GASTROCNEMIUS RELEASE (STRAYER PROCEDURE)

What Is a Gastrocnemius Release?

The gastrocnemius (gastroc) and the soleus are two muscles that make up the calf. The gastroc is the larger and more superficial of the two muscles. The soleus is a deeper muscle within the lower leg. The gastroc tendon combines with the soleus tendon to form the Achilles tendon.

Tightness in the calf can limit how far the ankle can flex up. This may make it difficult to walk with the heel on the floor. Over time, calf tightness may contribute to many foot problems, including heel pain, Achilles tendon pain, flatfoot deformity, toe pain, and bunions.

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A gastrocnemius release lengthens the gastrocnemius tendon. This is done to increase the flexibility of the calf muscle, which can decrease pressure at the front of the foot, improve function, and decrease deformity.

Diagnosis

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Your foot and ankle orthopaedic surgeon may recommend this surgery if you have tightness of the gastroc that has not improved with stretching exercises. This procedure can be combined with other reconstructive procedures or be performed by itself.

Surgery may not be recommended if you can obtain an appropriate range of motion and flexibility with conservative treatment (stretching). It should also be avoided if there are contractures of multiple tendons in the leg, and not just the gastroc.

Treatment

Your surgeon may perform this surgery through several different incisions. Most commonly, a small incision is made on the inner side of the lower leg. Sometimes an incision directly in the back of the calf is used, or even an endoscopic incision, which is about ½ inch. Once the gastroc tendon is identified, it is separated from the underlying muscle belly of the soleus, then cut straight across. Once the tendon is released, the ankle is flexed up and an increased range of motion is noted intraoperatively.

Recovery

For the first two weeks after surgery, the patient typically is immobilized in a splint or boot. It is important to keep the ankle in a proper position while the tendon is healing. A cramping feeling in the back of the calf is normal. Gentle range of motion and stretching exercises begin once the ankle is removed from the splint/boot. Timing can vary depending upon the other procedures that are performed.

Risks and Complications

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After a gastroc release, some patients experience nerve injury that results in irritation or numbness over the outside of the heel. This usually is temporary. In addition, some patients may notice a difference in the appearance of one calf compared to the other and temporary calf weakness.

FAQs

Why are my calf muscles tight?

Most frequently a tight calf muscle is an inherited problem that only causes problems later in life. Other reasons for calf tightness are nerve injuries, muscle problems, and other medical problems like stroke and diabetes. People can also get tight calf muscles after trauma to the leg, ankle, or foot.

Will a gastrocnemius lengthening affect my strength or ability to walk?

This procedure will cause some weakness but most patients will not notice it. Some patients may have a subtle limp, but this typically resolves within six months of surgery.

Original article by Kelly Apostle, MD, FRCSC Last reviewed by Patrick Maloney, MD, 2018

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