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Clinical Tip: Localization of the Gastrocnemius-Soleus Aponeurosis Using Ultrasound

Since its initial description by Vulpius and Stoeffel in 1913, the gastrocnemius aponeurosis equinus contracture has been recognized in the development of pathological foot and ankle conditions.1–3,6–7 These include achilles tendinopathy, symptomatic adult acquired flatfoot, hallux valgus, diabetic ulcers, heel pain syndrome, and forefoot overload.3,5 Naturally, gastrocnemius recession has become an important part of the various reconstructive procedures dealing with these conditions. The original technique described by Vulpius involves a chevron type release of the aponeurosis which was later modified by Strayer into more of a transverse type.3 Both of these procedures involve a long incision with a large amount of soft tissue dissection leading to potentially increased pain from adhesions between skin and fascia, as well as a cosmetically undesirable scar.3,10 Many authors have made modifications to these techniques in order to achieve a smaller scar.10,11 These consist of strategically moving the surgical incision medially, both at the medial edge of the aponeurosis and at the level of the distal gastrocnemius muscle.10 Endoscopic release has also been described.3,11 However, optimal localization of the incision site can be challenging as it relies on surface