Use this search box to search our site






equinus

AUTHOR: Marc Mitnick DPM

REVIEWED BY: Podiatric Medical Review Board

--> equinus

WHAT IS AN EQUINUS DEFORMITY



An ankle equinus deformity is not a medical condition as such but is more reflective of a condition where the foot is unable to dorsiflex, or bend upwards at the level of the ankle joint. As a result of this condition, there are many foot and ankle problems that can occur. Patients rarely present to the office complaining of a restricted range of motion in the ankle, but rather present with one or more of the problems that this condition can create.

The problem is defined as insufficient dorsiflexion in the ankle in order for normal gait to occur. This lack of dorsiflexion then requires the lower limb to compensate in some capacity to make up for this lack of motion.

ankle equinus deformity

There are various opinions as to what is normal ankle dorsiflexion but in general 10 degrees or more dorsiflexion is considered normal. This amount of ankle motion has to occur with the knee joint extended (locked).

It is generally accepted that dorsiflexion between 5-10 degrees is associated with minimal foot and leg compensation during gait, while dorsiflexion below five degrees is associated with significant gait compensation as well as an increase of pressure on the forefoot which increases the risk of forefoot pathology. The picture to the right reveals zero degrees of dorsiflexion.

WHAT CAUSES AN EQUINUS DEFORMITY



There are a few different ways to classify equinus based on the causative factors. Some of these classifications have become complicated. Thus it is easier to classify this problem based on either osseus (bone) or soft tissue restrictions.

SOFT TISSUE ORIGINS

  • The most common cause is known as gastroc-soleus equinus. This results from a shortening of the co-joined tendon of the gastrocnemius and soleus muscles as they come together to form the Achilles tendon.
  • Damage to the Achilles tendon from either trauma or collagen disease may also cause a limitation of ankle motion.

OSSEUS ORIGINS

  • bone spurs arising from the tibia and fibula bones of the leg
  • abnormal alignment of tibia and fibula bones as they attach to each other at the level of the ankle joint
  • bone spurs on the talus bone, which is the foot bone that the tibia and fibula bone “hinge” to, may also cause an equinus deformity.
normal ankle joint


EFFECTS OF ANKLE EQUINUS ON THE GAIT CYCLE



The importance of the ability of the foot to dorsiflex relative to the leg occurs during what is known as the stance phase of gait and the swing phase of gait.

In gait, when the heel hits the ground, the body then moves over the foot, and the ankle joint has to be able to dorsiflex in preparation for propulsion where the foot propels the body forward. If there is not enough dorsiflexion in the ankle, at this stage, then there is excessive pressure exerted on the forefoot and this can lead to pathology.

After the foot propels the body forward, the foot itself then has to swing forward while weight is being put on the other foot. In order for the foot to swing forward, dorsiflexion of the foot relative to the leg has to occur in order to avoid dragging the toes on the ground.

In the above situations, if there is not adequate dorsiflexion occurring at the level, the body then has to compensate for this deficiency. If the body is unable to compensate there will be a shortened gait, or limitation in stride. If compensation does occur it will happen in the joints either in the foot itself or the joints above the ankle.

Above the ankle, compensation may result in a hyperextension of the knee which is increased motion in the knee joint, or compensation may also occur at the level of the hips which result in over flexion of the hip joint. Although this compensation at the knee or hip joint may allow the body to overcome the limited ankle motion, this may result in knee pathology or even lower back and hip issues.

If the foot is called upon to carry the bulk of compensation, it occurs in two ways. One is early heel rise, where the heel lifts up before the foot is firmly planted on the ground, while the other means is a flattening of the arch which includes calcaneal eversion (heel bending outward). Heel eversion lessens the strain on the Achilles tendon. A number of foot pathologies may develop, including all of the following:

WHAT IS THE TREATMENT FOR AN EQUINUS DEFORMITY

There are various treatments for an equinus deformity ranging from conservative care to surgical care. The goal of all treatments is to try and maintain a relative range of motion within the ankle joint while minimizing any compensation in the foot or leg.

conservative treatment

Stretching People continuously mention stretching as a means to increase motion in the ankle joint. The problem is that there is a diminishing rate of return as you age. Essentially stretching exercises are truly effective in ages up to adolescence. In this age group, stretching along with perhaps serial casting (in toe walkers) can be very beneficial.

Although stretching of the Achilles tendon is usually recommended in adults, the amount of increased range of motion within the ankle joint is usually minimal. However, even a small increase in ankle motion may be enough to be the difference between pain and no pain. Suffice it to say that in an adult, stretching is usually only one part of the equation in trying to negate the effect of a tight heel cord. Keep in mind, stretching will not be of much help in an osseus (bone) deformity.

Heel lifts For many simple equinus related problems, a simple heel lift to both heels, even though there may only be symptoms in one foot, can be very beneficial. This is particularly true for those suffering from Achilles tendonosis. Usually a one quarter inch cork heel lift is all that is needed.

Orthotics For many problems occurring in the forefoot and midfoot, an orthotic with an external rearfoot post is what is indicated to alleviate pain. Most of these problems are not only the result of an equinus condition but are also exacerbated by the excess pronation that occurs to compensate for the lack of motion in the ankle. So not only do we have to control the tight heel cord, but we also have to reduce the pronation that is occurring.

rear foot posted orthotic

An orthotic with a rearfoot post means that the back portion of the orthotic which generally controls motion in the heel as the heel hits the ground, is built on the bottom of the heel portion of the orthotic. It is what is known as posting. Essentially, posting changes the angle at which the heel hits the ground. Because this external posting has thickness to it, it also acts as a heel lift thus reducing the strain on the achilles tendon while the orthotic itself reduces pronation during midstance of gait.

These types of orthotics are usually of the custom made variety because you are asking the orthotic to do a couple of functions and for that reason the measurements of the orthotic have to be exact. You will not find that in a medical grade orthotic, or any other device you may purchase in a store.

surgical treatment

In cases that do not respond to conservative care, surgical intervention has to be considered. Cases of equinus due to bone impingement have a greater tendency to not respond to conservative care and thus become surgical issues. In these cases surgical removal of the boney impingement is the indicated treatment. An Achilles lengthening procedure may also be done at this time.

There are many soft tissue procedures for Achilles tendon lengthening. The chosen procedure is the one that deals directly with the soft tissue cause of equinus as determined by the surgeon.

REFERENCES

Journal of Rehabilitation Research and Development

American College of Foot and Ankle Surgeons

National Institutes of Health

Want more information? CLICK HERE




translate page

ORTHOTICS for multiple types of foot pain
best buy in a pre-made orthotic
click link below


SuperStepOrthotics


ORTHOTICS for heel and arch pain for those who must wear dress shoes
click link below


redithotics





I've been doing some aggressive research lately (it's how I found your incredible website) and realize now that my symptoms are not consistant with the diagnosis. Jennifer

Hunterville, NC
….after reviewing your amazing site (great for the avg. jill). So thank you very much!!!

Liesbeth

NY
I am really, really impressed with your plain-speak explanations for the various conditions.

Jacqueline

NJ
This was an extremely helpful site. I have an appointment on the 18th and your info. Was right on target…..

Jack

Fla
A well organized site containing much information written in a manner that the average reader can comprehend.

Jean

Ontario, Canada
I found your website and articles most interesting.

Andrew

Fla.
Thank you for a quick response. I think your site is the best information site on foot pain and I have viewed many.

Judy

(location unknown)
I came to your website, footspecialist.net via www.foot-pain explained .com which I think is also your website? I thought explanations for different types of problems were well addressed and thoughtfully stated for the patient in mind.

L.W.

New York
You have an amazing and extremely informative site. I enjoyed looking through all of the data and stats.

Yvette

Memphis, TN
Thanks again so much for the information in the article. Very interesting.

Anna

Scotland
Great article. I have had plantar fasciitis since I was in high school……..

J. Simmons

(location unknown)
Dear Dr. Mitnick, The orthotics arrived four days ago and I slipped them into my shoes immediately. I was skeptical as to the usefulness of the item, they really didn't look very exotic. I have to say though, after using them for just four days, I have experienced grand relief from my foot pain. Even the very first day, I was able to do a lot of work while on my feet with at least a 75% reduction of pain. It has only gotten better every day, and I go nowhere without my shoes with the orthotics. I had been experiencing extreme heel and sole pain for about six months and had to take extended breaks off my feet many times a day as well as regular doses of Ibuprofen. Since getting the orthotics, my life has returned to normal and I feel good again. Just wanted to say thanks for the recommendation for a very effective item, I had no idea what a change this item could affect.

Yours truly,

J.C. Forbes

Tennessee
Thanks for the Response, you hit it on the head.

Steve

Redondo Beach, CA
Thank you for your time and expertise in answering my question…..

LH

(location unknown)
First, thanks for putting together this website. Its the most informative site I have found dealing with foot problems. Last June I started having pain and swelling at …….

Joe

(location unknown)
First of all, thank you for having all this useful information available in one place. I've been through most of your website and based on my research, pain and evaluations I think I've narrowed things down quite a bit.

Pete M.

(location unknown)
Thank you for the best site I have found when researching foot pain.

Glenda B.

Madison, Alabama
Thanks for replying so quickly. I was a bit concerned. I think your website is great, and chock full of info.....

Carol

Denison, TX
Dr. Marc, Thank you so much for your reply which seemed to be right on. I have researched many sites but you put me on the right path to the possible answer. My foot pain may not rule the rest of my life after all! I believe I'll make a sign that reads, "THE END IS NEAR!" Thanks Very Much,

Dawn

West lafayette, IN
Dear sir...no doubt you get positive comments re your site...May I please be added to the list of your admirers. In all of my years of web surfing I would say your site is right there with the very best. Thank you for taking the time to write the terrific info you provide and for putting things into laymen terms for us mere mortals. I pray you have much on going success and thank you again for a deed well done. As for me I did not find much help for my symptoms and will continue on my quest. Were you anywhere in the South I would make and appointment...Thanks again dear sir...m.e.

Michael E.

Tampa, Florida 33624
Hi. This is a great site! I'm a healthy middle aged woman who is in good health, but.....

Kelly

Texas
Just a wee word of thanks for your wonderful website...It is a terrific service...Thank you for providing your knowledge and help...With highest regards, m ebeling

Michael D. Ebeling

Tampa, Florida 33624


Thanks for a most interesting website, which has helped a lot.

Steve

UK


Dear Dr.Mitnick

I usually do my research on the Mayo clinic website. I think your website is the most informative site I have found when researching foot pain.

I thank you for putting together this incredible website.

Regards,

Dragica W.

Edmonton,Canada


....I have been told that it is not hard enough to be cut off. Please help, I am not sure what to do now! THANKS FOR A WONDERFUL AND VERY HELPFUL SITE!

Roxy

South Africa


You have an unusually clear, informative and well-written website for laypersons. Thank you for that.

Matthew W.

Mansfield Ctr, CT


First, I'd like to thank you for all the information that you provide on your website and the opportunity to write to you.

Steve

Placentia, California


First, I want to let you know that you have the best web site I've found related to foot issues. (The only thing I had difficulty finding was the "ask a question" page.)

Unknown

Unknown location


I received the orthotics Monday afternoon and began wearing them Tuesday. After two days I would say that I have noticed a huge improvement in the discomfort I have been experiencing. My foot feels better than it has in months.

Ric J.

Unknown location


I greatly admire someone like you who would donate and dedicate so much time and effort to helping strangers with no compensation. Truly, it is uncommonly kind. And your site is so intelligently arranged.

Ron R.

Pacific Grove, CA


I used to work for a podiatrist (front desk) back during summers in college years ago, so I know the benefits of good care. Again, I want to thank you for an EXCELLENT website. It was so great to get to your site (top of google search) and actually find all the answers I needed EASILY and QUICKLY! Clearly you put a ton of work into it and I really appreciate it.

All the best,

Victoria

Alameda, California


By the way, millions of websites could use yours as a guideline on how to organize information and make the site user-friendly. Kudos to you!

Anonymous


Thank you for your very interesting and informative site!

Anonymous




Hi. I come to your site often looking for information. It is really informative and I appreciate it very much. I have RA and have been having considerable amount of foot pain...... Dee RN


Thanks very much for the wonderful informative site.

Catherine

New Zealand


Thank You for my answer! I have been schedule for a bone density scan, allingment, and I am in the process of getting orthotics made, and checking out the natural remedies. Thank again! What a great web site!

Sincerely

Josette


Yes I want both pair of orthotics. You don't have an option of ordering 2 at one time so I had to place the order twice. Thanks. My husband likes these and wants to put them in all of his shoes. (referring to Superstep orthotics)

Cindy H.

Arizona
I searched the internet everywhere for a clear description and illustration of my symptoms/problem. https://www.foot-pain-explained.com/ was where I ended my search with answers. If I lived in Jersey (left 30 years ago) and didn't live in Florida I would definetly make an appointment with Dr. Mitnick.

Thanks, Kathy

Florida
1st of all THANKS A LOT for your great site......

Anna

Poland
Thank you so much for your response. I will let you know how I am doing if you would like. Your website is awesome!

M P

South Carolina
Hello! I want to thank you for such an informative website! I found you based on my ankle pain search and am happy to realize that there may be a relatively simple cause and solution....

Natalie

unknown location


...Thanks for your fantastic service.

Gary

Arlington, VA


Thank you so very much, that would be much appreciated. I love those insoles, by the way. (referring to Superstep orthotics)

Kelly W.

San Clemente, CA


Dr Marc is fantastic...He seems to know exactly what you are feeling with the problems you are having. I wish he was in my home town so I could go to him with my problems!!!!!!!!!!!!!

Pam

location unknown


Great insights! Thanks Doc, you're the best.

Glen

location unknown


I have been experiencing foot pain of various sorts and am working to figure out what it is. I found this site and can only say BRAVO!! What an excellent site! The time it must have taken to put all this together must've been a daunting task! I am sure it has helped so many people. Thank you so very much for doing this.

Bre

location unknown


Dr. Mitnick, Thank you so much for your reply. I did let my physician know and they took an x-ray - all is well! Also, thank you for providing this wonderful site, it is very helpful with lots of useful information! I appreciate your gift of time! God bless.

anonymous




Dr. Mitnick, Thank you, you were 100% correct. The pain finally brought me to the ER. I spent 8 days in the hospital. The Doppler you spoke of was able to show that there was no pulse in that foot. This was an arterial clot that split and traveled throughout my leg. My leg was almost amputated. I am in rough shape but have all my parts intact!! You certainly know what you are talking about. Thank you for taking the time to answer. Yours Truly!

anonymous




Staying at home after hallux surgery I spend quite a lot of time seaching info useful for avoiding problems which might come back. Today I found your site and I am .... delighted it happened. It's one of the best site I found last days.

Anna

Poland




Thanks for taking time to read and answer so many questions. It is truly a public service!

Esh

Seattle, WA


I just wanted to say that I am very greatful for this website!!

Bonnie

location unknown




Also, and importantly, just want to praise this web site. Thorough and thoughtfully presented, it certainly must be of considerable assistance to anyone with a foot problem. Terrific -- and very interesting.I trust the address comes up easily for those seeking information.

Bill

New Jersey




Thanks so much for answering my question. You've been more help to me than my own Dr. has been lately. Thanks again....I hope to be able to walk without pain someday.

Debbie

location unknown




Wow, that is exactly the information needed!!! thank you thank you thank you!!! I appreciate this help so very much from Marc Mitnick DPM. Excellent information and help to improve One's life.

Chrissy

location unknown




Thanks so much for this website Dr. Marc! It is so nice that you have this ask the doctor feature..I'm sure I'ts been helpful for alot of people. I will try what you suggested and see if it helps...thanks again!

Tracy

Evansville, IA




Dear Marc

I just want to say thank you for the quick response and the good info. I find it amazing and a super nice thing that you do here by answering medical questions at no charge.

Russ W.

location unknown




Your website is full of a lot of helpful information, and I am very impressed with the time in which you responded to my post. Thank you again for your time and consideration in your response.

-Sunny.

location unknown




Thank you very much for the information, I will consider it. Excellent web site.

Jackie

San Diego, CA




Dr. Mitnick, Just want to say thank you so very much for your quick response and very informative reply! After reading what you had to say, I called the doctor's office and was able to get in and see him the same day as my injury. Toe was x-rayed and luckily, it is not broken or fractured. Very badly bruised and will probably lose the toe nail. And although my toe and toe nail are still very black and blue and very sore, they ARE both starting to feel a little better. So again, thank you! I am so very happy that I came across your website. The service you provide is outstanding and immeasurable!

Rivi,

Albany, NY




Thank you so much for all of your advice. In searching the web for people dealing with this same issue i can tell you that you are a Knight In shining Armor! If I lived in Jersey I would gladly be your Spokesperson. Hopefully next time you hear from me it will be good news. God Bless,

Jill S.

location unknown




THANK YOU SO VERY MUCH FOR YOUR TIME AND EFFORTS, YOU ARE SO VERY APPRECIATED. THANK YOU FOR ALL YOU DO.

Jackie

Whichita, KS




thanks again, this site is very helpful.

mark

Boston, MA




Like others have stated...This site is amazing and I am so thankful that it was created.

....Keep up what your doing. Your a life saver.

Michelle

Colorado




Thanks again for the information provided on your site. It's easy for non-medical folk to understand your writing, and helps provide better communication between patient and doctor.

annielou

Colorado


Wonderful advice

by: Anonymous

This is the best site for foot problem info.


Thank you for this information. This description fits my pain and inflammation behind my 2nd toe perfectly.

by: Max

location unknown
Again, I really appreciate that you responded to my inquiry, and that your mention of Parkinson's helped me to find my way to a diagnosis of this difficult to diagnose disease. Most patients see on average 16 doctors before they are diagnosed. I hope that you can help other people that ask for your expertise in the future.

Barb D.

Canada
I just wanted to say that I am very greatful for this website!! I have had a fusion in my rt foot and am finally getting a little bit better......

Bonnie

location unknown
Again, Thank you from the bottom of my heart for taking the time to answer my question....your an angel!

Nancie

Wisconsin
Thank you for your response. You have provided some great insight (to my question)....

Julie

location unknown
Thank-you so very much for responding so quickly and in such detail to my question!! I will give my surgeon a call today!! This website is terrific!!!! Thank-you again!

Renae

North Carolina
Many Thanks Dr Marc!
Thank you for your response. It sounds like a good plan to me. He did not cut the wart out first ...

KG

location unknown


Thanks again doc for having this website and we STILL need qualified Podiatrists in beautiful sunny Tampa Bay (Bradenton) Florida.

Bessie Mae

Florida
Dear Dr. Mitnick, Thank you so very much for taking your time to answer my question. You have greatly relieved my anxiety related to the continual tingly I feel in my feet. I will share your response with my podiatrist next week. God bless you for having this question and answer page on your website! Most gratefully,

Lynne T.

location unknown
Your webpage is excellent, I commend you on sharing your knowledge to the public.

Robert

New Jersey


Thank you. you were more detailed than what others have told me they finally called from the last xrays and my son is now in a cast for 2 weeks he did have a fracture that was not noticeable.

a mom

location unknown


I have read your website and I have to admit that I am amazed at all the information that is on here. I have learned more than the three years I have been going to several doctors that I have seen!!

Melody

Lenoir, NC


Thank you so much Doc for a quick and thorough response!

Rustam

Bellevue, WA


I cannot thank you enough for your response, opinion, and suggestions! I want you to know how much it means to me, and I'm sure everyone else who has ever asked you a question! I feel like you're a lifesaver and have empowered me to take a stronger role and stand up for myself and my feet!

Jodi

location unknown



Recent Articles

  1. Vitamin D impact on health

    Feb 06, 23 07:17 PM

    Researchers are suggesting that the effectiveness of Vitamin D in fighting and preventing disease is predicated on a persons body mass index (BMI). The thinner the person the greater the positive impa…

    Read More

  2. Foods to speed up healing

    Feb 01, 23 02:41 PM

    One of the best ways to help yourself heal faster after surgery is to eat well. Getting the proper nutrition will provide your body with the essentials it needs to promote healing. Here is a suggestio…

    Read More

  3. Cancer and Type 2 Diabetes

    Jan 25, 23 04:52 PM

    An article revealing that older type 2 diabetics have a higher incidence of cancer then non-diabetics. It is suggested that cancer may surpass CVD as the number one cause of death in older diabetics.

    Read More

  4. Does glucosamine or MSM reduce arthritis pain?

    Jan 22, 23 01:41 PM

    A good review of the possible benefits to taking glucosamine, chondroitin or MSM for arthritis. Always beware of the possible side effects of over the counter supplements.

    Read More

  5. shin splints

    Jan 18, 23 05:12 PM

    A great review on the various causes of shin splints, along with treatment options.

    Read More

  6. Whats new in skin cancer?

    Jan 15, 23 08:32 PM

    A presentation of newer skin protection combinations in an effort to better protect the skin from the hazards of sun exposure.

    Read More

  7. Causes and risk factors of warts

    Jan 14, 23 05:02 PM

    A good review of the causes of warts and protective measures you can take to prevent developing them.

    Read More

  8. Do chronic wounds need to be dressed daily?

    Jan 11, 23 02:18 PM

    Because of supply chain shortages as well as staffing shortages particularly during the pandemic, many institutions extended the time between dressing changes for chronic wounds. Is this really the be…

    Read More

  9. Food choices that raise your risk of type 2 diabetes

    Jan 08, 23 10:07 AM

    A good review of how blood sugars can become elevated and the harm that can do. Certain food groups have a tendency to raise your blood sugars and should be avoided.

    Read More

  10. Outcome stats from Scarf bunionectomy

    Jan 03, 23 03:04 PM

    The Journal of Foot and Ankle Surgery recently reported a meta analysis of outcomes in 1583 Scarf bunionectomies that met their inclusion criteria. Adverse events did not seem to be any better or wors…

    Read More