Foot & Ankle International - July 2016 - (Page 766)

638128 FAIXXX10.1177/1071100716638128Foot & Ankle InternationalNawoczenski et al research-article2016 Article Ankle Power and Endurance Outcomes Following Isolated Gastrocnemius Recession for Achilles Tendinopathy Foot & Ankle International® 2016, Vol. 37(7) 766-775 © The Author(s) 2016 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1071100716638128 fai.sagepub.com Deborah A. Nawoczenski, PT, PhD1, Frank E. DiLiberto, PT, PhD2, Maxwell S. Cantor, DPT, OCS3, Josh M. Tome, MS4, and Benedict F. DiGiovanni, MD1 Abstract Background: Studies have demonstrated improved ankle dorsiflexion and pain reduction following a gastrocnemius recession (GR) procedure. However, changes in muscle performance during functional activities are not known. The purpose of this study was to determine the effect of an isolated GR on ankle power and endurance in patients with Achilles tendinopathy. Methods: Fourteen patients with chronic unilateral Achilles tendinopathy and 10 healthy controls participated in this study. Patient group data were collected 18 months following GR. Pain was compared to preoperative values using a 10-cm visual analog scale (VAS). Patient-reported outcomes for activities of daily living (ADL) and sports were assessed using the Foot and Ankle Ability Measure (FAAM). Kinematic and kinetic data were collected during gait, stair ascent (standard and high step), and repetitive single-limb heel raises. Between-group and side-to-side differences in ankle plantarflexor muscle power and endurance were evaluated with appropriate t tests. Results: Compared with preoperative data, VAS pain scores were reduced (pre 6.8, post 1.6, P < .05). Significant differences were observed between GR and Control groups for FAAM scores for both ADL (GR 90.0, Control 98.3, P = .01) and Sports subscales (GR 70.6, Control 94.6, P = .01). When compared to controls, ankle power was reduced in the involved limb of the GR group for all activities (all P < .05). Between-group and side-to-side deficits (GR group only) were also found for ankle endurance. Conclusion: The gastrocnemius recession procedure provided significant pain reduction that was maintained at the 18-month follow-up for patients with chronic Achilles tendinopathy who failed nonoperative interventions. There were good patient-reported outcomes for activities of daily living. However, compared to controls, ankle plantarflexion power and endurance deficits in the GR group were noted. The functional implications of the muscle performance deficits are unclear, but may be reflective of patients' self-reported difficulty during more challenging activities. Level of Evidence: Level III, comparative study. Keywords: gastrocnemius recession, Achilles tendinopathy, ankle power, foot and ankle biomechanics Introduction Achilles tendinopathy (AT) is one of the most common foot and ankle pathologies for which patients seek outpatient care.9,15,22,25,26 The overall incidence rate has been reported as 2.35 per 1000 persons.9,21 Runners and athletes who are involved with jumping activities are most frequently affected,2,26,44 but AT is also present in individuals who are mildly active or even sedentary.20 AT is classified as either insertional or noninsertional and although the exact etiology of the pathology is not known, cumulative tendon microtrauma from repetitive mechanical overload is regarded as the main pathologic stimulus.18 In both types of 1 Department of Orthopaedics and Rehabilitation, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA 2 Department of Physical Therapy, Rosalind Franklin University of Medicine & Science, North Chicago, IL, USA 3 Physical Therapist, Wellesley Therapeutic Services, Holliston, MA, USA 4 School of Health Science and Human Performance, Ithaca College, Ithaca, NY, USA Corresponding Author: Deborah A. Nawoczenski, PT, PhD, Department of Orthopaedics and Rehabilitation, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Box 665, Rochester, NY 14642, USA. Email: dnawoczenski@ithaca.edu http://www.sagepub.com/journalsPermissions.nav http://fai.sagepub.com

Table of Contents for the Digital Edition of Foot & Ankle International - July 2016

TOC/TOC/Verso
Editorial Board
Advertiser Index
Long Term Follow-up of a Randomized Controlled Trial Comparing Scarf to Chevron Osteotomy in Hallux Valgus Correction
Clinical Outcome and Fusion Rate following Simultaneous Subtalar Fusion and Total Ankle Arthoplasty
Anterior Heterotopic Ossification at the Talar Neck After Total Ankle Arthroplasty
Secondary Arthrodesis After Total Ankle Arthroplasty
Functional Outcomes Following First Metatarsophalangeal Arthrodesis
Increased Reduction Clamp Force Associated With Syndesmotic Overcompression
Pain Threshold Tests in Patients With Heel Pain Syndrome
Long-term Results of Chronic Achilles Tendon Ruptures With V-Y Tendon Plasty and Fascia Turndown
Peroneal Tendon Abnormalities on Routine Magnetic Resonance Imaging of the Foot and Ankle
Incisura Morphology as a Risk Factor for Syndesmotic Malreduction
Total Arthroplasty of the Metatarsophalangeal Joint of the Hallux
Ankle Power and Endurance Outcomes Following Isolated Gastrocnemius Recession for Achilles Tendinopathy
Survey of Patient Insurance Status on Access to Specialty Foot and Ankle Care Under the Affordable Care Act
Proximal Gastrocnemius Release in the Treatment of Mechanical Metatarsalgia
Gastrocnemius Proximal Release in the Treatment of Mechanical Metatarsalgia: A Prospective Study of 78 Cases.
Response to "Letter Regarding: Gastrocnemius Proximal Release in the Treatment of Mechanical Metatarsalgia"
The Internal Brace for Midsubstance Achilles Ruptures
The Evolution of Patient Safety
Education Calendar
Foot & Ankle International - July 2016

Foot & Ankle International - July 2016