Isolated Musculus gastrocnemius tightness is a common cause for foot and ankle pathologies. Currently no standardized examination procedure exists. This manuscript demonstrates that 20 degree of knee flexion eliminates the restraining effect of the M. gastrocnemius on ankle dorsiflexion and presents a video description of a standardized examination protocol.
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Method Article
Diagnosis of Musculus Gastrocnemius Tightness - Key Factors for the Clinical Examination
In This Article
Summary
Abstract
Common foot and ankle pathologies have been linked to isolated Musculus gastrocnemius tightness (MGT). Various examination techniques have been described to assess MGT. Still, a standardized examination procedure is missing. Literature argues for weightbearing examination but the degree of knee flexion needed to eliminate the restraining effect of the M. gastrocnemius on ankle dorsiflexion (ADF) is unknown. This manuscript investigates the effect of knee flexion on ankle dorsiflexion and provides a detailed description of a standardized examination protocol. Examination on 20 healthy individuals revealed, that 20° of knee flexion is sufficient to fully eliminate the influence of the M. gastrocnemius on ADF. This builds the prerequisite for a standardized examination for MGT. Non-weightbearing and weightbearing examination of ADF has to be conducted with the knee fully extended and at least 20° flexed. Two investigators should conduct non-weightbearing testing with the subject in supine position. In order to obtain reliable results, the axis of the fibula should be marked. One examiner can conduct weightbearing examination with the subject in lunge stance. Isolated MGT is present if ADF is impaired with the knee fully extended and knee flexion results in a significant ADF increase. The herein presented standardized examination is the prerequisite for future studies aiming at establishing norm values.
Introduction
Limited ankle dorsiflexion (ADF) alters the gait kinematics and is held responsible for common foot pathologies including Achilles tendinopathy, stress fractures, metatarsalgia and plantar heel pain 1-5. The most common cause for limited ADF is isolated Musculus gastrocnemius tightness (MGT) 3,6.
The joint kinematics of the ankle are influenced by knee flexion as the M. gastrocnemius bridges both joints. The muscle is under tension when the knee is fully extended, as the origin of the muscle is then furthest proximal. The M. gastrocnemius then restrains ADF. Knee flexion approximates the musc....
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Protocol
Ethics statement: The study was approval by the local ethics committee of the University of Munich (# 007-14).
Note: An examination couch freely accessible on both sides and the foot end is required for non-weightbearing testing. A line (tape, approximately 2 meters) on the ground perpendicular the wall is needed for weightbearing testing. A standard goniometer with 2° increments and 20 cm length is used. We recommend documenting the results using a standardized fourfold table containing ADF measurement for the knee extended and flexed for each leg separately.
1. Participant Preparation
- Have the subject take off their pants and remove th....
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Results
Both ankles of 20 healthy individuals (mean age of 27.1 ± 3.9 years), 50% female, were examined. Non-weightbearing and weightbearing tests at six different degrees of knee flexion (full extension, 20°, 30°, 45°, 60°, 75°) and the Lunge Test (uncontrolled knee flexion) were conducted. A functional brace was used to control knee flexion. Measurements were performed by two investigators blinded to each other's results. Between each individual, the order of the investigators and the order of .......
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Discussion
Examinations on 20 healthy individuals revealed, that 20 degrees of knee flexion already eliminates the influence of the M. gastrocnemius on ADF. Further knee flexion resulted in no significant ADF increase. The herein presented video description of a standardized non-weightbearing and weightbearing examination for MGT builds the prerequisite for future studies establishing physiological norm values.
The study has limitations. First, no custom-made measurement device was used to asses.......
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Disclosures
The authors have nothing to disclose.
A biometric version of this study has been published 17. The herein presented paper focuses on the actual conduct of the clinical examinations for isolated MGT. The findings of the biometric paper 17 on the influence of the degree of knee flexion are implanted in this paper.
Acknowledgements
We would like to thank Jakob Binder for his help in subject acquisition and organization of the examinations, Mrs. Hella Thun for designing Figure 1 and 2 and finally Mr. Dipl.-Ing. (FH), M.Sc. M. Saller for his statistical support.
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Materials
| Name | Company | Catalog Number | Comments |
|---|---|---|---|
| Examination couch | |||
| Standard goniometer | MDF Instruments USA, Inc. Malibu, CA, USA | 2° increments |
References
- Wilder, R. P., Sethi, S. Overuse injuries: tendinopathies, stress fractures, compartment syndrome, and shin splints. Clin Sorts Med. 23, 55-81 (2004).
- Irving, D. B., Cook, J. L., Menz, H. B. Factors associated with chronic plantar heel pain: ....
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