The Effect of Targeting the Plantaris Muscle-tendon in Surgical Correction of Ankle Equinus in Children

NCT07090057 | Recruiting

• 1 other identifier: Pro00123505
• Study Type: interventional
• Target: 42
• Locations: 1 country
• Sites: 1

Brief Summary

Tight ankle muscles can produce ankle equinus (limited ability to pull the foot upward) and occur often in children, significantly impacting their ability to walk. If not treated, children with ankle equinus frequently experience reduced function and long-term foot problems, such as pain. Currently, treatment options include surgery or Botulinum toxin (BoNTA) injection into the large calf muscles that point the foot downwards, aiming to reduce their tightness. However, these treatments can be less effective over time, can create prolonged calf weakness, and may require long-term bracing. Another small muscle in the leg, the plantaris, is believed to have some contribution to equinus in many children. It is sometimes included in treatment plans for equinus but its contribution is poorly understood. It is unclear whether targeting the plantaris alone could lead to better treatment of ankle equinus. Understanding the effect of treatments targeting the plantaris could help clinicians improve the management of ankle equinus. In this study, the investigators will look at the impact of surgical treatment to the plantaris in ankle equinus. The investigators hypothesize that the plantaris is a significant contributor to equinus. In this study, data will be collected from children undergoing surgical correction of ankle equinus, including lengthening of the plantaris and lengthening of the larger muscles producing equinus (the gastrocsoleus mechanism). Children will be randomly assigned to have either their plantaris or the gastrocsoleus lengthening be done first during surgery. All children will have both structures lengthened during surgery, only the order will be varied and all surgical procedures for each patient will be completed in a single setting. In both groups, maximum passive ankle dorsiflexion (upwards bend of the ankle with the knee straight) will be measured before and after each structure is lengthened. The outcome is maximum passive ankle dorsiflexion (upwards bend of the ankle) with the knee straight. The investigators expect that maximum passive ankle dorsiflexion will increase after lengthening of the plantaris. Understanding the contribution of the plantaris muscle in ankle equinus could lead to significant improvements in the treatment of children with tight ankles.

Conditions

Idiopathic Toe Walking; Cerebral Palsy; Hereditary Spastic Paraparesis; Traumatic Brain Injury; Spinal Cord Injury; Spinal Cord Tethering; Stroke; Hereditary Sensory-motor Neuropathy

Keywords

tendoachilles lengthening; gastrocnemius recession; Plantaris lengthening

Outcome Measures

Primary Outcomes (4)

• Maximum passive ankle dorsiflexion

  Ankle dorsiflexion (unit: degree) will be measured by the surgeon with a sterile goniometer during the surgery.

  Prior to skin incision

• Maximum passive ankle dorsiflexion

  Ankle dorsiflexion (unit: degree) will be measured by the surgeon with a sterile goniometer during the surgery.

  Prior to division of first tendon/aponeurosis

• Maximum passive ankle dorsiflexion

  Ankle dorsiflexion (unit: degree) will be measured by the surgeon with a sterile goniometer during the surgery.

  After division of first tendon/aponeurosis

• Maximum passive ankle dorsiflexion

  Ankle dorsiflexion (unit: degree) will be measured by the surgeon with a sterile goniometer during the surgery.

  After division of second tendon/aponeurosis

Study Arms (2)

Tendoachilles (TA) lengthening or gastrocnemius (GN) recession, then Plantaris tenotomy

EXPERIMENTAL

Participants undergo Tendoachilles (TA) lengthening or gastrocnemius (GN) recession surgery before Plantaris tenotomy.

Procedure: Tendoachilles (TA) lengthening or gastrocnemius (GN) recession, then Plantaris tenotomy

Plantaris tenotomy, then Tendoachilles (TA) lengthening or gastrocnemius (GN) recession

EXPERIMENTAL

Participants undergo Plantaris tenotomy surgery before Tendoachilles (TA) lengthening or gastrocnemius (GN) recession.

Procedure: Plantaris tenotomy, then Tendoachilles (TA) lengthening or gastrocnemius (GN) recession

Interventions

Tendoachilles (TA) lengthening or gastrocnemius (GN) recession, then Plantaris tenotomy PROCEDURE

Participants undergo Tendoachilles (TA) lengthening or gastrocnemius (GN) recession surgery before Plantaris tenotomy.

Tendoachilles (TA) lengthening or gastrocnemius (GN) recession, then Plantaris tenotomy

Plantaris tenotomy, then Tendoachilles (TA) lengthening or gastrocnemius (GN) recession PROCEDURE

Participants undergo plantaris tenotomy surgery before Tendoachilles (TA) lengthening or gastrocnemius (GN) recession.

Plantaris tenotomy, then Tendoachilles (TA) lengthening or gastrocnemius (GN) recession

Eligibility Criteria

• Age: 4 Years - 17 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17)

You may qualify if:

• Ability to provided informed consent/assent in English.
• Pediatric patients (4-17 years) who have consented for surgery for the management of equinus contracture \* (either TA lengthening or GN recession) at the Stollery Children's Hospital
• Known underlying diagnosis of any of the following: idiopathic toe walking, cerebral palsy, hereditary spastic paraparesis, traumatic brain injury, spinal cord injury/tethering, hereditary sensory-motor neuropathy, stroke
• Ability to maintain hindfoot and midfoot neutral during assessment
• Passive plantarflexion on affected side greater than 20° and greater than degree of equinus contracture.
• Note: may be isolated or in conjunction with other orthopaedic procedures; in bilateral ankle equinus procedures, data will be collected bilaterally, but included as a single participant (i.e., single randomization).

You may not qualify if:

• Unable to provide informed consent/assent in English.
• Previous surgery for equinus
• Limb deficiency on affected side
• Knee flexion contracture of greater than 5°
• Surgical intervention of the lower extremities below the affected knee in the last twelve months
• BoNTA injections below the affected knee within the last six months
• Known or suspected arthrofibrosis.

Sponsors & Collaborators

• University of Alberta: lead

Study Sites (1)

Stollery Children's Hospital

Edmonton, Alberta, T6G2B7, Canada

RECRUITING

MeSH Terms

Conditions

Cerebral Palsy; Spastic Paraplegia, Hereditary; Brain Injuries, Traumatic; Spinal Cord Injuries; Stroke; Charcot-Marie-Tooth Disease

Condition Hierarchy (Ancestors)

Brain Damage, Chronic; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Hereditary Sensory and Motor Neuropathy; Nervous System Malformations; Heredodegenerative Disorders, Nervous System; Neurodegenerative Diseases; Polyneuropathies; Peripheral Nervous System Diseases; Neuromuscular Diseases; Congenital Abnormalities; Congenital, Hereditary, and Neonatal Diseases and Abnormalities; Genetic Diseases, Inborn; Brain Injuries; Craniocerebral Trauma; Trauma, Nervous System; Wounds and Injuries; Spinal Cord Diseases; Cerebrovascular Disorders; Vascular Diseases; Cardiovascular Diseases

Study Officials

• Sukhdeep Dulai, MD, MHSc, FRCSC

  University of Alberta

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Ailar Ramadi, PhD

CONTACT

780-492-2398; Ailar.Ramadi@albertahealthservices.ca

Collaborative Orthopaedic Research (CORe)

CONTACT

frmcore1@ualberta.ca

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: Data will be collected from 42 children undergoing surgical intervention for ankle equinus. Subjects will be randomly allocated into two groups of equal size: 1) plantaris lengthened before the lengthening of gastrocsoleus and 2) plantaris lengthened after gastrocsoleus lengthening. All surgical procedures for each patient will be completed in a single setting.

Study Record Dates

• First Submitted: July 22, 2025
• First Posted: July 29, 2025
• Study Start: March 13, 2023
• Primary Completion (Estimated): December 31, 2026
• Study Completion (Estimated): December 31, 2026
• Last Updated: March 12, 2026

Record last verified: 2026-03

Data Sharing

• IPD Sharing: Will not share

Locations

CA (1)