About That Torn Calf Muscle...

As those of you who've been following this blog already know, I did a bad thing to my right knee a few months back - torn meniscus, torn medial collateral ligament, and, to the surprise of even the docs, torn muscle fibers in my medial gastrocnemius, or calf muscle. This last item is perplexing on several aspects - it is not consistent with the other injuries, it appears to be older than the other injuries, and the docs said it would have been the result of something like a football tackle. Not something I am known for.

And, as some of you also know, I am doing on-going post-club feet research, via an examination of any and all papers and books on the topic. The current paper I am reading and dissecting, "Long-Term Follow-Up of Patients with Clubfeet Treated with Extensive Soft-Tissue Release", by Dobbs, Nunley, and Schoenecker, from JBJS, 2006. This study looks at 45 patients at an average of 30 years post-treatment, which makes it perhaps the best such study available. While there are flaws, in my opinion, there are a number of very revealing items, which I will go in to in greater depth soon.

For now, however, there is one finding that lept out at me, and I thought it worth sharing here, especially for those of us well beyond 30 years post-treatments. In the Discussion section, this item caught my attention:

The few studies in which patients were followed to skeletal maturity showed that the early results obtained with extensive soft-tissue release deteriorate with time, indicating that longer follow-up is necessary to evaluate the lifelong function of a surgically treated club foot. Ippolito, et. al. found that patients in whom clubfoot was treated with a more extensive soft-tissue release surgery functioned less well at skeletal maturity than did those treated with the Ponsetti method of manipulation and casts. Unsatisfactory results were attributed to increased osteoarthritis in the foot and ankle, increased ankle stiffness, and increased gastrocnemius weakness in the patients treated with the more extensive surgery.

So first, "few studies." This is apparent throughout the literature, and I've editorialized on this before, and will undoubtedly do so again. But of more importance now are the other two bolded items: that soft-tissue surgery, while effective in changing the appearance and general function of the club foot, may actually contribute to later degenerative changes; and it may also result in increased gastrocnemius weakness. So there's the answer to my torn calf muscle. And to so much more related to my chronic pain. Essentially it boils down to this - it should come as no surprise. The very surgeries played a role in subsequent deterioration, as the papers reference to radiographic studies show. All that arthritis was, in this study's conclusion, inevitable.

And do note the comparison to the people treated via the Ponsetti method. Elsewhere in the same paper a comparison made between the two approaches show a nearly 90% better outcome with Ponsetti than with soft-tissue releases and the older Kite casting technique. It is this one specific item that further validates my demand for additional long-term follow-up studies. Here, with a relatively small sample group, is seen how such a study can validate or invalidate previously held assumptions that were/are the basis for treatment that will have a life-long impact on the persons so treated. To fail to carry out such studies, especially on a broader sample group, is in my view, a failure of the Hippocratic oath itself.

Now the question is, what can I do, with even hope for moderate success, to heal my gastrocnemius? I'll keep you all informed on my progress with the prolotherapy. In the meantime, besides the size of your calf muscles, have you or do you experience weakness in the calf? And what, if anything, has worked to help improve that condition?