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Equinus Condition: Causes, Symptoms, Diagnosis & Treatment

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What Is Equinus?

Equinus is a condition limiting the upward bend of the ankle due to tight calf muscles, a restrictive Achilles tendon, or bone obstruction. Due to  suboptimal ankle mobility, equinus can trigger various foot issues.

In this article, individuals will learn about the causes and symptoms of equinus, as well as how it is diagnosed and treated. 

ankle dorsiflexion

What Causes Equinus?

Equinus is caused by tightness in the calf muscles which form the Achilles tendon, halfway down the leg. The condition is present if ankle joint mobility is less than 10 degrees. 

While sometimes hereditary, equinus can be aggravated by wearing certain shoe gear (like high heels) that encourage the Achilles tendon to become contracted. 

In some cases, it is caused by “bone blocks” in the ankle from ankle arthritis or previous fractures. Bone blocks in the ankle restrict upward ankle movement during walking.

Some people inherit neuromuscular disorders like Cerebral Palsy that cause Achilles tendon tightening, leading to equinus.

toe walker

What Are the Symptoms of Limited Ankle Dorsiflexion?

  • Premature heel elevation during walking
  • Habitual toe walking
  • Discomfort in the ball of the foot
  • Heel pain
  • Ankle stiffness
  • Knee or lower back discomfort 

How Does Limited Ankle Range of Motion Affect the Feet?

The effect of equinus on the feet is significant, with limited ankle range of motion triggering multiple foot complications. 

When equinus causes the Achilles tendon to constrict, the heel cannot fully contact the ground, resulting in early heel lift or toe walking. 

This symptom of equinus often improves by age seven, with most children transitioning to a heel-to-toe walking pattern. 

Persistent toe walking from equinus can place undue pressure on the forefoot, causing metatarsalgia. Metatarsalgia is an inflammation of the foot’s ball due to excessive pressure. 

This same pressure can cause painful calluses and pinched nerves (neuromas) within the foot due to overpressure or injury. 

For diabetics with neuropathy, an equinus-induced increase in forefoot pressure intensifies the risk of foot ulcers. 

For a more detailed explanation on managing diabetic foot ulcers, refer to the supplemental post: A Simple Guide To Managing Diabetic Foot Ulcers. 

An equinus deformity can also cause plantar fasciitis due to excessive foot pronation from a tight Achilles tendon. 

Tendon inflammation, such as Achilles tendonitis (occurring lower in the heel) is another potential outcome of equinus. It occurs due to the strain caused by the tight tendon. 

Other effects of equinus on the body include hyperextension of the knees and lumbar lordosis. These conditions can cause chronic knee, hip, and back pain to occur. 

This can be problematic if you just underwent a knee replacement or hip replacement surgery. 

How is Equinus Diagnosed?

To diagnose an equinus ankle deformity, doctors perform a test called the “Silfverskiold test”.

They use a tool called a goniometer to see how much the ankle can bend upward with a straight knee. If this bending, or “dorsiflexion”, is less than 10 degrees, it’s called gastrocnemius equinus.

Then, doctors check the ankle’s bend again, but this time with a bent knee. If the ankle still can’t bend enough in both situations, it’s called gastro-soleal equinus. This happens because bending the knee relaxes one muscle, allowing the doctor to test another.

What Is the Treatment for Foot Equinus?

What Are Non-surgical Treatments for Equinus?

Equinus can usually be managed non-surgically through various measures. 

Regular calf muscle and Achilles tendon stretching exercises, performed three times daily for 10-15 minutes, can alleviate the condition. 

For guidance on executing these stretches, consider this supplemental article on Achilles tendon stretching exercises.

Physical therapy can significantly reduce Achilles tendon tightness and enhance joint mobility.

 For additional support and stabilization, doctors recommend custom orthotics. These are custom-made for the individual’s feet, helping to ease pressure in specific areas. 

Generally durable for 5-10 years, custom orthotics can relieve discomfort from painful calluses or ulcers.

For patients suffering from plantar fasciitis or Achilles tendonitis, a heel lift can be beneficial. 

This device, which can be bought prefabricated on platforms like Amazon, elevates the heel, reducing strain on the Achilles tendon. Start with a ⅛” lift.

Another useful device is a night splint, especially for those who experience heel pain upon waking. 

This brace, worn during sleep, holds the ankle in an upwardly flexed position, gently stretching the calf muscles and Achilles tendon overnight. 

After a few nights of use, pain relief should be noticeable. A dorsiflexion night splint can also be purchased on Amazon.

What Are Surgical Treatments for Equinus?

When non-surgical interventions are inadequate to treat an equinus deformity, surgery is needed. This treatment option for equinus involves lengthening the heel cord and securing the tendon in an elongated position. 

This is designed to enhance the ankle’s range of motion and alleviate the effects of equinus. In instances where equinus is complicated by a bone block hindering joint movement, it will be surgically removed. 

Such operations, which are essential to the treatment of equinus, are typically performed under general anesthesia in an operating room. 

Post-surgery, patients undergoing this equinus treatment are usually required to avoid weight-bearing activities for 6-8 weeks while wearing a posterior splint or cast boot. 

This period of restricted movement is followed by a phase of gradual weight-bearing over the subsequent four weeks. 

To further assist in the recovery from equinus surgery, physical therapy may also be suggested to restore strength and improve post-surgical range of motion.

Conclusion

In conclusion, equinus foot is more than just an isolated gastrocnemius contracture that affects the ankle. Due to diminished ankle flexibility, it can lead to numerous complications that negatively affect the overall health of a patient. 

It is important for patients suffering from equinus to receive prompt recognition and targeted treatment to avoid  health complications. The range of treatment options for these patients varies widely, including non-surgical interventions such as dedicated stretching exercises, physical therapy, and the use of customized orthotics.

In more severe instances, the treatment protocol may require surgical procedures, such as a gastrocnemius recession or excision of a bone block resulting from a fracture. The selection of the most suitable treatment for a patient typically depends upon the specific cause and severity of the patient’s equinus condition. Regardless of the treatment route pursued, the ultimate goal remains the same: to enhance the patient’s flexibility, improve the function of their lower extremities, and alleviate the associated pain. 

Equinus is a complex condition that necessitates a comprehensive understanding and a patient-centric approach to treatment. In managing the patient’s pain and other symptoms, careful, individualized treatment becomes important in enabling the patient to regain control over their health and life. 

If individuals experience pain secondary to equinus, they should make a list of their symptoms and contact their foot doctor for treatment.

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The information, including but not limited to, text, graphics, images and other material contained on this website are for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.

Vaishnavi Bawa
Dr. Vaishnavi Bawa is a Podiatrist who specializes in treating foot and ankle pathology. LifesLittleSteps mission is to educate the public about foot health in an easy-to-understand manner using evidence-based medicine.
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