Equinus: Its surprising role in foot pathology

Treatment for equinus should be aimed at increasing ankle joint dorsiflexion to facilitate normal gait mechanics. In most cases, non-spastic forms of equinus tend to be more treatable and easily corrected than the spastic neuro-induced forms of equinus. A variety of conservative measures can be employed, including stretching, bracing, and orthotic devices.

Although milder than the spasticity-induced cases of equinus, limited ankle dorsiflexion in the non-neurological pop­ulation is increasingly recognized as a source of excessive strain throughout the foot and a factor in the pathogenesis of many foot conditions.

By Nicholas V. DiMassa and Jeffrey M. Whitaker DPM FACFAS, Lower Extremity Review November 2015.

Equinus has been investigated extensively throughout the literature, and can be described as an inability to dorsiflex the ankle joint enough to allow for normal pain-free ambulation. Equinus of the foot is the most common deformity in children with spastic cerebral palsy and, as early as the 1920s, Swedish orthopedic surgeon Nils Silfverskiöld advocated the use of a gastrocnemius recession as a way to treat cerebral palsy patients who suffered from a contracture of the posterior calf muscles. Practitioners, however, are beginning to emphasize a form of soft tissue equinus that occurs as a result of an isolated contracture of the gastrocnemius muscle in the healthy adult population.

Although milder than the spastic neuro-induced cases of equinus, the gastrocnemius contracture in the non-neurologically impaired population is being highlighted as a source of deformity that will lead to excessive strain throughout the foot. It is thought to be a primary factor in the pathogenesis of many common pedal ailments, including plantar fasciitis, hallux valgus, metatarsalgia, Achilles tendinopathy, fatigue of the anterior extensor muscles, ulcers, and a variety of other pathologies that are seen in clinics daily.

The reported prevalence is astounding. In a 1995 article in the Journal of the American Podiatric Medical Association (JAPMA), Hill stated that 96.5% of examined patients in his clinic had reduced ankle joint dorsiflexion requiring compensation during gait. Patel and DiGiovanni corroborated that finding by evaluating every patient that presented with either acute or chronic plantar fasciitis. They revealed that 83% of patients suffered from equinus, with 57% being diagnosed as an isolated gastrocnemius contracture.

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Ankle equinus. Prevalence and linkage to common foot pathology, Hill RS. J Am Podiatr Med Assoc. 1995 Jun;85(6):295-300.

Association between plantar fasciitis and isolated contracture of the gastrocnemius, Patel A, DiGiovanni B. Foot Ankle Int. 2011 Jan;32(1):5-8. doi: 10.3113/FAI.2011.0005.


The influence of knee position on ankle dorsiflexion – a biometric study, Baumbach SF, Brumann M, Binder J, Mutschler W, Regauer M, Polzer H. BMC Musculoskelet Disord. 2014 Jul 23;15:246. doi: 10.1186/1471-2474-15-246.

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