Is Gastrocnemius Tightness a Normal Finding in Children?: A Cross-Sectional Study of 204 Norwegian Schoolchildren

Abstract

Background:Isolated gastrocnemius tightness has been associated with several foot conditions. We do not know whether gastrocnemius tightness is a normal finding in the developing child or whether tightness is associated with foot symptoms. Recurrent foot and leg pain is common in children, and more knowledge of gastrocnemius tightness is of interest.Methods:Passive ankle dorsiflexion was measured with the knee flexed and extended (Silfverskiöld test) in 204 Norwegian schoolchildren (408 feet). School classes from 4 different age groups were recruited (5 to 6 years, 8 to 9 years, 11 to 12 years, and 14 to 15 years). Footprints were also recorded in order to assess for any association between foot morphology and dorsiflexion results, specifically, gastrocnemius tightness.Results:Ankle dorsiflexion decreased with increasing age. The thresholds for equinus contracture were set at either ≤5° or ≤0° of ankle dorsiflexion when measured with the knee extended, and the Silfverskiöld test was considered to be positive when ankle dorsiflexion was reduced by ≥10° from the flexed knee position to the extended knee position. The rate of gastrocnemius tightness was 54.9% if the threshold was set at ≤5° and only 3.7% if the threshold was set at ≤0°. The data did not provide evidence of an association between dorsiflexion and footprints.Conclusions:Ankle dorsiflexion decreased with increasing age in this population of schoolchildren, highlighting the importance of age-matched norms. A majority had a tight gastrocnemius when the ankle dorsiflexion threshold was set at ≤5°, indicating that isolated gastrocnemius tightness should not be interpreted as a pathological finding.Level of Evidence:Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.