Aims. Gastrocnemius tightness predisposes to musculoskeletal pathology and may require surgical treatment. However, it is not clear what proportion of patients with foot and ankle pathology have clinically significant gastrocnemius tightness. The aim of this study was to compare the prevalence and degree of gastrocnemius tightness in a control group of patients with a group of patients with foot and ankle pathology. Patients and Methods. This prospective, case-matched, observational study compared gastrocnemius tightness, as assessed by the lunge test, in a control group and a group with foot and ankle pathology. Gastrocnemius tightness was calculated as the difference in dorsiflexion of the ankle with the knee extended and flexed. Results. A total of 291 controls were paired with 97 patients with foot and ankle pathology (FAP). The mean gastrocnemius tightness was 6.0° (. sd. 3.5) in controls and 8.0° (. sd. 5.7) in the FAP group (p < 0.001). Subgroup analysis showed a mean gastrocnemius tightness of 10.3° (. sd.  6.0) in patients with forefoot pathology versus 6.9° (. sd. 5.3) in patients with other pathology (p = 0.008). A total of 12 patients (37.5%) with forefoot pathology had gastrocnemius tightness of > two standard deviations of the control group (> 13°). Conclusion. Gastrocnemius tightness of > 13° may be considered abnormal. Most patients with foot and ankle pathology do not have abnormal degrees of gastrocnemius tightness compared with controls, but it is present in over a third of patients with forefoot pathology. Cite this article: Bone Joint J 2018;100-B:945–52

Myoneural blockade is a well-established means of reducing tone in spastic muscles, thereby delaying or avoiding the need for operative intervention. The recent interest in botulinum A toxin has tended to obscure the fact that other agents such as alcohol have been used for many years to achieve a similar effect. Eighty-two children between the ages of 2 and 16 years with cerebral palsy underwent myoneural blocks using 45% ethanol for dynamic contracture of the hamstrings and/or gastrocnemius. The injections were performed under a light general anaesthetic, using a nerve stimulator to localise the myoneural junction. A total of 153 muscle groups were injected. Hamstring tightness improved as a result of ethanol injection, the popliteal angle reducing from a mean of 73° (range 40° – 90°) to 43° (range 10° – 70°). Gastrocnemius tightness also improved, the ankle dorsiflexion with knee extended improving from a mean of −7° to +3°. The maximal effect was achieved in a mean of 12 weeks and was maintained for a further 12 weeks before starting to deteriorate. The time from injection to the next intervention ranged from 13 weeks to over 2 years. There were no complications or adverse effects. The effect of any one therapy in cerebral palsy is difficult to establish, given that there are often several different modalities of treatment operating concurrently. However, the results from this series indicate that myoneural blockade with ethanol is a useful and safe adjunct to other therapies in the child with lower limb spasticity