Which procedure is described as performed in zone 3 of the gastrosoleus complex?

• A. Z-lengthening tal
• B. Double/triple hemisection TAL
• C. Gastrosoleus recession
• D. Calcaneal osteotomy

Answer: (A)

Gastrosoleus lengthening is planned by zones, with zone 3 targeting lengthening of the proximal gastrocnemius portion of the complex. The Z-lengthening of the gastrosoleus complex is performed by making a Z-shaped incision in the gastrocnemius aponeurosis and opening it to gain length. This provides controlled, incremental lengthening while preserving continuity of the muscle-tendon unit, reducing the risk of overlengthening and weakness compared with more distal or more aggressive tendon releases.

Other options involve different tissues or approaches: lengthening the Achilles tendon with multiple hemisections is a more distal, more aggressive method; a gastrosoleus recession uses a different lengthening technique not specifically the zone 3 Z-lengthening; and a calcaneal osteotomy is a bone procedure that realigns the hindfoot rather than lengthening the gastrosoleus complex.