The foot condition when the upward bending motion of the ankle joint is limited

E

quinus (pronounced e-qui-nus) is a foot condition when the upward bending motion of the ankle joint is limited. Someone with equinus lacks the flexibility to bring the top of the foot toward the front of the leg. It can occur in one or both feet, but usually there is one worse than the other.

There are several possible causes for the limited range of motion in the ankle joint. Often, it is due to tightness in the Achilles tendon or calf muscles (namely the soleus and/or gastrocnemius muscles). In some patients, this tightness is congenital (present at birth), or inheritted. Other patients get the tightness from being in a cast, being on crutches or frequently wearing high-heeled shoes. In addition, diabetes can affect the fibers of the Achilles tendon and cause them to be tight. Sometimes Equinus is due to a bone blocking the ankle motion. For example, a fragment of a broken bone following an ankle injury, or bone block, can get in the way and restrict motion. Equinus may also result from one leg being shorter than the other. Less often, equinus is caused by spasms in the calf muscle often seen in people with neurologic disorders.

Foot problems related
to equinus

Depending on how a patient adjusts for the inability to bend at the ankle, a variety of foot conditions can develop, including plantar fasciitis (arch/heel pain), calf cramping, tendonitis (inflammation in the Achilles tendon), metatarsalgia (pain and/or callusing on the ball of the foot), flatfoot, arthritis of the midfoot (middle area of the foot), pressure sores on the ball of the foot or the arch, bunions and hammertoes, ankle pain, or shin splints.

How equinus affects walking

People with equinus adjust for their limited ankle motion that can lead to other foot, leg or back problems. The most common methods of adjusting are flattening of the arch or picking up the heel early when walking, placing increased pressure on the ball of the foot. Other patients compensate by toe walking, while a smaller number take steps by bending abnormally at the hip or knee.

Diagnosis

Most patients with equinus are unaware they have this condition when they first visit the doctor. Instead, they come to the doctor seeking relief for foot problems associated with equinus.

To diagnose equinus, the foot and ankle surgeon will evaluate the ankle’s range of motion when the knee is flexed (bent) as well as extended (straightened). This enables the surgeon to identify whether the tendon or muscle is tight or if it is the bone that stopping the ankle motion. X-rays may also be ordered. In some cases, the foot and ankle surgeon may refer the patient to the neurologist (nerve doctor) for an evaluation.

Nonsurgical treatment

Treatment includes strategies aimed at relieving the symptoms and conditions associated with equinus. In addition, the patient is treated for the equinus itself through one or more of the following options:

Night splint: The foot may be placed in a splint at night to keep it in a position that helps reduce tightness of the calf muscle. There are some braces that can be worn one per day as well to stretch the muscles in the foot and ankles.

Heel lifts: Placing heel lifts inside the shoes or wearing shoes with a moderate heel takes stress off the Achilles tendon when walking and may reduce symptoms.

Arch supports or orthotic devices: Custom orthotic devices that fit into the shoe are often prescribed to keep weight distributed properly and to help control muscle/tendon imbalance.

Physical therapy: To help with the muscle tightness, exercises that stretch the calf muscle(s) are recommended.

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When surgery is needed

In some cases, surgery may be needed to correct the cause of equinus if it is related to a tight tendon or a bone blocking the ankle motion. The foot and ankle surgeon will determine the type of procedure that is best suited to the individual patient.

 • For more information, email us at foothealth242@gmail.com or visit www.apma.org. To see a podiatrist, telephone 325-2996 for an appointment, visit Bahamas Foot Centre on Rosetta Street, or call 394-5824 for an appointment; or visit Bahamas Surgical Associates Centre on Hilltop Medical Centre off 4th Terrace Collins Avenue. In Grand Bahama, call Lucayan Medical Centre at 373-7400 for an appointment.