Gill, Narinder Singh
(2014)
Study on outcome of gastrocnemius recession surgery in diabetic equinus contracture.
Masters thesis, Universiti Sains Malaysia.
Abstract
BACKGROUND: Diabetic equinus secondary to gastrocnemius contracture is a known
predominant risk factor in diabetic foot ulceration characterized by reduction of ankle
dorsiflexion. Recession surgery involves release of the gastrocnemius muscle at its aponeurosis and is one of the treatments of choice in improvement of diabetic equinus contracture.
OBJECTIVE: To measure degree of improvement of ankle dorsiflexion and length gained at
gastrocnemius aponeurosis following gastrocnemius recession surgery in diabetic equinus
contracture. To assess correlation between the lengths gained at gastrocnemius aponeurosis with degrees of improvement in ankle dorsiflexion following surgery.
METHODOLOGY: Total of 76 patients was recruited in the Orthopaedic clinics and wards at Penang General Hospital. Presence of gastrocnemius equinus was established with a positive Silfverskiold test. Gastrocnemius recession surgery using the Modified Strayer Technique was done following failed conservative therapy. Pre and post-operative ankle dorsiflexion was measured. Length gained at gastrocnemius aponeurosis was measured at 6 weeks post-operative using Ultrasound done in maximal ankle dorsiflexion. Results were analyzed using SPSS version 20.0
RESULTS: The severity of equinus contracture did not correlate to chronicity of diabetes
mellitus. There was improvement of ankle dorsiflexion seen at 6 weeks post-operatively. It
ranged from 6 to 16 degrees and was coupled with statistical significant length gained at gastrocnemius aponeurosis that ranged from a mean of 0.8cm to 3.8cm. Mean improvement ofankle dorsiflexion was 11.05 degrees. Mean improvement of length gain at gastrocnemius
aponeurosis was 1.54cm.
CONCLUSION: Gastrocnemius recession surgery appropriately addresses diabetic equinus
secondary to gastrocnemius contractures by improving ankle dorsiflexion and is evidenced by a significant increase in length at the aponeurosis.
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