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Updated: Oct 23, 2025
Diagnosis of Musculus Gastrocnemius Tightness - Key Factors for the Clinical Examination
Published on: July 7, 2016
Is Gastrocnemius Tightness a Normal Finding in Children?: A Cross-Sectional Study of 204 Norwegian Schoolchildren
Suki Liyanarachi1, Gunn Hulleberg1, Olav A Foss1,2
1St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway.
Insights
Gastrocnemius tightness is common in children and decreases with age. This finding suggests that isolated gastrocnemius tightness is a normal developmental variation, not necessarily a pathological condition.
Area of Science:
- Pediatrics
- Orthopedics
- Sports Medicine
Background:
- Isolated gastrocnemius tightness is linked to various foot conditions.
- The prevalence and significance of gastrocnemius tightness in developing children remain unclear.
- Recurrent foot and leg pain in children warrants further investigation into gastrocnemius tightness.
Purpose of the Study:
- To determine if gastrocnemius tightness is a normal finding in children.
- To investigate the association between gastrocnemius tightness and foot symptoms in pediatric populations.
- To establish age-matched norms for ankle dorsiflexion in schoolchildren.
Main Methods:
- Passive ankle dorsiflexion was measured using the Silfverskiöld test (knee flexed and extended) in 204 Norwegian schoolchildren across four age groups.
- Footprints were analyzed to assess potential correlations between foot morphology and ankle dorsiflexion.
- Gastrocnemius tightness was defined based on specific ankle dorsiflexion thresholds.
Main Results:
- Ankle dorsiflexion significantly decreased with increasing age.
- Using a threshold of ≤5° for ankle dorsiflexion with the knee extended, gastrocnemius tightness was observed in 54.9% of participants.
- No association was found between ankle dorsiflexion measurements and footprint characteristics.
Conclusions:
- Ankle dorsiflexion declines with age in schoolchildren, emphasizing the need for age-specific reference values.
- A high prevalence of gastrocnemius tightness was noted when using a ≤5° threshold, suggesting it is often a normal developmental finding.
- Isolated gastrocnemius tightness in children should not automatically be considered pathological.
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.
