Find out in in this short article about Proximal Medial Gastrocnemius Release (PMGR), what it is, what are the risks and how can treatment help.
What is a PMGR?
This is a day case procedure that is routinely performed under local anaesthetic with sedation. The release is done to reduce the tightness in the Gastrocnemius muscle.
The Gastrocnemius muscle lies in the back of the calf and along with another muscle (Soleus), forms a common tendon that inserts into the heel bone (calcaneus).
Tightness in this muscle/tendon complex can cause:
- Tension in the Plantar Fascia (causing plantar fasciitis/fasciopathy)
- Tension in the Achilles Tendon (causing tendinopathy)
- Tibialis posterior dysfunction (causing weakness and flat foot deformity)
- Forefoot overload (causing bunions, metatarsalgia, ulcers).
Why am I having a PMGR?
You may have trialled a course of stretching or splinting to try and reduce the tightness in your calf. If this has not improved your symptoms, surgery may be the best option for you.
The aim of surgery is to address any of the common problems listed above.
What are the risks?
PMGR is a very safe procedure, however every operation carries an element of risk. Sometimes the improvement to your symptoms may be minor or absent.
There is a small risk of infection, bleeding, nerve injury or deep vein thrombosis (DVT). A small amount of pain, swelling and muscle ache is to be expected and should resolve in the first few weeks after surgery.
Your consultant will give an indication of your level of risk for the above complications when completing your consent form.
What happens during the surgery?
The operation is normally performed under sedation with local anaesthetic. A small incision is made on the back of the calf just below the knee and the covering of the muscle is released to help relieve the calf tightness.
Dissolvable stitches are then used to close the wound and dressings applied.
What can I expect after the surgery?
Most patients can go home the same day as the surgery. Somebody will need to accompany you as you leave hospital.
You will be able to fully weight bear on the leg immediately after the surgery. You will have a bulky bandage around the top of the calf which can be removed 48 hrs after the operation. The adhesive dressing underneath should be kept in place until you see your consultant again after two weeks to check the wound. During this time the dressing should be kept dry.
A small amount of pain and swelling is to be expected and you should take the prescribed pain killers regularly for the first few days.
What can I do after PMGR surgery?
Physiotherapy
You should restart stretching exercises seven days after the surgery. This is an important part of your recovery.
Driving
You should inform your insurance company of your operation. We advise that you should avoid driving for the first 3 days after the operation or until you can perform an emergency stop without restriction.
Work
Most people can return to work one to two weeks after surgery. If you have a physically demanding job you may need longer before returning to work.
Sport
We advise you to avoid strenuous exercise, including swimming, until you are reviewed by your consultant after your operation.
If you have any questions about PMGR or if you are experiencing any of the symptoms mentioned and need an accurate diagnosis, please contact our team to arrange an initial consultation.
