Mid-term Results of Intramuscular Lengthening of Gastrocnemius and/or Soleus to Correct Equinus Deformity in Flatfoot

Foot Ankle Int. 2015 Oct;36(10):1223-8. doi: 10.1177/1071100715588994. Epub 2015 Jun 3.


Background: Intramuscular lengthening of the gastrocnemius and/or soleus (Baumann procedure) is widely used in patients who have cerebral palsy, with several advantages over other lengthening techniques. Tightness of the gastrocnemius or gastrocnemius-soleus complex has been confirmed to be related to flatfoot deformity. The purpose of this study was to evaluate the mid-term results of the Baumann procedure as a part of the treatment of flatfoot with equinus deformity.

Methods: We reviewed 35 pediatric and adult patients (43 feet) with flatfoot who underwent the Baumann procedure for the concomitant equinus deformity. The mean duration of follow-up was 39.4 months. Preoperative and follow-up evaluations included the maximal angle of dorsiflexion of the ankle with the knee fully extended and with the knee flexed to 90 degrees, the American Orthopaedic Foot & Ankle Society ankle-hindfoot (AOFAS-AH) scores, and postoperative complications.

Results: Preoperatively, the mean angle of passive ankle dorsiflexion with the knee extended was -4.7 ± 2.7 degrees and that with the knee flexed was 2.3 ± 2.5 degrees. At the final follow-up, both values improved significantly by a mean of 13.6 degrees (P < .001) and 9.7 degrees (P < .001), respectively. The average AOFAS-AH scores improved from 56.8 points preoperatively to 72.1 at the final follow-up. Recurrence of equinus was observed in 3 patients (4 feet). There were no cases of overcorrection, neurovascular injury, or healing problems.

Conclusions: Our results indicate that the Baumann procedure can effectively and sequentially correct the tightness of the gastrocnemius or the gastrocnemius-soleus complex in patients with flatfoot deformity, without obvious postoperative complications.

Level of evidence: Level IV, retrospective case series.

Keywords: Baumann procedure; equinus contracture; flatfoot; intramuscular lengthening.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Child
  • Cohort Studies
  • Confidence Intervals
  • Equinus Deformity / complications*
  • Equinus Deformity / diagnosis
  • Equinus Deformity / surgery*
  • Female
  • Flatfoot / complications*
  • Flatfoot / diagnosis
  • Flatfoot / surgery
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Orthopedic Procedures / methods
  • Patient Positioning / methods
  • Recovery of Function
  • Retrospective Studies
  • Risk Assessment
  • Sex Factors
  • Tenotomy / methods*
  • Time Factors
  • Treatment Outcome
  • Young Adult