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gastric recession

Posted by Dave R on 6/28/05 at 07:40 (177405)

Its been one one since I had a gastric recession done on my right foot for heel pain. I have had heel pain for 8 years. i lost the job I loved because of it and most of my sanity. I have had eswt done twice and had a open plantar fasciotomy twice. At last, finally I can walk around all day long without any trouble. If anyone is thinking about having heel spur surgery to lengthen the plantar fascia i have to say make sure that you have a good doctor...In my case they didnt help that much. I did get some relief from it but not enough. My doctor that perform the gastric recession on my right achilles did a great job and I am very happy with the results. I have been doing great for 5 months, I just bought a new house with three acres and I can finally walk my dogs around.
My case of pf was extremely bad. I wasnt able to walk more than 100 yards without wanting to sit down. Sometimes even crawling to the bathroom. There is alot of talk on this board about plantar fasciosis. I can tell you that yes I still have some of that but its getting better all the time. Im unsure why.
I have been on and off this board for years and with the advice of Dr. Ed and Dr.W i was able to locate a good doctor that performs this type of surgery. All I have to say is thank you, thank you, thank you...

Re: gastric recession

Ralph on 6/28/05 at 11:41 (177421)

Dave,
How did your doctor determine that gastric recession would help you when the other surgeries for P.F. didn't? Also mind telling us the surgeon you used. How long were you layed up after the gastric recession and do you notice any weakness? Someone posted they had weakness in their calf following this surgery. Sounds like you are on your way to a full recovery. Thanks.

Re: gastric recession

Norm on 6/28/05 at 14:02 (177432)

What is gastric recession?

Re: gastric recession

Dave R on 6/28/05 at 14:32 (177434)

I had limited dorsiflexion with my foot. I was unable to bend it upwards or stretch it without my heel causing magor pain. That limited range of motion wasnt allowing the calf muscle and achilles to stretch. After the second partial plantar fasciotomy I wanted to have a complete release but I was unable to find a podiatrist that wanted to do it. So I asked Dr. W from this board and he gave me the name of a doctor in the milwaukee area that performs the gastric recession. Basically the bottom of the soloes muscle is cut where it attaches to the achilles tendon. I have a scar that is about 1/4' long. It was done endoscopically. A knife is ran across the area to cause a rupture. This will enable you to bend your foot up towards your head. very important that to much isnt cut.....I was in a cast for three weeks. Then a cam walker for another two weeks. I wasnt able to put any weight on it until week 6. It was a slow process. My leg was week for a long time.
By the way, I went from a negative 11 degrees to a postive 22 degrees of dorsiflexion after the surgery.....

Re: gastric recession

Ed Davis, DPM on 6/29/05 at 10:30 (177484)

Ralph:
Gastroc. recessions work when the culprit is a tight heel cord, made up the the gastrocnemius muscle and the soleus muscle -- a prime instigating factor in PF. Someone forgot to look for the tightness long ago!
Ed

Re: gastric recession

Ed Davis, DPM on 6/29/05 at 10:31 (177485)

A lenthening of the gastrocnemius muscle, the larger of the two muscles making up the heel cord.
Ed

Re: gastric recession

Dr. Zuckerman on 6/29/05 at 10:36 (177488)

Ed,
I find that alot of pf patients have a tight heel cord that is due to guarding and resolves with stretching and reduction of pain after ESWT is performed or some type of conservative treatment is effectively used.

Re: gastric recession

Hah on 6/30/05 at 18:10 (177591)

David:
I think it can be a vicious cycle (unlike a Harley). A tight heel cord helps induce plantar fasciitis which causes the heel cord to tighten more and so on...
Ed

Re: gastric recession

Dr. Zuckerman on 7/01/05 at 07:57 (177631)

I agree. The tough part is to when to skip the pf treatments and go to the AT procedures. This is the tough part

Re: gastric recession

Mike C on 7/07/05 at 05:45 (177988)

The gastroc is NOT the larger of the two.

Re: gastric recession

Cooper Hospital FootAnkle Service on 7/07/05 at 06:03 (177989)

Gentlemen, I was on this board several months ago discussing the etiology of plantar fasciitis.

The gastrocnemius muscle is not the larger of the two muscles inserting at the Achilles tendon.
The gastroc is not the culprit when the heel cord is tight. It is the culprit when there is a gastroc equinus contracture (99% of people with plantar fasciitis) that is when dorsiflexion of the ankle is restricted with knee extension and improves with knee flexion.

No functional deficit results from releasing the gastrocnemius as this muscle is rarely recruited, hence it's tightness.

In the over 1000 patients I have treated with plantar fasciitis less then a dozen have failed to improve with stretching and a night splint. In those patients a gastrocnemius recession eliminted there heel pain within 3 weeks of having the procedure.

Shock wave therapy is expensive and has no long term studies to support it's efficacy.

Re: gastric recession

Dr. Z on 7/07/05 at 08:16 (177994)

We await your paper that shows that your specific treatment shows a long term improvement and the degree of improvement. In what journal is this article published by you.
I think that you better go to medline and review your statements about shockwave and it long term efficacy.
I bet that a gastroncenmius recession with all pre, post follow up in an ASC is alot of more expensive then ESWT but that isn't really the point is it.?
Interesting Cooper Hospital Foot and Ankle Service. Are you in Camden, New Jersey.?

Re: gastric recession

Cooper University Hospital FootAnkle on 7/09/05 at 05:13 (178087)

We are in the process of data collection for both the clinical study and a biomechanical analysis. I will send you reprints.

I was merely sharing my experience with this menacing problem.

I rewiewed the published material you referred me to several months ago and found an editorial written the author you mentioned. He stated that long term studies were necessary to determine the efficacy or this treatment.

I have seen many patients who have had shock wave therapy and have not been helped. My point about gastrocnemius recession is that when indicated, 1) it addresses the cause of the problem and 2) insurance pays for it 3) the outcomes are consistently good.

Re: gastric recession

Ed Davis, DPM on 7/09/05 at 19:44 (178108)

Mike:
What anatomy book are you using? You are the first and only person who I have ever seen dispute the fact that the gastroc is larger than the soleus.
Ed

Re: gastric recession

Ed Davis, DPM on 7/09/05 at 19:49 (178109)

I have never heard such nonsense. Are you afraid to come out and identify yourself as Dr. Z and I have. Every anatomy book written shows that the gastrocnemius is the larger or the two primary muscles that insert into the achilles tendon. You will have to take up your argument with Gray's Anatomy, not to mention, just about the entire orthopedic and podaitric professions.
Ed

Re: gastric recession

scott r - moderator on 7/09/05 at 20:50 (178114)

Dear 'Cooper Hospital',
Using the name 'Cooper Hospital' implies Cooper hospital stands behind your posts. If the partners or administrators of Cooper Hospital do not support or are not aware of your posts, then the name you're using could be considered deceptive. So, please use a different but consistent ID like 'Franklin' or 'Visiting DPM'.

From my knowledge, the gastroc certainly is the larger of the two muscles and is at least a major contributor to a 'tight heel cord', no matter how 'tight heel cord' is defined.

Scott Roberts, owner
heelspurs.com LLC

Re: gastric recession

Dr. Z on 7/09/05 at 21:03 (178115)

Please send me reprints. The question is what is long term. One year, two years three years four years. I personaly have six year follow ups from ESWT plantar fasciosis treatment.
Not sure what materials I referred you too since there are pages and pages on medline
The gastro recession procedure does have a place as well as ESWT. One of the most consistant statments that here from doctors is that they won't use a procedure that insurace won't cover because they are afraid of rejection from their patient. The typical comment I hear is hey they won't pay for a co-pay so how am I going to get my pateints to pay for ESWT. The answer is to learn as much as you can and understand as much as you can so that you can give your patients a CHOICE
If you want to really send me the reprints
David Zuckerman DPM\
341 South Evergreen Ave
Woodbury, New Jersey -8-96

So are you located in Camden New Jersey??????????????????? The former Cooper Hospital Chief of Foot and Ankle Serices uses ESWT. His name is Dr. Fox

Re: gastric recession

Dr. Michael Castro on 7/26/05 at 03:45 (179087)

Mr. Roberts,

I am the director of the Foot&Ankle Service at Cooper Hospital in Camden, NJ. My undergraduate training is in exercise physiology and biomechanics. My graduate training is in biochemistry and biomechanics. After completing a residency in orthopaedic surgery I completed a fellowship in foot and ankle reconstruction, both in the US and Switzerland. I have presented and published re: foot & ankle biomechanics. No deception intended. Regarding gastrocnemius: 'tight heel cord' and gastroc equinus are two very different things. In the vast majority of individuals the gastrocnemius is certainly not the larger of the two muscles inserting into the Achilles tendon. Knowledge of recruitment patterns and muscle fiber type adds to the understanding of the anatomy and pathoanatomy.
I would be happy to discuss this and any other related issues.

Re: gastric recession

Dr. Z on 7/26/05 at 07:18 (179095)

So you are an orthopedic surgeon? I know your hospital very well.

Re: gastric recession

marie m. on 1/20/06 at 17:39 (191801)

I am having grastric recession surgery on both my legs in a few short days. Does anyone know some specifics such as the scarring? Also I need to return to school immediately after the surgery, how was walking around after the procedure? Sorry for so many question but I am a college runner who would really like to hear some opinions on the topic.