The Effect of Physiotherapy on Lower Extremity Function and Gait in Children with Isolated Gastrocnemius Muscle Tightness

The Effect of a Physiotherapy on Lower Extremity Function and Gait in Children with Isolated Gastrocnemius Muscle Tightness

Since the gastrocnemius muscle crosses both joints, the joint kinematics of the ankle are affected by knee flexion. According to the Kendall & McCreary assessment of normal joint motion angles, the generally accepted normal range of motion for ankle dorsiflexion is 20° when the knee joint is in extension and can approach 30° when the knee joint is flexed due to relaxation of the gastrocnemius. In the mid-stance phase of gait, it is observed that the ankle joint allows 8-10° dorsi flexion movement.

In this study, a minimum 13° increase in dorsiflexion with knee flexion compared to dorsiflexion with knee extension will be considered as isolated gastrocnemius muscle tightness. Isolated gastrocnemius muscle tightness has been associated with many biomechanical changes such as pes planus, talar equinus, hindfoot pronation and symptoms such as plantar fasciitis, leg pain, metatarsalgia, achilles tendinopathy by compensatory effects on the lower extremity and foot during gait. The association of increased hindfoot pronation with isolated gastrocnemius tightness has been shown in many studies. Regardless of the etiology of pronation of the hindfoot, there will be adaptive isolated gastrocnemius tightness with talar plantar flexion. Isolated gastrocnemius tightness, which causes plantar flexion in the ankle joint and pronation in the subtalar joint, also prevents the distribution of the load to the base of the foot within normal limits during weight bearing. However, no study investigating the effect of physiotherapy program on function and gait has been encountered. The aim of this study was to investigate the effect of a physiotherapy program on lower extremity function and gait in children with isolated gastrocnemius muscle tightness.

Study Overview

• Status: Completed
• Conditions: Lower Extremity Biomechanics; Pes Planovalgus; Gastrocnemius Tightness
• Intervention / Treatment: Other: physiotherapy

• Study Type: Interventional
• Enrollment (Actual): 30
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey
  • Istanbul, Turkey, 34050
    • Bezmialem Vakif University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Presence of bilateral pes planovalgus due to the isolated gastrocneius tightness
• Being the ages between 4-10 years old
• Having body mass index between within normal limits

Exclusion Criteria:

• Presence of high femoral anteversion (Craig test > 30 degrees) and/or internal tibial torsion and/or metatursus adductus
• Having of leg length discrepancy
• Accompanying any neurological, rheumatologic, musculoskeletal, metabolic and connective tissue disease
• Presence of pain associated with the vertebral column and lower extremities
• Presence of any lower extremity and/or vertebral column deformity or history of surgery
• Cognitive, mental, serious psychiatric illness
• Participation in any exercise program and/or sportive activity in the last six months

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Study Group; Exercise group

Other: physiotherapy; Bilateral gastrosoleus stretching, iliopsoas and hamstring stretching (if a shortness is detected), foot intrinsic and extrinsic muscle strengthening, lower extremity muscle strengthening and parkour walking training will be performed. Therapeutic exercises will be performed once a week for 12 weeks under the supervision of a physiotherapist. Parents will be asked to follow a 12-week home exercise program at home during the five days. The home exercise program will include the exercises performed in the pediatric physiotherapy and research laboratory. Parents will be instructed to perform each exercise twice a day at home. Children will be given a weekly exercise diary to increase adherence to the exercise program.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Gait analyses with Kinovea ® software	The following assessments will be carried out before starting the exercise program. Then the children will be positioned at the beginning of the prepared 5-meter walking path with their underwear on. First, they will be asked to take trial walks and then they will be asked to walk 5 times on this path at their normal walking pace. Video recordings will be taken from frontal (antero-posterior) and sagittal (lateral) planes with a camera placed on a tripod. The same assessments and video recordings will be repeated at the end of the 12-week physiotherapy program. Observational gait analysis will be performed by scoring with the Edinburg Observational Gait Scoring using the frame-by-frame tracking feature of the video. Video recordings of the children obtained from 3 different angles (anterior-posterior-lateral) will be monitored and scored in slow motion with Kinovea ® software	Baseline and immediately after the physiotherapy program
Edinburgh Observational Gait Score	The Edinburgh Observational Gait Score is an easy-to-use, reliable visual scoring system. In 2003, Read et al. developed this scoring system by identifying the key points of pathologic gait in CP. It has 17 parameters evaluating gait in sagittal, coronal and transverse planes, selected in association with computerized gait analysis. It allows the evaluation of archived gait videos for trunk, pelvis, hip, knee, ankle and foot according to the phases of gait.	Baseline and immediately after the physiotherapy program
Lower Extremity Function Scale	It is a test completed by the parents to assess health-related quality of life. It includes some activities that require the use of the foot and leg in daily life. The degree of difficulty of the child with isolated gastrocnemius muscle tightness to perform these activities is scored between 0 (not difficult) and 4 (unable). As the test score gets closer to 0 (zero), the functional level of the child increases.	Baseline and immediately after the physiotherapy program

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Foot Posture Index (FPI-6)	It is a practical method that provides information about the alignment disorders of the foot and allows evaluation in multiple plans. FPI-6 is a scoring system in the range of -12 and +12 obtained by scoring the data in the range of +2 and -2 for 6 separate analyzes. The evaluation will be performed in the position in which the children feel comfortable, with their arms at their sides, in a standing posture while looking straight ahead. Each analysis will be scored on a 5-point scale (+2, +1, 0, -1, -2) with positive values indicating pronation and negative values indicating supination.	Baseline and immediately after the physiotherapy program
Navicular Drop Test	The navicular drop test is a test used clinically to determine the presence and degree of pes planus. In this test, the navicular tubercle is first palpated and marked and the distance between the navicular tubercle and the floor is measured while the person is in a sitting position and the feet are only in contact with the floor (without weight on the feet). The distance between the navicular tubercle and the floor is then measured again with the person standing up and putting equal weight on the feet. Measurements will be made bilaterally and recorded in millimeters (mm). In the navicular drop test, the difference between weighted and unweighted measurements between 5-9 mm is considered normal (neutral), 10 mm or more is considered pronation, and 4 mm or less is considered supination.	Baseline and immediately after the physiotherapy program
Sit to Stand Test	The child will be asked to get up from a chair without armrests and sit back down again with his/her hips and knees flexed at 90° and feet in full contact with the floor. The number of sit-ups within 30 seconds will be recorded with a stopwatch.	Baseline and immediately after the physiotherapy program

Collaborators and Investigators

• Sponsor: Bezmialem Vakif University

Study record dates

Study Major Dates

• Study Start (Actual): October 20, 2024
• Primary Completion (Actual): March 22, 2025
• Study Completion (Actual): March 22, 2025

Study Registration Dates

• First Submitted: November 4, 2024
• First Submitted That Met QC Criteria: November 5, 2024
• First Posted (Actual): November 7, 2024

Study Record Updates

• Last Update Posted (Estimated): March 26, 2025
• Last Update Submitted That Met QC Criteria: March 22, 2025
• Last Verified: November 1, 2024

More Information

Terms related to this study

• Keywords: gait; physiotherapy; lower extremity function; Isolated gastrocnemius muscle tightness
• Additional Relevant MeSH Terms: Talipes; Musculoskeletal Diseases; Musculoskeletal Abnormalities; Congenital Abnormalities; Lower Extremity Deformities, Congenital; Limb Deformities, Congenital; Foot Deformities; Foot Deformities, Acquired; Foot Deformities, Congenital; Flatfoot
• Other Study ID Numbers: 12.10.2024-168536

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No