Myerson The Gastrocnemius, An issue of Foot and Ankle Clinics of North America

1. Auflage 2014
ISBN: 978-0-323-32649-0
Verlag: Elsevier HealthScience EN
Format: EPUB
Kopierschutz: Adobe DRM (»Systemvoraussetzungen)

E-Book, Englisch, Band Volume 19-4, 289 Seiten

Reihe: The Clinics: Orthopedics

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.

Autoren/Hrsg.

Myerson, Mark S.

Inhaltsverzeichnis

1;Front Cover;1
2;The Gastrocnemius;2
3;Copyright;3
4;Contributors;4
5;Contents;8
6;Foot And Ankle Clinics
;12
7;Foreword;14
8;Preface;16
9;Dedication;18
10;Dedication;20
11;Dedication;24
12;Anatomy of the Triceps Surae;26
12.1;Key points;26
12.2;Introduction;26
12.3;Triceps surae;27
12.3.1;Gastrocnemius;27
12.3.1.1;Medial head;27
12.3.1.2;Lateral head;27
12.3.2;Plantaris;29
12.3.3;Soleus;30
12.3.4;Calcaneal Tendon;33
12.3.5;Innervation;37
12.3.6;Function of the Triceps Surae;37
12.3.7;Achilles-Calcaneal-Plantar System;39
12.3.8;Plantar Aponeurosis;40
12.3.8.1;Medial component;41
12.3.8.2;Lateral component;41
12.3.8.3;Central component;42
12.4;Surgical anatomy;43
12.4.1;Level 5;45
12.4.2;Level 4;47
12.4.3;Level 3;48
12.4.4;Levels 2 and 1;54
12.5;Summary;54
12.6;Acknowledgments;54
12.7;References;54
13;The Gastrocnemius;60
13.1;Key points;60
13.2;Introduction;60
13.3;A limited review of literature;61
13.4;The origins of the calf contracture;62
13.5;Activity changes: lifestyle influences;64
13.5.1;General Decreased Activities as People Age;64
13.5.2;Recent Changes in Activities;64
13.5.3;Athletes and Increased Activity Situations;64
13.6;Physiologic changes to muscles and tendons: internal influence;64
13.7;Genetics;64
13.8;Reverse evolution: the human influence and the predilection pattern;65
13.8.1;The Perfect Foot;65
13.8.2;The Gastrocnemius: Cause and Effect;66
13.9;Discussion;66
13.10;Summary;67
13.11;Acknowledgments;68
13.12;References;68
14;Effects of Gastrocnemius Tightness on Forefoot During Gait;72
14.1;Key points;72
14.2;Introduction;72
14.3;Anatomy and physiology of the gastrocnemius muscle;73
14.3.1;Anatomy;73
14.3.2;Hill Model;73
14.3.3;Energy Considerations;73
14.4;Normal gait analysis;73
14.4.1;Kinematics of the Stance Phase;73
14.4.2;Dynamics of the Stance Phase: Ground Reaction Studies;75
14.4.2.1;Ground reaction and center of gravity;76
14.4.2.2;Center of pressures;76
14.4.3;Electromyographic Analysis;76
14.4.4;Combined Analysis of Kinematics Dynamics and Electromyography;76
14.5;Discussion;77
14.6;Summary;78
14.7;References;79
15;Clinical Diagnosis of Gastrocnemius Tightness;82
15.1;Key points;82
15.2;Introduction;82
15.3;Clinical examination: the Silfverskiold test;82
15.3.1;The Force Under the Foot Is Applied;83
15.3.2;Correction of Hindfoot Valgus Deformity;83
15.3.3;Correction of an Eventual Contraction of the Foot Extensors;83
15.3.4;Strength Applied, and Definition of Gastrocnemius Tightness;83
15.3.5;The Taloche Sign (Maestro);89
15.4;Clinical examination: the associated signs caused by the equinus;89
15.5;Summary;89
15.6;References;89
16;Functional Hallux Rigidus and the Achilles-Calcaneus-Plantar System;92
16.1;Key points;92
16.2;Introduction;92
16.3;Functional hallux rigidus of biomechanical origin: the influence of equinus contracture;93
16.3.1;Sagittal Plane Block and Compensatory Mechanisms;98
16.3.2;The Achilles-Calcaneus-Plantar System During the Gait Cycle;101
16.3.3;Relationship Between the Degree of Equinnus and the Resulting Pathology;102
16.4;Clinical examination and diagnosis;104
16.5;Treatment of functional hallux rigidus;113
16.6;Summary;119
16.7;References;120
17;The Effect of the Gastrocnemius on the Plantar Fascia;124
17.1;Key points;124
17.2;Introduction;124
17.3;Achilles–calcaneus–plantar system;125
17.4;Modeling the foot in the sagittal plane;126
17.5;Gastrocnemius tightness and clinical applications;133
17.6;Summary;136
17.7;Acknowledgments;136
17.8;References;136
18;Gastrocnemius Shortening and Heel Pain;142
18.1;Key points;142
18.2;Background;142
18.3;Management of heel pain;143
18.4;Achilles tendinopathy;144
18.5;Terminology in Achilles tendon pain;144
18.6;Local anatomy;144
18.7;Demographics;144
18.8;Examination;145
18.9;Insertional tendinopathy;146
18.10;Retrocalcaneal bursitis;146
18.11;Noninsertional tendinopathy;146
18.12;Imaging;146
18.13;Treatment;146
18.13.1;Nonoperative Treatment;146
18.13.1.1;Stretching;146
18.14;Plantar fasciopathy;147
18.15;Examination;147
18.16;Imaging;148
18.17;Treatment;149
18.18;Gastrocnemius contracture;150
18.18.1;Pathomechanics of Calf Contracture;150
18.19;Clinical and epidemiologic data;151
18.20;Operative treatment;152
18.21;Gastrocnemius lengthening surgery;152
18.22;Results of gastrocnemius lengthening;154
18.23;Gastrocnemius lengthening for recalcitrant heel pain;154
18.24;Proximal medial gastrocnemius release for Achilles tendinopathy;155
18.25;Summary;156
18.26;References;156
19;The Use of Ultrasound to Isolate the Gastrocnemius-Soleus Junction Prior to Gastrocnemius Recession;162
19.1;Key points;162
19.2;Introduction;162
19.3;Procedure;163
19.4;Discussion;163
19.5;Summary;165
19.6;References;165
20;Surgical Techniques of Gastrocnemius Lengthening;168
20.1;Key points;168
20.2;Introduction;169
20.3;Anatomic basis;169
20.4;Indications;169
20.5;Surgical techniques;171
20.5.1;Proximal Gastrocnemius Recession Techniques;172
20.5.1.1;Traditional medial and lateral gastrocnemius muscle release: the Silfverskiold procedure;172
20.5.1.2;Isolated medial gastrocnemius release: a Barouk modification;173
20.5.2;Midaspect Gastrocnemius Recession Techniques;173
20.5.2.1;The Baumann procedure;173
20.5.3;Distal Gastrocnemius Recession Techniques;176
20.5.3.1;The original Vulpius and Baker procedures;176
20.5.3.2;The Strayer procedure;176
20.5.3.3;The modified Strayer procedure (author’s preferred technique);176
20.5.3.4;Endoscopic distal gastrocnemius recession;179
20.6;Postoperative care;181
20.7;Outcomes;182
20.8;Complications;184
20.9;Summary;185
20.10;References;186
21;Gastrocnemius Recession;190
21.1;Key points;190
21.2;Background;190
21.3;Anatomy;191
21.4;Arch collapse;191
21.5;Outcomes;193
21.5.1;Grand Rapids Type I Outcomes;193
21.5.2;Grand Rapids Type II Outcomes;194
21.5.3;Grand Rapids Type III Outcomes;196
21.5.4;Grand Rapids Type IV Outcomes;197
21.5.5;Type V Deformity;199
21.5.6;Techniques;199
21.5.7;Silfverskiold Procedure;200
21.5.8;Baumann Procedure;203
21.5.9;Strayer Procedure;205
21.5.10;Hoke (Tendoachilles Lengthening) Procedure;207
21.6;Summary;208
21.7;References;208
22;Endoscopic Gastrocnemius Release;210
22.1;Key points;210
22.2;Introduction;210
22.3;Surgical technique;211
22.4;Results;215
22.5;Future directions;215
22.6;Summary;215
22.7;References;216
23;Technique, Indications, and Results of Proximal Medial Gastrocnemius Lengthening;218
23.1;Key points;218
23.2;Introduction;218
23.2.1;Indications for Proximal Gastrocnemius Release;219
23.2.2;Surgical Technique;220
23.2.3;Preparation;220
23.3;Discussion;224
23.3.1;Bilaterality;224
23.3.2;Five Reasons to Lengthen Just the Medial Gastrocnemius;224
23.3.3;Reasons to Prefer Proximal Versus Distal Lengthening;225
23.3.4;Final Points;226
23.4;Chronology;226
23.5;Patient information;227
23.6;Summary;227
23.7;References;227
24;The Effect of Gastrocnemius Tightness on the Pathogenesis of Juvenile Hallux Valgus;230
24.1;Key points;230
24.2;Introduction;230
24.3;Anatomy;231
24.3.1;The Plantar Aponeurosis;231
24.3.1.1;Distal insertion;231
24.4;Pathogenesis of hallux valgus deformity in relation to gastrocnemius tightness;232
24.4.1;Role of Reduced Dorsiflexion of the Metatarsophalangeal Joint;233
24.4.1.1;In hallux limitus;233
24.4.1.2;Dorsal flexion of the interphalangeal joint;234
24.4.1.3;In juvenile hallux valgus;234
24.4.1.4;Summary;236
24.4.2;Problems Associated with the Planovalgus Foot;237
24.4.3;Spastic Paraplegia in Children;237
24.5;Relationship between gastrocnemius tightness and juvenile hallux valgus;237
24.5.1;Discussion;238
24.5.2;Elements Increasing the Deformity;239
24.5.3;Specific Structural Abnormalities;239
24.5.4;Clinical Consequences;240
24.6;Correction of hallux valgus and gastrocnemius tightness;240
24.6.1;Gastrocnemius Tightness;240
24.6.2;Bunionectomy;241
24.6.3;Our Series;241
24.7;Summary;242
24.8;Acknowledgments;243
24.9;References;243
25;Index;246

Leseproben

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*[e-mail] 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...