Gastrocnemius Tightness and Foot Pain in Children

Is There an Association Between Gastrocnemius Tightness and Foot- and Legpain in Children?

Foot and leg pain among otherwise healthy children is a common reason for referral to our pediatric orthopaedics outpatient clinic. The pain is often intermittent and transient, but for some the pain is more dominating and has an impact on the child and families. Children grown and have normal anatomical variations such as in-toeing, out-toeing, hypermobility, flatfeet, knock knees etc. Assessing such normal variants is a major part of pediatric orthopaedic practice, and a common finding is a positive Silvferskiöld test, indicating gastrocnemius tightness. This is when dorsiflexion of the ankle is limited with extended knee, compared to flexed knee. We do not know if this is a more frequent finding among children with foot and leg pain. There is however evidence that adults with painful foot conditions often have gastrocnemius tightness.

This project will investigate for gastrocnemius tightness in otherwise healthy children referred to our pediatric orthopaedic outpatient clinic with foot and leg pain, and compare results with a similar control group of children without pain. The aim is to investigate if there is an association, and how pain and tightness develops over time. The knowledge from this project will enable us to develop new treatment strategies to this patient group, where current evidence based recommendations are few.

Study Overview

• Status: Recruiting
• Conditions: Child Development; Gastrocnemius Equinus
• Intervention / Treatment: Other: Clinical examination

• Study Type: Observational
• Enrollment (Estimated): 200

Contacts and Locations

• Study Contact: Name: Tina Wik; Phone Number: +4772826521; Email: tina.stromdal.wik@stolav.no

Study Locations

• Norway
  • Trondheim, Norway
    • Recruiting
    • St Olavs hospital
    • Contact: Suki Liyanarachi; Phone Number: +4772821126; Email: suki.liyanarachi@stolav.no

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Children referred to pediatric orthopaedic outpatients clinic from a family doctor

Description

Inclusion Criteria:

• Otherwise healthy children referred to pediatric orthopaedic outpatient clinic with foot and/or leg pain with a normal leg function

Exclusion Criteria:

• Patients with foot conditions, general medical conditions affecting the foot or clinical findings indicating a need for further investigation for a diagnosis. Such as:

Foot deformities (cavo-varus foot, clubfoot) Tarsal coalitions Neuro-orthopedic conditions (CP, MMC) Fracture sequelae Infections and tumour

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Children with pain; These are children referred with fot and leg pain. Following outcomes will be measured on all included children: Silvferskiölds test Height Weight Gender Age PROM child: Oxford Ankle and Foot Questionnaire for children PROM parent: Oxford Ankle and Foot Questionnaire for parents FPS pain scoring over 1 week	Other: Clinical examination; No intervention, only clinical examination
Control group children without pain; Following outcomes will be measured on all included children in control group: Silvferskiölds test Height Weight Gender Age	Other: Clinical examination; No intervention, only clinical examination

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Silvferskiölds test	Clinical measurement of gastrocnemius tightness	2 years

Collaborators and Investigators

• Sponsor: St. Olavs Hospital
• Collaborators: National Taiwan Normal University
• Investigators: Principal Investigator: Håkon Langvatn, St. Olavs hospital

Study record dates

Study Major Dates

• Study Start (Actual): May 9, 2023
• Primary Completion (Estimated): June 1, 2027
• Study Completion (Estimated): June 1, 2028

Study Registration Dates

• First Submitted: May 8, 2023
• First Submitted That Met QC Criteria: May 8, 2023
• First Posted (Actual): May 17, 2023

Study Record Updates

• Last Update Posted (Estimated): June 5, 2025
• Last Update Submitted That Met QC Criteria: June 4, 2025
• Last Verified: June 1, 2025

More Information

Terms related to this study

• Other Study ID Numbers: 526706

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No