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Is the Gastroc Just Pulling Some Strings?

Chang, Song Ho, MD, PhD*,†; Waryasz, Gregory R., MD; Morris, Brandon, MD; Hagemeijer, Noortje, MD*,§; Guss, Daniel, MD, MBA; DiGiovanni, Christopher W., MD

doi: 10.1097/BTF.0000000000000240
Special Focus: PDF Only

Whether ankle equinus predominantly contributes to or ensues from an adult-acquired flatfoot deformity (AAFD) remains unknown. Regardless of the exact nature of this relationship, current evidence supports a distinct role for concomitant gastrocnemius recession or Achilles tendon lengthening during surgical correction of significant AAFD deformity. Achieving the appropriate degree of surgical correction for components of ankle equinus, hindfoot valgus, and/or Chopart collapse that may contribute to AAFD requires proper clinical evaluation and an appreciation of contributory pathophysiology. Review of recent literature describing gastrocnemius contracture and its potential role in AAFD provides a platform from which to approach this challenging problem.

Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.

*Foot and Ankle Research and Innovation Laboratory, Massachusetts General Hospital

Massachusetts General Hospital and Newton-Wellesley Hospital, Harvard Medical School, Boston, MA

Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Japan

§Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands

Supported in part by Kanzawa Medical Research Foundation, The Nakatomi Foundation and Japan Rheumatism Foundation to S.H.C.

The authors declare no conflict of interest.

Address correspondence and reprint requests to Song Ho Chang, MD, PhD, Massachusetts General Hospital, 55 Fruit Street Yawkey Building, Suite 3F Boston, MA 02114. E-mail:

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