{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T11:42:18Z","timestamp":1779882138334,"version":"3.53.1"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,7,23]],"date-time":"2020-07-23T00:00:00Z","timestamp":1595462400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,7,23]],"date-time":"2020-07-23T00:00:00Z","timestamp":1595462400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Surg Radiol Anat"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>The surgical procedure itself of lengthening the gastrocnemius muscle aponeurosis is performed to treat multiple musculoskeletal, neurological and metabolical pathologies related to a gastro-soleus unit contracture such as plantar fasciitis, Achilles tendinopathy, metatarsalgia, cerebral palsy, or diabetic foot ulcerations. Therefore, the aim of our research was to prove the effectiveness and safety of a new ultrasound-guided surgery-technique for the lengthening of the anterior gastrocnemius muscle aponeurosis, the \u201cGIAR\u201d- technique: the gastrocnemius-intramuscular aponeurosis release.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods and results<\/jats:title>\n                <jats:p>An ultrasound-guided surgical GIAR on ten fresh-frozen specimens (10 donors, 8 male, 2 females, 5 left and 5 right) was performed. Exclusion criteria of the donated bodies to science were BMI above 35 (impaired ultrasound echogenicity), signs of traumas in the ankle and crural region, a history of ankle or foot ischemic vascular disorder, surgery or space-occupying mass lesions. The surgical procedures were performed by two podiatric surgeons with more than 6\u00a0years of experience in ultrasound-guided procedures. The anterior gastrocnemius muscle aponeurosis was entirely transected in 10 over 10 specimens, with a mean portal length of 2\u00a0mm (\u00b1 1\u00a0mm). The mean gain at the ankle joint ROM after the GIAR was 7.9\u00b0 (\u00b1 1.1\u00b0). No damages of important anatomical structures could be found.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Results of this study indicate that our novel ultrasound-guided surgery for the lengthening of the anterior gastrocnemius muscle aponeurosis (GIAR) might be an effective and safe procedure.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00276-020-02536-1","type":"journal-article","created":{"date-parts":[[2020,7,23]],"date-time":"2020-07-23T21:21:09Z","timestamp":1595539269000},"page":"53-61","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Anatomical basis of a safe mini-invasive technique for lengthening of the anterior gastrocnemius aponeurosis"],"prefix":"10.1007","volume":"43","author":[{"given":"Simone","family":"Moroni","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro","family":"Fern\u00e1ndez-Gibello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel Camunas","family":"Nieves","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruben","family":"Montes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marit","family":"Zwierzina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa","family":"Vazquez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Garcia-Escudero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrice","family":"Duparc","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Moriggl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9706-7396","authenticated-orcid":false,"given":"Marko","family":"Konschake","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,7,23]]},"reference":[{"key":"2536_CR1","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1097\/BTF.0b013e318199986b","volume":"8","author":"VR Adelman","year":"2009","unstructured":"Adelman VR, Szczepanski JA, Adelman RP, Lincoln DR (2009) Endoscopic gastrocnemius recession ultrasound-guided analysis of length gained. Tech Foot and Ankle Surg 8:24\u201329. https:\/\/doi.org\/10.1097\/BTF.0b013e318199986b","journal-title":"Tech Foot and Ankle Surg"},{"key":"2536_CR2","doi-asserted-by":"publisher","first-page":"767","DOI":"10.1016\/j.fcl.2014.09.001","volume":"19","author":"JG Anderson","year":"2014","unstructured":"Anderson JG, Bohay DR, Eller EB, Witt BL (2014) Gastrocnemius recession. Foot Ankle Clin 19:767\u2013786. https:\/\/doi.org\/10.1016\/j.fcl.2014.09.001","journal-title":"Foot Ankle Clin"},{"key":"2536_CR3","doi-asserted-by":"publisher","first-page":"313","DOI":"10.2106\/00004623-195638020-00007","volume":"38-A","author":"LD Baker","year":"1956","unstructured":"Baker LD (1956) A rational approach to the surgical needs of the cerebral palsy patient. J Bone Joint Surg Am 38-A:313\u2013323. https:\/\/doi.org\/10.2106\/00004623-195638020-00007","journal-title":"J Bone Joint Surg Am"},{"key":"2536_CR4","doi-asserted-by":"publisher","first-page":"464","DOI":"10.7547\/0950464","volume":"95","author":"SL Barrett","year":"2005","unstructured":"Barrett SL, Jarvis J (2005) Equinus deformity as a factor in forefoot nerve entrapment: treatment with endoscopic gastrocnemius recession. J Am Podiatr Med Assoc 95:464\u2013468. https:\/\/doi.org\/10.7547\/0950464","journal-title":"J Am Podiatr Med Assoc"},{"key":"2536_CR5","doi-asserted-by":"publisher","first-page":"915","DOI":"10.3113\/FAI.2012.0915","volume":"33","author":"HL Barske","year":"2012","unstructured":"Barske HL, DiGiovanni BF, Douglass M, Nawoczenski DA (2012) Current concepts review: isolated gastrocnemius contracture and gastrocnemius recession. Foot Ankle Int 33:915\u2013921. https:\/\/doi.org\/10.3113\/FAI.2012.0915","journal-title":"Foot Ankle Int"},{"key":"2536_CR6","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1007\/BF02514828","volume":"1","author":"JU Baumann","year":"1989","unstructured":"Baumann JU, Koch HG (1989) Ventrale aponeurotische Verl\u00e4ngerung des Musculus gastrocnemius. Oper Orthop\u00e4die und Traumatol 1:254\u2013258. https:\/\/doi.org\/10.1007\/BF02514828","journal-title":"Oper Orthop\u00e4die und Traumatol"},{"key":"2536_CR7","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1053\/j.jfas.2006.11.003","volume":"46","author":"NM Blitz","year":"2007","unstructured":"Blitz NM, Eliot DJ (2007) Anatomical aspects of the gastrocnemius aponeurosis and its insertion: a cadaveric study. J Foot Ankle Surg 46:101\u2013108. https:\/\/doi.org\/10.1053\/j.jfas.2006.11.003","journal-title":"J Foot Ankle Surg"},{"key":"2536_CR8","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1053\/j.jfas.2008.08.006","volume":"47","author":"NM Blitz","year":"2008","unstructured":"Blitz NM, Eliot DJ (2008) Anatomical aspects of the gastrocnemius aponeurosis and its muscular bound portion: a cadaveric study-part II. J Foot Ankle Surg 47:533\u2013540. https:\/\/doi.org\/10.1053\/j.jfas.2008.08.006","journal-title":"J Foot Ankle Surg"},{"key":"2536_CR9","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1016\/j.fas.2015.02.001","volume":"21","author":"CC Cychosz","year":"2015","unstructured":"Cychosz CC, Phisitkul P, Belatti DA, Glazebrook MA, DiGiovanni CW (2015) Gastrocnemius recession for foot and ankle conditions in adults: evidence-based recommendations. Foot Ankle Surg 21:77\u201385. https:\/\/doi.org\/10.1016\/j.fas.2015.02.001","journal-title":"Foot Ankle Surg"},{"key":"2536_CR10","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1016\/j.fcl.2014.08.002","volume":"19","author":"M Dalmau-Pastor","year":"2014","unstructured":"Dalmau-Pastor M, Fargues-Polo B Jr, Casanova-Martinez D Jr, Vega J, Golano P (2014) Anatomy of the triceps surae: a pictorial essay. Foot Ankle Clin 19:603\u2013635. https:\/\/doi.org\/10.1016\/j.fcl.2014.08.002","journal-title":"Foot Ankle Clin"},{"key":"2536_CR11","first-page":"822","volume":"25","author":"EH Daseler","year":"1943","unstructured":"Daseler EH, Anson BJ (1943) The plantaris muscle: an anatomical study of 750 specimens. JBJS 25:822\u2013827","journal-title":"JBJS"},{"key":"2536_CR12","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1016\/j.cpm.2016.10.008","volume":"34","author":"PA DeHeer","year":"2017","unstructured":"DeHeer PA (2017) Equinus and Lengthening Techniques. Clin Podiatr Med Surg 34:207\u2013227. https:\/\/doi.org\/10.1016\/j.cpm.2016.10.008","journal-title":"Clin Podiatr Med Surg"},{"key":"2536_CR13","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1007\/s00276-018-2127-9","volume":"41","author":"A Fernandez-Gibello","year":"2019","unstructured":"Fernandez-Gibello A, Moroni S, Camunas G, Montes R, Zwierzina M, Tasch C, Starke V, Sanudo J, Vazquez T, Konschake M (2019) Ultrasound-guided decompression surgery of the tarsal tunnel: a novel technique for the proximal tarsal tunnel syndrome-Part II. Surg Radiol Anat 41:43\u201351. https:\/\/doi.org\/10.1007\/s00276-018-2127-9","journal-title":"Surg Radiol Anat"},{"key":"2536_CR14","doi-asserted-by":"publisher","first-page":"1033","DOI":"10.1007\/s11999-009-1084-3","volume":"468","author":"JF Grady","year":"2010","unstructured":"Grady JF, Kelly C (2010) Endoscopic gastrocnemius recession for treating equinus in pediatric patients. Clin Orthop Relat Res 468:1033\u20131038. https:\/\/doi.org\/10.1007\/s11999-009-1084-3","journal-title":"Clin Orthop Relat Res"},{"key":"2536_CR15","doi-asserted-by":"publisher","first-page":"1154","DOI":"10.3113\/FAI.2007.1154","volume":"28","author":"JE Herzenberg","year":"2007","unstructured":"Herzenberg JE, Lamm BM, Corwin C, Sekel J (2007) Isolated recession of the gastrocnemius muscle: the Baumann procedure. Foot Ankle Int 28:1154\u20131159. https:\/\/doi.org\/10.3113\/FAI.2007.1154","journal-title":"Foot Ankle Int"},{"key":"2536_CR16","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1016\/j.aanat.2014.07.002","volume":"196","author":"M Konschake","year":"2014","unstructured":"Konschake M, Brenner E (2014) \"Mors auxilium vitae\"\u2013causes of death of body donors in an Austrian anatomical department. Ann Anat 196:387\u2013393. https:\/\/doi.org\/10.1016\/j.aanat.2014.07.002","journal-title":"Ann Anat"},{"key":"2536_CR17","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1123\/jsr.20.3.333","volume":"20","author":"DA Krause","year":"2011","unstructured":"Krause DA, Cloud BA, Forster LA, Schrank JA, Hollman JH (2011) Measurement of ankle dorsiflexion: a comparison of active and passive techniques in multiple positions. J Sport Rehabil 20:333\u2013344. https:\/\/doi.org\/10.1123\/jsr.20.3.333","journal-title":"J Sport Rehabil"},{"key":"2536_CR18","doi-asserted-by":"publisher","first-page":"18","DOI":"10.7547\/0950018","volume":"95","author":"BM Lamm","year":"2005","unstructured":"Lamm BM, Paley D, Herzenberg JE (2005) Gastrocnemius soleus recession: a simpler, more limited approach. J Am Podiatr Med Assoc 95:18\u201325. https:\/\/doi.org\/10.7547\/0950018","journal-title":"J Am Podiatr Med Assoc"},{"key":"2536_CR19","doi-asserted-by":"publisher","first-page":"e615","DOI":"10.1016\/j.eats.2015.06.011","volume":"4","author":"TH Lui","year":"2015","unstructured":"Lui TH (2015) Endoscopic gastrocnemius intramuscular aponeurotic recession. Arthrosc Tech 4:e615\u2013618. https:\/\/doi.org\/10.1016\/j.eats.2015.06.011","journal-title":"Arthrosc Tech"},{"key":"2536_CR20","first-page":"1","volume":"12","author":"S McHanwell","year":"2020","unstructured":"McHanwell S, Brenner E, Chirculescu AR, Drukker J, van Mameren H, Mazzotti G, Pais D, Paulsen F, Plaisant O, Caillaud MM (2020) The legal and ethical framework governing Body Donation in Europe-A review of current practice and recommendations for good practice. Euro J Anatomy 12:1\u201324","journal-title":"Euro J Anatomy"},{"key":"2536_CR21","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1007\/s00276-019-02196-w","volume":"41","author":"S Moroni","year":"2019","unstructured":"Moroni S, Gibello AF, Zwierzina M, Nieves GC, Montes R, Sanudo J, Vazquez T, Konschake M (2019) Ultrasound-guided decompression surgery of the distal tarsal tunnel: a novel technique for the distal tarsal tunnel syndrome-part III. Surg Radiol Anat 41:313\u2013321. https:\/\/doi.org\/10.1007\/s00276-019-02196-w","journal-title":"Surg Radiol Anat"},{"key":"2536_CR22","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1007\/s00276-018-2124-z","volume":"41","author":"S Moroni","year":"2019","unstructured":"Moroni S, Zwierzina M, Starke V, Moriggl B, Montesi F, Konschake M (2019) Clinical-anatomic mapping of the tarsal tunnel with regard to Baxter's neuropathy in recalcitrant heel pain syndrome: part I. Surg Radiol Anat 41:29\u201341. https:\/\/doi.org\/10.1007\/s00276-018-2124-z","journal-title":"Surg Radiol Anat"},{"key":"2536_CR23","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1177\/0268355515627262","volume":"32","author":"O Rodriguez-Acevedo","year":"2017","unstructured":"Rodriguez-Acevedo O, Elstner K, Zea A, Diaz J, Martinic K, Ibrahim N (2017) The sural nerve: Sonographic anatomy, variability and relation to the small saphenous vein in the setting of endovenous thermal ablation. Phlebology 32:49\u201354. https:\/\/doi.org\/10.1177\/0268355515627262","journal-title":"Phlebology"},{"key":"2536_CR24","doi-asserted-by":"publisher","first-page":"1223","DOI":"10.1177\/1071100715588994","volume":"36","author":"K Rong","year":"2015","unstructured":"Rong K, Ge W-t, Li X-c, Xu X-y (2015) Mid-term results of intramuscular lengthening of gastrocnemius and\/or soleus to correct equinus deformity in flatfoot. Foot Ankle Int 36:1223\u20131228. https:\/\/doi.org\/10.1177\/1071100715588994","journal-title":"Foot Ankle Int"},{"key":"2536_CR25","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1007\/s00264-015-2860-1","volume":"40","author":"K Rong","year":"2016","unstructured":"Rong K, Li XC, Ge WT, Xu Y, Xu XY (2016) Comparison of the efficacy of three isolated gastrocnemius recession procedures in a cadaveric model of gastrocnemius tightness. Int Orthop 40:417\u2013423. https:\/\/doi.org\/10.1007\/s00264-015-2860-1","journal-title":"Int Orthop"},{"key":"2536_CR26","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1302\/0301-620x.82b4.9850","volume":"82","author":"V Saraph","year":"2000","unstructured":"Saraph V, Zwick EB, Uitz C, Linhart W, Steinwender G (2000) The Baumann procedure for fixed contracture of the gastrosoleus in cerebral palsy. Evaluation of function of the ankle after multilevel surgery. J Bone Joint Surg Br 82:535\u2013540. https:\/\/doi.org\/10.1302\/0301-620x.82b4.9850","journal-title":"J Bone Joint Surg Br"},{"key":"2536_CR27","doi-asserted-by":"publisher","first-page":"671","DOI":"10.2106\/00004623-195032030-00022","volume":"32","author":"LM Strayer Jr","year":"1950","unstructured":"Strayer LM Jr (1950) Recession of the gastrocnemius: an operation to relieve spastic contracture of the calf muscles. JBJS 32:671\u2013676. https:\/\/doi.org\/10.2106\/00004623-195032030-00022","journal-title":"JBJS"},{"key":"2536_CR28","doi-asserted-by":"publisher","first-page":"1094","DOI":"10.2174\/1874325001711011094","volume":"11","author":"ACK Tan","year":"2017","unstructured":"Tan ACK, Tang ZH, Fadil MFBM (2017) Cadaveric anatomical study of sural nerve: where is the safe area for endoscopic gastrocnemius recession? Open Orthopaedics J 11:1094. https:\/\/doi.org\/10.2174\/1874325001711011094","journal-title":"Open Orthopaedics J"},{"key":"2536_CR29","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1177\/107110070302400807","volume":"24","author":"RZ Tashjian","year":"2003","unstructured":"Tashjian RZ, Appel AJ, Banerjee R, DiGiovanni CW (2003) Endoscopic gastrocnemius recession: evaluation in a cadaver model. Foot Ankle Int 24:607\u2013613. https:\/\/doi.org\/10.1177\/107110070302400807","journal-title":"Foot Ankle Int"},{"key":"2536_CR30","doi-asserted-by":"publisher","first-page":"1099","DOI":"10.1007\/s00264-015-2723-9","volume":"39","author":"G Thevendran","year":"2015","unstructured":"Thevendran G, Howe LB, Kaliyaperumal K, Fang C (2015) Endoscopic gastrocnemius recession procedure using a single portal technique: a prospective study of fifty four consecutive patients. Int Orthop 39:1099\u20131107. https:\/\/doi.org\/10.1007\/s00264-015-2723-9","journal-title":"Int Orthop"},{"key":"2536_CR31","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1186\/s12891-016-1265-7","volume":"17","author":"M Villanueva","year":"2016","unstructured":"Villanueva M, Iborra A, Rodriguez G, Sanz-Ruiz P (2016) Ultrasound-guided gastrocnemius recession: a new ultra-minimally invasive surgical technique. BMC Musculoskelet Disord 17:409. https:\/\/doi.org\/10.1186\/s12891-016-1265-7","journal-title":"BMC Musculoskelet Disord"},{"key":"2536_CR32","doi-asserted-by":"publisher","first-page":"183","DOI":"10.7547\/0980183","volume":"99","author":"PK Vohra","year":"2009","unstructured":"Vohra PK, Japour CJ (2009) Ultrasound-guided plantar fascia release technique: a retrospective study of 46 feet. J Am Podiatr Med Assoc 99:183\u2013190. https:\/\/doi.org\/10.7547\/0980183","journal-title":"J Am Podiatr Med Assoc"},{"key":"2536_CR33","unstructured":"Vulpius O, Stoffel A (1913) Orthopadische Operationslehre: Mit 627 zum Teil farbigen Abbildungen. F. Enke"}],"container-title":["Surgical and Radiologic Anatomy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00276-020-02536-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00276-020-02536-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00276-020-02536-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,22]],"date-time":"2021-07-22T23:22:35Z","timestamp":1626996155000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00276-020-02536-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7,23]]},"references-count":33,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,1]]}},"alternative-id":["2536"],"URL":"https:\/\/doi.org\/10.1007\/s00276-020-02536-1","relation":{},"ISSN":["0930-1038","1279-8517"],"issn-type":[{"value":"0930-1038","type":"print"},{"value":"1279-8517","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,7,23]]},"assertion":[{"value":"20 February 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 July 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 July 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"No outside funding was received. Nothing to declare.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}