Dr. DeHeer's Article Review: Gastrocnemius Contracture in Patients With and Without Foot Pathology

Article: Gastrocnemius Contracture in Patients With and Without Foot Pathology

Jastifer, James R., and Jessica Marston. Foot & Ankle International (2016): 1071100716659749.

Abstract Link: http://fai.sagepub.com/content/early/2016/07/21/1071100716659749.abstract

Key Points:

  1. This study examined ankle joint dorsiflexion in patients with and without foot pathology as well as a control group utilizing a validated measuring technique
  2. 66 consecutive patients and 66 control patients were examined with ankle joint measurements obtained using three different methods
    1. Clinical examination
    2. Goniometer examination
    3. Iowa Ankle Range of Motion (IAROM) type of device – previously validated instrument to measure ankle joint dorsiflexion
  3. No statistically significant difference in demographic categories between two groups
  4. Ankle dorsiflexion measurements
    1. IAROM (3 measurements with statistical difference between measurements) – pathology group 11.6°/control group 17.2° (p<0.0001)
    2. Goniometer – pathology group 3.6°/control group 6.1° (p=0.02)
    3. Clinical exam – pathology group 3.0°/control group 6.0° (p=0.002)
  5. Subgroups (sex, gender, BMI) showed statistical difference between pathology and control groups
  6. Conclusion: “Patients with foot and ankle pain had less ankle dorsiflexion than the control group. This is the largest study to date using a validated measurement device as well as a control group and supports the findings of previous authors. This study supports the notion that an isolated gastrocnemius contracture may be associated with foot and ankle pain.”

DeHeer’s Opinion: This article is the largest to date to show that patients with limited ankle joint dorsiflexion is associated with foot and ankle pathologies. It adds to the substantial amount of literature supporting the significance of equinus on the lower extremity. The device used in the study is not commercially available. There was a significant difference between the goniometer/clinical numbers and those from the IAROM. The important point is that in all groups, a clinically significant difference in ankle joint dorsiflexion between the pathology group and the control group was found. The authors did stress the importance of proper technique when measuring ankle joint dorsiflexion (putting the hindfoot in varus or neutral position, reproducible goniometer landmarks, and proper amount of force applied to the foot).

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