Ankle Equinus Condition and How It Affects the Feet

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What Is Ankle Equinus?

Ankle equinus is a condition in which the ankle joint cannot bend upward sufficiently. This can be due to tightness in the Achilles tendon or calf muscles, or a bone block that blocks the ankle’s range of motion. When the ankle cannot bend upward properly, it’s said to be in “equinus.” This condition can lead to a variety of foot problems. 

In this article, we’ll discuss in detail the effects of ankle equinus and how it can affect your feet. 

Let’s dive in…

Anatomy

The two calf muscles (gastrocnemius and soleus) make up the Achilles tendon halfway down the leg. The gastrocnemius muscle originates in the back of the femur, while the soleus muscle originates in the back of the tibial (shin bone) and fibula. 

The Achilles tendon inserts at the back of the heel bone (calcaneus). The Achilles tendon helps you push off when you walk and helps you point your foot in a downward position (plantarflexion). 

The ankle joint range of motion (with the knee extended) should be 10 degrees. If you have less motion than this at your ankle joint, then equinus is present. 

This suggests that your calf muscles/Achilles tendon is tight. This can be hereditary, but can also be exacerbated by wearing high heel shoes.

Some people, however, may have a bone block causing their equinus. This can happen when there is bone growth in the front of your ankle that blocks the ankle from moving in an upwards direction. The bone may be present due to arthritis or from an old fracture. 

Some people are born with neuromuscular disorders, such as Cerebral Palsy, that cause spasticity and tightening of the Achilles tendon.

Symptoms of Ankle Equinus and How It Affects the Feet

• Early heel lift when walking
• Toe walking
• Ball of foot pain
• Heel pain
• Stiffness in the ankle
• Knee pain/back pain

Having less range of motion in your ankle than normal can cause a slew of foot issues. When the Achilles tendon is tight, your heel may not fully touch the ground, leading to “early heel lift” or toe walking.

When children are young, they often toe-walk. However, by age 7, many people will start walking heel to toe. Toe walking can cause excess pressure to be placed on your forefoot and midfoot. Not to mention that it can tighten your Achilles tendon further. 

Equinus can also cause metatarsalgia to develop. Metatarsalgia is a condition where the ball of the foot (metatarsal heads) becomes inflamed due to excess pressure. Excess pressure being placed in the ball of the foot can cause painful calluses to develop. This can make it difficult to walk. 

In addition, if there is excess pressure being placed on the ball of the feet, painful neuromas can develop. A neuroma is a pinched nerve that occurs in the ball of the foot due to excessive pressure/injury. 

Excessive pressure in the forefoot can also cause diabetic foot ulcers. This is a big problem in diabetics who have neuropathy and are already at risk for diabetic foot ulcers. Chronic foot ulcers can lead to bone infections and amputation. 

To read more about diabetic foot ulcers in detail, check out this supplemental post: A Simple Guide To Managing Diabetic Foot Ulcers.

When you have an equinus deformity, you may develop plantar fasciitis due to excessive pronation of the foot. Not only that, excessive pronation can increase the likelihood of developing a bunion deformity.  

Tightness of the Achilles tendon can also cause Achilles tendonitis. You may experience pain in the back of your heel due to the pulling of the tight tendon.

Your body compensates when you have less than optimal ankle joint dorsiflexion. You may notice hyperextension of the knees or even lumbar lordosis. This can cause chronic knee and back pain. 

How Do You Test for Ankle Equinus?

You can confirm the presence of and the type of equinus by performing the Silfverskiold test. Your doctor will use a device called a goniometer to check ankle joint dorsiflexion with the knee extended. If ankle joint dorsiflexion is less than 10 degrees, gastrocnemius equinus is said to be present. 

Your doctor will then check your ankle joint range of motion with the knee flexed. If there is a limitation in ankle joint dorsiflexion with the knee extended and flexed, there is the presence of gastro soleal equinus. This is because when the knee is bent, the gastrocnemius muscle is relaxed, and thus this allows you to test the soleus muscle contracture. 

How Is Equinus Deformity Treated?

How Can I Lengthen My Achilles Tendon Without Surgery?

Ankle equinus can be treated non-surgically by performing calf muscle/Achilles tendon stretching exercises. Perform this 3 times daily for 10-15 minutes at a time.

Check out this supplemental article on how to perform achilles tendon stretching exercises.

Physical therapy can help immensely in reducing tightness in the Achilles tendon and improving ankle joint range of motion.

Other Non-surgical Options for Equinus

Your doctor may recommend custom orthotics to help support and stabilize the feet. Custom orthotics are custom-made for your feet and can help reduce pressure in certain areas of the feet. Custom orthotics generally last 5-10 years before they need to be replaced. If you have painful calluses or ulcers, custom orthotics can help alleviate the discomfort. 

If you suffer from plantar fasciitis or Achilles tendonitis, your doctor may suggest a heel lift to lift the heel and take tension away from the Achilles tendon. You can obtain a prefabricated heel lift on Amazon to put into your shoe. Start by using a ⅛” lift first. 

If you experience heel pain early in the morning when you first get out of bed, you may benefit from wearing a night splint. A night splint is a brace that you wear at night that holds your ankle up in a dorsiflexed position.

It gently stretches the calf muscles and Achilles tendon when you sleep. After wearing this for a few days, you should notice pain relief. You can obtain a dorsiflexion night splint on Amazon. 

Surgery for Equinus Deformity

If you suffer from an equinus that has failed conservative therapy, your doctor may suggest surgery to correct this.

Your doctor will lengthen the heel cord and suture the tendon in a lengthened position. This will improve your ankle range of motion.

If there is a bone block present in the ankle, your doctor will shave it off. The surgery will be done in the operating room under general anesthesia. 

After surgery, you will need to remain non-weight bearing in a posterior splint or cast boot for 6-8 weeks, followed by gradual weight bearing for another 4 weeks. Your doctor may recommend physical therapy to regain strength and improve your range of motion after surgery. 

Conclusion

In conclusion, long-standing equinus deformity can affect the feet negatively in many different ways. It’s important to start stretching exercises early to prevent long-term complications that could occur. Wearing custom orthotics can be greatly beneficial in alleviating pressure points in the feet. If you suffer from an equinus, make sure to visit your local foot doctor for an evaluation. 

Do you suffer from equinus? Has stretching helped? I would love to hear your thoughts. Leave a comment below!

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References

1.Shore, B. J., White, N., & Kerr Graham, H. (2010). Surgical correction of equinus deformity in children with cerebral palsy: a systematic review. Journal of children’s orthopaedics, 4(4), 277-290.https://journals.sagepub.com/doi/10.1007/s11832-010-0268-4

2. Goldstein, M., & Harper, D. C. (2001). Management of cerebral palsy: equinus gait. Developmental medicine and child neurology, 43(8), 563-569.https://www.cambridge.org/core/journals/developmental-medicine-and-child-neurology/article/abs/management-of-cerebral-palsy-equinus-gait/0F17163DC2DC6A11D415FA3D68865174

3. Orendurff, M. S., Rohr, E. S., Sangeorzan, B. J., Weaver, K., & Czerniecki, J. M. (2006). An equinus deformity of the ankle accounts for only a small amount of the increased forefoot plantar pressure in patients with diabetes. The Journal of bone and joint surgery. British volume, 88(1), 65-68.https://online.boneandjoint.org.uk/doi/full/10.1302/0301-620X.88B1.16807

4. Digiovanni, C. W., Holt, S., Czerniecki, J. M., Ledoux, W. R., & Sangeorzan, B. J. (2001). Can the presence of equinus contracture be established by physical exam alone?. Journal of Rehabilitation research and Development, 38(3), 335-340.https://www.rehab.research.va.gov/jour/01/38/3/pdf/Digiovanni.pdf

5. Manca, M., Ferraresi, G., Cosma, M., Cavazzuti, L., Morelli, M., & Benedetti, M. G. (2014). Gait patterns in hemiplegic patients with equinus foot deformity. BioMed research international, 2014.https://www.hindawi.com/journals/bmri/2014/939316/

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