Isolated gastrocnemius tightness
Isolated gastrocnemius tightness
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DOI：
10.2106/00004623-200206000-00010
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发表时间：
2002-06-01
影响因子：
5.3
通讯作者：
Sangeorzan, BJ
中科院分区：
文献类型：
--
作者：
DiGiovanni, CW;Kuo, R;Sangeorzan, BJ
背景：在痉挛或神经受损个体中，腓肠肌 - 比目鱼肌复合体挛缩对下肢功能的有害影响已有充分记录。然而，关于孤立性腓肠肌挛缩的存在及其在其他方面正常的患者中的影响，文献资料很少。我们假设，由于马蹄足挛缩导致的踝关节背屈不能会引起前足和/或中足疼痛增加，因此有此类疼痛的人群最大踝关节背屈角度将小于对照组。我们还进一步假设，无论膝关节伸直还是屈曲，这种差异都会存在。
方法：本研究是对两个年龄、体重和性别匹配的健康组在足部底面施加负荷时最大踝关节背屈（作为腓肠肌张力的替代指标）的前瞻性比较。患者组包括34例连续诊断为跖骨痛或相关中足和/或前足症状的患者。对照组由34例无足部或踝关节症状的个体组成。对参与者进行腓肠肌和比目鱼肌挛缩的临床检查，随后使用专门设计的电子测角仪评估其紧张度。在膝关节伸直（腓肠肌紧张）和膝关节屈曲（腓肠肌放松）两种情况下进行测量。
结果：膝关节完全伸直时，患者组平均最大踝关节背屈为4.5°，对照组为13.1°（p < 0.001）。膝关节屈曲90°时，患者组平均为17.9°，对照组为22.3°（p = 0.09）。当将腓肠肌挛缩定义为膝关节伸直时背屈小于或等于5°时，在65%的患者中被发现，而在对照组中为24%。然而，当将腓肠肌挛缩定义为背屈5 - 10°时，分别在88%和44%的人群中存在。当将腓肠肌 - 比目鱼肌挛缩定义为膝关节屈曲90°时背屈小于或等于10°时，在患者组中29%被发现，在对照组中为15%。
结论：平均而言，有前足和/或中足症状的患者在膝关节伸直时的最大踝关节背屈角度小于无足部或踝关节症状的对照组。当膝关节屈曲90°使腓肠肌放松时，这种差异不再存在。
临床相关性：这些发现支持在其他方面健康的人群中，孤立性腓肠肌挛缩在引发前足和/或中足病变中的存在。这些数据可能对慢性足部问题患者的预防和治疗护理有影响。
Background: Contracture of the gastrocnemius-soleus complex has well-documented deleterious effects on lower-limb function in spastic or neurologically impaired individuals. There is scarce literature, however, on the existence of isolated gastrocnemius contracture or its impact in otherwise normal patients. We hypothesized that an inability to dorsiflex the ankle due to equinus contracture leads to increased pain in the forefoot and/or midfoot and therefore a population with such pain will have less maximum ankle dorsiflexion than controls. We further postulated that the difference would be present whether the knee was extended or flexed.Methods: This investigation was a prospective comparison of maximal ankle dorsiflexion, as a proxy for gastrocnemius tension, in response to a load applied to the undersurface of the foot in two healthy age, weight, and sex-matched groups. The patient group comprised thirty-four consecutive patients with a diagnosis of metatarsalgia or related midfoot and/or forefoot symptoms. The control group consisted of thirty-four individuals without foot or ankle symptoms. The participants were clinically examined for gastrocnemius and soleus contracture and were subsequently assessed for tightness with use of a specially designed electrogoniometer. Measurements were made both with the knee extended (the gastrocnemius under tension) and with the knee flexed (the gastrocnemius relaxed).Results: With the knee fully extended, the average maximal ankle dorsiflexion was 4.5degrees the patient group and 13.1degrees in the control group (p < 0.001). With the knee flexed 90, the average was 17.9degrees in the patient group and 22.3degrees in the control population (p = 0.09). When gastrocnemius contracture was defined as dorsiflexion of less than or equal to5degrees during knee extension, it was identified in 65% of the patients compared with 24% of the control population. However, when gastrocnemius contracture was defined as dorsiflexion of 510, it was present in 88% and 44%, respectively. When gastrocnemius-soleus contracture was defined as dorsiflexion of less than or equal to10degrees with the knee in 90degrees of flexion, it was identified in 29% of the patient group and 15% of the control group.Conclusions: On the average, patients with forefoot and/or midfoot symptoms had less maximum ankle dorsiflexion with the knee extended than did a control population without foot or ankle symptoms. When the knee was flexed 90 to relax the gastrocnemius, this difference was no longer present.Clinical Relevance: These findings support the existence of isolated gastrocnemius contracture in the development of forefoot and/or midfoot pathology in otherwise healthy people. These data may have implications for preventative and therapeutic care of patients with chronic foot problems.