Equinus of the Foot and Ankle

What is equinus?

Equinus is a condition with limited dorsiflexion/up wards bending of the ankle joint. People with equinus are unable to bend there ankle joint past about 90 degrees, typically people are supposed to get an additional 10 degrees. 

What are the causes of equinus?

Equinus is typically caused by a tight achilles tendon that is formed from the gastrocnemius and soleus muscle. This tight achilles can be inherited or acquired through being in a cast for a long time, wearing high heels excessively, diabetes, and aging can cause tightness of achilles to form. A bone block can also limit ankle dorsiflexion from having high arches, a bone fragment or bone spur growth. Some congenital issues that can cause equinus are limb length discrepancy and calf spasms (spastic equinus from cerebral palsy). 

How to diagnose equinus?

Clinically the silfverskiold exam is done to test equinus. Ankle dorsiflexion is tested with the knee straight and knee bent. If there is improvement in ankle dorsixfleion with knee flexed it is gastrocnemius equinus and if the the dorsiflexion is the same with the knee bent/straight than the patient has achilles tightness. X-rays are taken to ensure there is not also a bone block. 

What are the consequences of having long term equinus?

Patients with equinus are at risk for developing foot conditions such as: plantar fasciitis, calf cramping, achilles tendonitis, metatarsalgia, flat foot, arthritis, shin splints, hammertoes. 

How to treat equinus?

Conservatively stretching, physical therapy, and a night splint are used. If the patient continues to have equinus after conservative treatment surgery is done to either lengthen the gastrocnemius muscle (Strayer) or achilles tendon lengthening. If the patient has equinus from a bone block issue that that has to be addressed. 

Video of the strayer procedure: https://www.youtube.com/watch?v=IQ-vDNIoV6k&t=101s

If you have foot or ankle pain and would like a consultation. Make an appointment at Orange County Podiatry with Dr. Andrew Yang https://ocfootandankleclinic.com/appointments/ or call (949) 651-1202