The Journal of Bone and Joint Surgery (American) 84:962-970 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.
Isolated Gastrocnemius Tightness
Christopher W. DiGiovanni, MD,
Roderick Kuo, MD,
Nirmal Tejwani, MD,
Robert Price, MS, ME,
Sigvard T. Hansen, Jr., MD,
Joseph Cziernecki, MD and
Bruce J. Sangeorzan, MD
Investigation performed at the Department of Orthopaedics, Harborview
Medical Center, and the Seattle Veterans Affairs Medical Center,
Seattle, Washington
Christopher W. DiGiovanni, MD
Department of Orthopaedics, Brown University School of Medicine,
University Orthopedics Incorporated, 1287 North Main Street, Providence,
RI 02904
Roderick Kuo, MD
P.O. Box 913, Strathfield, Sydney, NSW, Australia 2135
Nirmal Tejwani, MD
Department of Orthopaedics, New York University School of Medicine,
101 Commodore Terrace, Edgewater, NJ 07020
Robert Price, MSME
Joseph Cziernecki, MD
Department of Rehabilitation Medicine, University of Washington,
RR&D Center, Mailstop 151, Veteran's Affairs Puget Sound Health
Care System, 1660 South Columbian Way, Seattle, WA 98108
Sigvard T. Hansen Jr., MD
Bruce J. Sangeorzan, MD
Department of Orthopaedics, University of Washington, 325 Ninth
Avenue, Seattle, WA 98104-2499
In support of their research or preparation of this manuscript, one
or more of the authors received a grant from the Department of Veterans
Affairs, Seattle Veterans Affairs Medical Center, Seattle, Washington.
The equipment was developed with use of a Department of Veterans
Affairs Center Grant, although no revenues were received. None of
the authors received payments or other benefits or a commitment
or agreement to provide such benefits from a commercial entity. No
commercial entity paid or directed, or agreed to pay or direct,
any benefits to any research fund, foundation, educational institution,
or other charitable or nonprofit organization with which the authors
are affiliated or associated.
Background:
Contracture of the gastrocnemius-soleus complex has well-documented
deleterious effects on lower-limb function in spastic or neurologically
impaired individuals. There is scarce literature, however, on the
existence of isolated gastrocnemius contracture or its impact in
otherwise normal patients. We hypothesized that an inability to
dorsiflex the ankle due to equinus contracture leads to increased
pain in the forefoot and/or midfoot and therefore a population with
such pain will have less maximum ankle dorsiflexion than controls.
We further postulated that the difference would be present whether the
knee was extended or flexed.
Methods:
This investigation was a prospective comparison of maximal ankle
dorsiflexion, as a proxy for gastrocnemius tension, in response
to a load applied to the undersurface of the foot in two healthy
age, weight, and sex-matched groups. The patient group comprised
thirty-four consecutive patients with a diagnosis of metatarsalgia
or related midfoot and/or forefoot symptoms. The control group consisted
of thirty-four individuals without foot or ankle symptoms. The participants
were clinically examined for gastrocnemius and soleus contracture and
were subsequently assessed for tightness with use of a specially
designed electrogoniometer. Measurements were made both with the
knee extended (the gastrocnemius under tension) and with the knee
flexed (the gastrocnemius relaxed).
Results:
With the knee fully extended, the average maximal ankle dorsiflexion
was 4.5° in the patient group and 13.1° in the control
group (p < 0.001). With the knee flexed 90°, the average
was 17.9° in the patient group and 22.3° in the
control population (p = 0.09). When gastrocnemius contracture was
defined as dorsiflexion of  5° during knee extension,
it was identified in 65% of the patients compared with 24% of the
control population. However, when gastrocnemius contracture was
defined as dorsiflexion of 10°, it was present in
88% and 44%, respectively. When gastrocnemius-soleus contracture
was defined as dorsiflexion of 10° with the knee
in 90° of flexion, it was identified in 29% of the patient
group and 15% of the control group.
Conclusions:
On the average, patients with forefoot and/or midfoot symptoms
had less maximum ankle dorsiflexion with the knee extended than
did a control population without foot or ankle symptoms. When the
knee was flexed 90° to relax the gastrocnemius, this difference
was no longer present.
Clinical Relevance:
These findings support the existence of isolated gastrocnemius
contracture in the development of forefoot and/or midfoot pathology
in otherwise healthy people. These data may have implications for
preventative and therapeutic care of patients with chronic foot
problems.
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