Gastrocnemius tightness: A population based observational study

Foot Ankle Surg. 2019 Aug;25(4):517-522. doi: 10.1016/j.fas.2018.04.002. Epub 2018 Apr 12.


Background: Gastrocnemius tightness is believed to be associated with multiple musculoskeletal pathologies such as back pain, plantar fasciitis and metatarsalgia. Although surgical treatment of gastrocnemius tightness is gaining popularity the objective definition of a gastrocnemius contracture has not been determined. The aim of our study was therefore to quantify gastrocnemius tightness in a normal population.

Methods: Adult participants with no obvious foot and ankle pathology were recruited. Gastrocnemius tightness was quantified using a weightbearing lunge test. Maximal ankle-foot dorsiflexion was measured on participants with the knee in full extension and flexed to 20° using a digital inclinometer. The ankle-foot dorsiflexion index or ADI (difference in ankle dorsiflexion with the knee extended and flexed) was calculated. The ADI values were plotted on a histogram to identify the distribution of values and were compared according to participant demographics.

Results: 800 limbs from 400 participants were examined. There was a wide distribution of absolute values of maximal ankle-foot dorsiflexion ranging from 8 to 52°. The ADI ranged from 0 to19° and approximated to a normal distribution. The mean ADI was 6.04±3.49° and was positively correlated with age (r=0.132, P<0.001) and negatively correlated with physical activity (r=-0.88, P=0.015).

Conclusion(s): Our study is the first to quantify gastrocnemius tightness in a large healthy adult population with differences observed by age and physical activity. We have defined an easy and reproducible weightbearing test that can be used in both research and clinical settings. The majority of the population have some degree of gastrocnemius tightness and values of ADI greater than 13° (>2 SD of the mean), as measured by the lunge test, may be considered abnormal.

Keywords: Gastrocnemius tightness; Weightbearing lunge test.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Adult
  • Contracture / diagnosis*
  • Female
  • Foot Joints / physiopathology
  • Humans
  • Knee Joint / physiopathology
  • Male
  • Middle Aged
  • Muscle, Skeletal*
  • Range of Motion, Articular
  • Weight-Bearing / physiology*
  • Young Adult