Gastrocnemius tightness in persons with and without foot and ankle pathology

S. Chambers, A. Goldberg, N. Cullen, D. Singh

Introduction: This study used the lunge test to measure the difference between ankle dorsiflexion with the knee flexed and extended in persons with and without foot and ankle pathology. This may help us devise a weight bearing test for GT. There is little credible research comparing GT in people with and without foot and ankle pathology. There is no normative data for ankle dorsiflexion range measured using a Lunge test and prevalence of GT in the normal population.

Methods: 97 ankles with foot and ankle (FA) pathology and 89 ankles of healthy volunteers (HV) without FA pathology were recruited from the royal national orthopaedic hospital (RNOH). Degrees of ankle dorsiflexion range were measured using an inclinometer and a version of the lunge test with the knee flexed and extended. These findings were then compared between groups.

Results: The difference between FA vs HV for knee flexed: Ankle dorsiflexion with the knee flexed was lower in the FA group (mean=27.56 degrees, SD=8.10) than the HV group (mean=29.95 degrees, SD=6.37) however, the mean difference (2.39 degrees) between the groups was not statistically significant (p=0.30 [CI 2.40-4.54]). The difference between FA vs HV for knee extended: Ankle dorsiflexion was lower in the FA group (mean=22.02 degrees, SD=8.27) than the HV group (mean = 26.25 degrees, SD=6.04) with the knee extended. The mean difference (4.23 degrees) between the groups was statistically significant (p=< 0.001 [CI 2.11-6.34]); Cohens d=0.58. The difference in ankle dorsiflexion between knee positions in FA vs HV: The difference in ankle dorsiflexion between knee positions was higher in the FA group (mean=5.62 degrees, SD=4.41) than the HV group (mean=3.62 degrees, SD=3.12). The mean difference (1.996 degrees) between the groups was statistically significant (p=0.001 [CI 0.88-3.11]); Cohens d=0.52.

Conclusion: FA patients have significantly lower ranges of ankle dorsiflexion with the knee extended when compared to controls using the lunge test. The difference in ankle dorsiflexion between knee positions is significantly higher in FA patients when compared to controls; this may be attributable to GT. We aim to continue recruiting healthy controls, patients with FA pathology and patients with other musculoskeletal pathology to show the prevalence of GT in the general population. These findings could improve both conservative and surgical management of GT in associated musculoskeletal pathology.