The Gastrocnemius is the largest and most superficial of calf muscles and the main propellant in walking and running. This issue of Foot and Ankle Clinics will cover everything from the anatomy and biomechanics to surgical techniques.
Front Cover 1
The Gastrocnemius 2
Copyright 3
Contributors 4
Contents 8
Foot And Ankle Clinics
12
Foreword 14
Preface 16
Dedication 18
Dedication 20
Dedication 24
Anatomy of the Triceps Surae 26
Key points 26
Introduction 26
Triceps surae 27
Gastrocnemius 27
Medial head 27
Lateral head 27
Plantaris 29
Soleus 30
Calcaneal Tendon 33
Innervation 37
Function of the Triceps Surae 37
Achilles-Calcaneal-Plantar System 39
Plantar Aponeurosis 40
Medial component 41
Lateral component 41
Central component 42
Surgical anatomy 43
Level 5 45
Level 4 47
Level 3 48
Levels 2 and 1 54
Summary 54
Acknowledgments 54
References 54
The Gastrocnemius 60
Key points 60
Introduction 60
A limited review of literature 61
The origins of the calf contracture 62
Activity changes: lifestyle influences 64
General Decreased Activities as People Age 64
Recent Changes in Activities 64
Athletes and Increased Activity Situations 64
Physiologic changes to muscles and tendons: internal influence 64
Genetics 64
Reverse evolution: the human influence and the predilection pattern 65
The Perfect Foot 65
The Gastrocnemius: Cause and Effect 66
Discussion 66
Summary 67
Acknowledgments 68
References 68
Effects of Gastrocnemius Tightness on Forefoot During Gait 72
Key points 72
Introduction 72
Anatomy and physiology of the gastrocnemius muscle 73
Anatomy 73
Hill Model 73
Energy Considerations 73
Normal gait analysis 73
Kinematics of the Stance Phase 73
Dynamics of the Stance Phase: Ground Reaction Studies 75
Ground reaction and center of gravity 76
Center of pressures 76
Electromyographic Analysis 76
Combined Analysis of Kinematics Dynamics and Electromyography 76
Discussion 77
Summary 78
References 79
Clinical Diagnosis of Gastrocnemius Tightness 82
Key points 82
Introduction 82
Clinical examination: the Silfverskiold test 82
The Force Under the Foot Is Applied 83
Correction of Hindfoot Valgus Deformity 83
Correction of an Eventual Contraction of the Foot Extensors 83
Strength Applied, and Definition of Gastrocnemius Tightness 83
The Taloche Sign (Maestro) 89
Clinical examination: the associated signs caused by the equinus 89
Summary 89
References 89
Functional Hallux Rigidus and the Achilles-Calcaneus-Plantar System 92
Key points 92
Introduction 92
Functional hallux rigidus of biomechanical origin: the influence of equinus contracture 93
Sagittal Plane Block and Compensatory Mechanisms 98
The Achilles-Calcaneus-Plantar System During the Gait Cycle 101
Relationship Between the Degree of Equinnus and the Resulting Pathology 102
Clinical examination and diagnosis 104
Treatment of functional hallux rigidus 113
Summary 119
References 120
The Effect of the Gastrocnemius on the Plantar Fascia 124
Key points 124
Introduction 124
Achilles–calcaneus–plantar system 125
Modeling the foot in the sagittal plane 126
Gastrocnemius tightness and clinical applications 133
Summary 136
Acknowledgments 136
References 136
Gastrocnemius Shortening and Heel Pain 142
Key points 142
Background 142
Management of heel pain 143
Achilles tendinopathy 144
Terminology in Achilles tendon pain 144
Local anatomy 144
Demographics 144
Examination 145
Insertional tendinopathy 146
Retrocalcaneal bursitis 146
Noninsertional tendinopathy 146
Imaging 146
Treatment 146
Nonoperative Treatment 146
Stretching 146
Plantar fasciopathy 147
Examination 147
Imaging 148
Treatment 149
Gastrocnemius contracture 150
Pathomechanics of Calf Contracture 150
Clinical and epidemiologic data 151
Operative treatment 152
Gastrocnemius lengthening surgery 152
Results of gastrocnemius lengthening 154
Gastrocnemius lengthening for recalcitrant heel pain 154
Proximal medial gastrocnemius release for Achilles tendinopathy 155
Summary 156
References 156
The Use of Ultrasound to Isolate the Gastrocnemius-Soleus Junction Prior to Gastrocnemius Recession 162
Key points 162
Introduction 162
Procedure 163
Discussion 163
Summary 165
References 165
Surgical Techniques of Gastrocnemius Lengthening 168
Key points 168
Introduction 169
Anatomic basis 169
Indications 169
Surgical techniques 171
Proximal Gastrocnemius Recession Techniques 172
Traditional medial and lateral gastrocnemius muscle release: the Silfverskiold procedure 172
Isolated medial gastrocnemius release: a Barouk modification 173
Midaspect Gastrocnemius Recession Techniques 173
The Baumann procedure 173
Distal Gastrocnemius Recession Techniques 176
The original Vulpius and Baker procedures 176
The Strayer procedure 176
The modified Strayer procedure (author’s preferred technique) 176
Endoscopic distal gastrocnemius recession 179
Postoperative care 181
Outcomes 182
Complications 184
Summary 185
References 186
Gastrocnemius Recession 190
Key points 190
Background 190
Anatomy 191
Arch collapse 191
Outcomes 193
Grand Rapids Type I Outcomes 193
Grand Rapids Type II Outcomes 194
Grand Rapids Type III Outcomes 196
Grand Rapids Type IV Outcomes 197
Type V Deformity 199
Techniques 199
Silfverskiold Procedure 200
Baumann Procedure 203
Strayer Procedure 205
Hoke (Tendoachilles Lengthening) Procedure 207
Summary 208
References 208
Endoscopic Gastrocnemius Release 210
Key points 210
Introduction 210
Surgical technique 211
Results 215
Future directions 215
Summary 215
References 216
Technique, Indications, and Results of Proximal Medial Gastrocnemius Lengthening 218
Key points 218
Introduction 218
Indications for Proximal Gastrocnemius Release 219
Surgical Technique 220
Preparation 220
Discussion 224
Bilaterality 224
Five Reasons to Lengthen Just the Medial Gastrocnemius 224
Reasons to Prefer Proximal Versus Distal Lengthening 225
Final Points 226
Chronology 226
Patient information 227
Summary 227
References 227
The Effect of Gastrocnemius Tightness on the Pathogenesis of Juvenile Hallux Valgus 230
Key points 230
Introduction 230
Anatomy 231
The Plantar Aponeurosis 231
Distal insertion 231
Pathogenesis of hallux valgus deformity in relation to gastrocnemius tightness 232
Role of Reduced Dorsiflexion of the Metatarsophalangeal Joint 233
In hallux limitus 233
Dorsal flexion of the interphalangeal joint 234
In juvenile hallux valgus 234
Summary 236
Problems Associated with the Planovalgus Foot 237
Spastic Paraplegia in Children 237
Relationship between gastrocnemius tightness and juvenile hallux valgus 237
Discussion 238
Elements Increasing the Deformity 239
Specific Structural Abnormalities 239
Clinical Consequences 240
Correction of hallux valgus and gastrocnemius tightness 240
Gastrocnemius Tightness 240
Bunionectomy 241
Our Series 241
Summary 242
Acknowledgments 243
References 243
Index 246
Anatomy of the Triceps Surae
A Pictorial Essay
Miquel Dalmau-Pastor, PodD, PTa, Betlem Fargues-Polo, Jr.a, Daniel Casanova-Martínez, Jr.b, Jordi Vega, MDc∗jordivega@hotmail.com and Pau Golanó, MDad†, aLaboratory of Arthroscopic and Surgical Anatomy, Human Anatomy Unit, Department of Pathology and Experimental Therapeutics, School of Medicine, University of Barcelona, C/Feixa Llarga, s/n, 08907, Hospitalet de Llobregat, Barcelona, Spain; bAnatomy Unit, Biomedical Department, University of Antofagasta, Av. Universidad de Antofagasta s/n (Campus Coloso), Antofagasta 1240000, Chile; cUnit of Foot and Ankle Surgery, Hospital Quirón, Plaça d'Alfonso Comín 5, Barcelona 08023, Spain; dDepartment of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, 4200 Fifth Avenue, Pittsburgh, PA 15213, USA
∗Corresponding author.
Gastrocnemius contracture has recently gained relevance owing to its suggested relationship with foot disorders such as metatarsalgia, plantar fasciopathy, hallux valgus, and others. Consequently this has induced a renewed interest in surgical lengthening techniques, including proximal gastrocnemius release, to resolve gastrocnemius contracture in patients with foot disorders. This article describes and discusses the general anatomy of the triceps surae and the surgical anatomy of the gastrocnemius.
Keywords
Anatomy
Surgical anatomy
Gastrocnemius
Gastrocnemius-soleus complex
Soleus
Calcaneal tendon
Plantaris muscle
Key points
• The triceps surae is a muscular group formed by the gastrocnemius, the soleus, and the plantaris muscles. The gastrocnemius and soleus muscles join to form the calcaneal tendon while the plantaris muscle inserts independently.
• Gastrocnemius and/or triceps surae lengthening is helpful in resolving foot disorders.
• There exist 5 different anatomic levels at which surgical lengthening of the triceps surae can be achieved. Mastering the anatomy of every level is the basis of these surgical procedures.
Introduction
Since the beginning of the twentieth century, several techniques have been reported for the treatment of triceps surae contracture in patients with cerebral palsy.1–6 The objective of these techniques was to lengthen this muscle group. However, it was not until the publications by Kowalski and colleagues7 in early 1999 and DiGiovanni and colleagues8 in 2002 that interest in the anatomy of the triceps surae gained relevance, owing to the suggestion by these investigators that gastrocnemius contracture in the healthy individual is associated with conditions affecting the midfoot and forefoot, such as calcaneal tendon injury, metatarsalgia, plantar fasciopathy, diabetic ulcer, hallux valgus, flat foot, and digital deformity.8–10
Therefore, an article on the anatomy of the triceps surae is a key contribution to this special issue on contracture of the gastrocnemius muscle. This article is divided into two parts: one discussing the general anatomy of the triceps surae and one addressing the surgical anatomy of the gastrocnemius, a key area of knowledge for surgeons applying lengthening techniques.
Triceps surae
The triceps surae is the muscular group that occupies the superficial posterior compartment of the leg and comprises the gastrocnemius, soleus, and plantaris. The junction of the gastrocnemius and soleus forms the longest and most powerful tendon in the human body,11,12 the calcaneal tendon. The plantaris, which is present in more than 90% of the population,13–16 can merge with this muscle group to form the calcaneal tendon.
In recent years, the term gastrocnemius-soleus complex has been used to refer to the triceps surae.17–20 Although the authors agree that gastrocnemius-soleus complex is a more clinical term and that, from a functional perspective, the gastrocnemius and soleus act as a single unit, the International Anatomical Terminology21 has established the term triceps surae to refer to the group formed by the gastrocnemius and soleus. Therefore, triceps surae is the term used in this article.
Similarly, the calcaneal tendon is usually referred to as the Achilles tendon. However, as this term is not included in the International Anatomical Terminology,21 calcaneal tendon is the preferred term here.
Gastrocnemius
The gastrocnemius comprises 2 heads, medial and lateral, at its origin. These heads insert proximally in the posterosuperior region of the corresponding femoral condyle (Fig. 1). However, the origin of the muscle varies depending on whether one is referring to the medial or lateral head.
Fig. 1 Posterior (A) and posteromedial (B) views of the femoral distal epiphysis showing the bony prominences and insertional areas of gastrocnemius muscle (insertional areas of the medial and lateral head of gastrocnemius muscle have been marked in green). 1, lateral supracondyloid tubercle; 2, medial supracondyloid tubercle; 3, adductor tubercle; 4, popliteal surface of the femur; 5, lateral supracondylar line; 6, medial supracondylar line. (Figure Copyright © Pau Golanó 2014.)
Medial head
The medial head of the gastrocnemius originates in a triangular area on the popliteal aspect of the distal epiphysis of the femur. A medial and a lateral origin can be considered. The medial origin comprises a flattened, thick, and resistant tendon that extends over the medial condyle immediately below the insertion of the tendon of the adductor magnus muscle and along the medial supracondylar ridge. The lateral origin, less important, inserts by means of short tendinous and muscle fibers on the popliteal aspect of the medial femoral condyle, at the site of a small eminence known as the medial supracondyloid tubercle22 (also called the medial supracondylar tubercle), and on the capsule of the knee joint (see Fig. 1; Fig. 2).
Fig. 2 Transversal section at the level of femoral condyles revealing the proximal insertion of the medial and lateral heads of gastrocnemius muscle (neurovascular structures have been painted with Adobe Photoshop). 1, proximal insertion of the lateral head of gastrocnemius muscle: a. tendinous insertion, b. muscular insertion; 2, knee capsule joint; 3, lateral collateral ligament of the knee joint; 4, proximal insertion of the medial head of gastrocnemius muscle: a. tendinous insertion, b. muscular insertion; 5, medial collateral ligament of the knee joint; 6, biceps femoris muscle; 7, sartorius muscle; 8, gracilis tendon; 9, semitendinosus tendon; 10, semimembranosus muscle; 11, common peroneal nerve; 12, lateral sural cutaneous nerve; 13, tibial nerve and branches; 14, popliteal artery; 15, popliteal vein; 16, great saphenous vein; 17, saphenous nerve. (Figure Copyright © Pau Golanó 2014.)
Lateral head
The lateral head of the gastrocnemius muscle originates from a tendon in a fossa situated posterior to the lateral epicondyle and proximal to the insertion of the popliteal muscle tendon in the lateral supracondylar ridge (see Figs. 1 and 2). Short tendinous fibers and muscle fibers situated medial to this tendon originate on the capsule of the knee joint and on the popliteal aspect, where a small bony eminence known as the lateral supracondyloid tubercle22 (also called the lateral supracondylar tubercle) can be observed, albeit less often than on the medial side (Fig. 3).
Fig. 3 Posterolateral view of the medial half of the femur distal epiphysis, showing in detail the medial supracondyloid tubercle of the femur. 1, medial supracondyloid tubercle; 2, adductor tubercle; 3, medial supracondylar line; 4, popliteal surface of the femur; 5, medial epicondyle; 6, intercondylar notch (footprint of the posterior cruciate ligament). (Figure Copyright © Pau Golanó 2014.)
An accessory ossicle, the fabella, which is found in 10% to 30% of the population, can be found embedded within the tendon of the lateral head (Fig. 4).18 This small sesamoid bone is generally round or oval, with its major axis (5–20 mm) running parallel to the tendinous fibers of the lateral head of the gastrocnemius.23 It is a casual finding in imaging studies and is usually bilateral.24 Although the fabella does not generally cause symptoms, it can lead to posterolateral knee pain,25 and can be fractured26 or dislocated.27
Fig. 4 Os fabella. (A) Lateral radiographic view of a right knee with an os fabella. (B) Sagittal T1-weighted magnetic resonance...
| Erscheint lt. Verlag | 8.2.2015 |
|---|---|
| Sprache | englisch |
| Themenwelt | Medizinische Fachgebiete ► Chirurgie ► Unfallchirurgie / Orthopädie |
| Medizinische Fachgebiete ► Innere Medizin ► Gastroenterologie | |
| Medizin / Pharmazie ► Medizinische Fachgebiete ► Orthopädie | |
| ISBN-10 | 0-323-32649-8 / 0323326498 |
| ISBN-13 | 978-0-323-32649-0 / 9780323326490 |
| Haben Sie eine Frage zum Produkt? |
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