastrocnemius Recession?
This procedure involves surgically cutting the calf muscle (a.k.a. gastrocnemius) and either letting it heal or surgically sewing it back together after partially cutting its tendon. It’s also called a Strayer or modified Strayer procedure. While the procedure (like many muscle/tendon-lengthening procedures) may be useful in children with cerebral palsy and certain leg deformities, it has instead been more recently used for patients with a chronically tight calf, plantar fasciitis, or heel pain.
Like all muscle-lengthening procedures offered to otherwise healthy patients, it’s not a good idea. Why? Your body is tuned to micromillimeter precision, and a surgery may heal with centimeter precision. In other words, trying to rearrange the biomechanics of the body with surgery is almost always a bad idea.
What Are Common Causes of a Tight Calf Muscle (That Don’t Involve This Barbaric Surgery)?
Patients considering a gastrocnemius recession surgery have likely already tried copious stretching, massage, and many other alternative types of care, like acupuncture. I’m also assuming that common medical things, like deep vein thrombosis (a blood clot in the calf), have been ruled out.
A chronically tight calf muscle is a common symptom of an irritated S1 nerve in the low back. The patient doesn’t have to have low back pain or something on his or her MRI that a surgeon wants to operate on; the patient just has to have an irritated nerve. The calf can also be tight due to microtearing of the Achilles tendon, the way the foot hits the ground, instability or laxity in the ankle ligaments, trigger points in the calf muscle, or a host of other things. Obviously the treatment for these things isn’t to surgically cut the calf-muscle tendon!
For an irritated nerve in the low back, an epidural injection around the nerve using your own growth factors isolated from your blood platelets works well. Tearing of the Achilles tendon can be treated with a precise ultrasound-guided platelet rich plasma injection. Issues with how the foot hits the ground may need orthotics, and an unstable ankle can often be fixed with ligament injections. Calf-muscle trigger points can be helped by using trigger-point dry needling.
Just because you have failed physical therapy, massage, or acupuncture doesn’t mean that you should let someone cut your tendon! You just need to see a physician who can carefully perform an exam and spend an hour with you to figure out the cause (the time spent with the nurse practitioner or physician’s assistant doesn’t count—this should be an hour of face-to-face time with the doctor).
Gastrocnemius Recession Recovery
All of the treatments I’ve reviewed above have fast recovery times, and none permanently alters your biomechanics. However, realize that the same doesn’t hold true for gastrocnemius recession recovery. First there are the side effects. If you get a surgical infection, then a second or subsequent surgery will be needed along with six weeks of IV antibiotics delivered through a catheter inserted near your heart. If you dodge that bullet, then the calf muscle may not heal, leaving you permanently disabled. In addition, the area of cutting and reattachment may also be permanently weaker, so tearing the calf-muscle tendon during normal activities or in a trauma may occur. So gastrocnemius surgery recovery may not be all roses…
The upshot? Please don’t allow a surgeon to permanently change your biomechanics by lengthening your calf just because it’s tight. Your calf is that way for a reason, and it’s a symptom of another problem! Please make sure a physician spends a solid hour with you face-to-face to figure out why rather than five minutes to schedule an unnecessary surgery!