What are the indications for this procedure?

Calf muscle tightness (relative shortening) is associated with several conditions of the foot and ankle including plantar fasciitis, metatarsalgia and Achilles tendinopathy. The tightness of the calf muscle may exacerbate or prevent resolution of symptoms. The vast majority of patients can reduce the calf tightness through a structured exercise / physiotherapy programme. With time and good exercise compliance, the foot / ankle symptoms should also improve.  Surgical treatment is indicated if there is failure of several months of nonsurgical treatment.

 

How is the operation done?

You will be admitted on the day of surgery for this daycase procedure. The operation takes about 20 min and is routinely done under a general anaesthetic. 

A small incision is made on the inside of your calf. The interval between your calf muscles (gastrocnemius and soleus) is separated with retractors. The aponeurosis (thin layer of fibrous tissue) of the gastrocnemius muscle is released to allow the calf muscle to stretch. The wound is closed with dissolvable stitches and your calf is dressed with a bandage.

 

You will be given a boot for 2 weeks and allowed to fully weight bear using it. You should remove the boot 2 to 3 times a day for approximately 10 mins to perform calf stretching exercises. Ideally, the boot should also be worn when you are asleep in order to prevent the calf muscle from tightening-up again.

 

Aftercare and FAQs

It is important to keep the leg elevated as much as possible especially for the first 2 weeks. You will usually be able to go home when you feel ready. You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours. Your first clinic follow-up is usually 12 to 14 days after surgery.

Wound care – The dressing should be kept dry. At yours first clinic appointment, wound inspection and suture removal will be undertaken.

Work - If you have a sedentary job you should be able to return to work within 2 weeks (if you can arrange safe transport). If your job is physical, you may need to stay off work for 3 to 4 weeks.

Driving - You will not be able to drive for 2 to 3 weeks following surgery. However, if you drive an Automatic and it was your LEFT side that was operated on; then you may start short drives 2 to 3 days following surgery. It is advisable to check the terms of your car insurance to ensure your cover is valid, as some policies state that you must not drive for a specific time period after an operation.

Flying after surgery - It is generally recommended to wait at least four to six weeks to fly after any lower limb surgery. It may be possible to fly on short-haul or domestic flights at an earlier time, but you should always check with your GP or surgeon. Always consult your doctor, your health insurance provider and the airline you are flying with before making your flight reservation.

 

What are the surgical risks?

 

  • Infection

  • Nerve damage – causing numbness or tender scar

  • Deep vein thrombosis (DVT) and pulmonary embolism (PE) – blood clots in the vein or lungs 

  • Muscle weakness

  • Residual pain in foot

It is beyond the scope of this document to list rarer risks (less than one in a thousand) but I will be very happy to discuss any worries about specific concerns and also about any family history or your past health problems. If there is anything you do not understand or if you have any questions or concerns, please feel free to discuss them with me.

 

Mr Dev Mahadevan
Consultant Foot and Ankle Surgeon