Motion in the human body depends upon a fine balance between strength and
flexibility. Muscles need to be strong enough to accomplish a given task, but
they also need to be flexible enough to allow for normal range of motion. Loss
of muscle flexibility can lead to injury. When the upward (dorsiflexion)
range of motion of the ankle is limited, the term equinus is used to describe
tightness in the calf and Achilles tendon.
Equinus is caused by soft tissue or bone pathology and caused by one or more of
Contracture or shortening of the Achilles tendon.
Anterior ankle bone block.
Posterior ankle contracture.
Congential posterior ankle or tendo-Achilles contracture.
The presence of one or more of these conditions will limit the range of
motion of the ankle resulting in equinus.
Folks with moderate to severe equinus will find a number of different foot
problems as a result of a tight calf. These problems may include bunions, flat
feet, hammer toes, tendonitis, heel pain and a host of other foot conditions.
These problems evolve from our first steps as children and continue to develop through
adulthood. Equinus contributes to the development of these problems by causing
an imbalance between each of the muscle groups of the lower extremity.
Treatment of Equinus
The initial steps in treating equinus
include the use of a
heel lift and
calf stretching exercises. Shoes with a
higher heel are also helpful. Folks with equinus should also avoid going
barefoot or in just their socks. Simply put, the lower the heel, the more
problems you'll have with equinus related foot problems.
In some cases, surgical care is required to
lengthen the Achilles tendon. This procedure can also be performed
endoscopically and is called an endoscopic gastrocnemius recession. The following
video shows the steps used to perform an endoscopic
gastrocnemius recession. Two
incisions are used, one on the medial and another on the lateral aspect of the
calf. The obturator and cannula are passed between these two incisions.
An endoscopic gastrocnemius recession (EGR) is performed on an outpatient
basis using a general anesthetic and thigh tourniquet. The procedure take
approximately 15 minutes to complete. Patients are able to walk the same
day of surgery. Follow-up care may include the use of compression hose to
accommodate swelling and the use of an anticoagulant as a prophylactic measure
to prevent deep vein thrombosis (DVT).
An alternative procedure to an EGR is a percutaneous Achilles tendon
lengthening (TAL). A percutaneous TAL is performed with three 0.5 cm stab
incision and often does not require suture closure. Each procedure has its
advantages and disadvantages. The EGR is an ambulatory procedure meaning
that patients can walk on the leg the same day of surgery. The
disadvantage of the EGR is that it weakens the force of equinus by only 5-10%.
A TAL has a significantly greater impact on equinus in that it can weaken to
force of equinus up to 50%. The disadvantage of the TAL is that it is a
non-ambulatory procedure and requires 6 weeks of non-weight bearing casting.
For more information regarding the biomechanical interaction of the leg,
ankle and foot, be sure to view our pages on
EGR - endoscopic gastroc recession.
Equinus - derived from the Latin word equus meaning
horse. Horses are toe walkers. A horse’s hoof is actually its toes. And
hence the comparison to humans with a tight calf.
TAL - tendo-Achilles lengthening.
The calf consists of two muscles, the gastrocnemius and the soleus. The
origin of the gastrocnemius is above the knee on the posterior thigh (femur) and
the origin of the soleus is below the knee on the lower leg (tibia). As these
two muscles descend the leg from the knee to the ankle, they merge to form the
Achilles tendon. The Achilles tendon inserts into the back of the heel bone
(calcaneus). Equinus is said to be present if the range of motion at the ankle
is limited due to tightness in the calf.
Normal range of motion in the ankle is measured by placing a person supine
with their knees extended (straight) and force is applied to the
forefoot, moving the toes and forefoot towards the knee. This motion at
the ankle is called dorsiflexion. To measure the range
of motion, an imaginary line is drawn down the lateral (outside) side of the leg and foot.
Range of motion is considered normal when the patient to be able to reach a
90 degree angle between the two lines plus an additional 10 degrees. Any
measurement shy of 90 degrees would be considered equinus.
Please note - accurate measurement of equinus requires positioning of several
joints and requires some training to be performed accurately. This brief
description is merely for sake of example.
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At the conclusion of this article you'll find a number of products that are
recommended by Myfootshop.com to treat this condition. These products have
been hand picked by the medical consulting staff at Myfootshop.com for their
effectiveness and reliability. Should you have any questions regarding the
selection or use of these products please don't hesitate to contact us at
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