Gastrocnemius contracture (ie, ankle dorsiflexion of <10° with the knee extended) can predispose to or aggravate various disorders of the foot and ankle (eg, plantar fasciitis, Achilles tendinosis, flatfoot, diabetic foot ulcer, metatarsalgia, nerve entrapment). In children, gastrocnemius contracture has been associated with equinus foot, spasticity, and cerebral palsy. Gastrocnemius recession can be performed alone or in combination with other techniques. It is indicated in adults with dorsiflexion of <10° with the knee extended. Our video shows how to perform ultrasound-guided proximal and distal gastrocnemius lengthening. Our preliminary study in cadaver specimens showed the surgical procedures to be safe and effective, with the nerves and vessels preserved. We performed proximal lengthening in patients with less marked gastrocnemius contracture, and preliminary results were excellent in most patients. The main indications for the surgical procedures were gastrocnemius contracture, noninsertional Achilles tendinopathy, equinus foot, plantar fasciitis, metatarsalgia, and tarsal tunnel syndrome. The mean increase was 14° for distal lengthening and 12° for proximal lengthening. Pain and function, as reflected by the visual analog scale score and American Orthopaedic Foot and Ankle Society score, improved significantly in all patients. Postoperative pain is minimal, despite the combination of procedures. The approach we present has several advantages. It reduces the size of the incision and can be performed under local anesthesia. It is relatively quick and painless and does not require the use of a tourniquet. Intraoperatively, the main structures, including the sural nerve and saphenous vein, are always visible. There are few complications and contraindications. Both techniques are considered stable, with no undesired overlengthening despite immediate weight bearing. Consequently, there is no weakness or crouch gait. Bilateral procedures may be performed alone or in combination with other ultrasound-guided surgical techniques in an outpatient setting, with proximal or distal ultrasound-guided procedures. The one disadvantage is the steep learning curve, which requires the surgeon to perfect the technique on cadaver specimens and become competent in the use of ultrasound.