Equinus describes the inability for the ankle to dorsiflex, or bend upwards, to an appropriate degree. During gait, approximately 10 degrees of dorsiflexion is required for efficient movement of the leg over the foot at mid stance. Lack of this motion leads to early heel lift and excessive mid foot and forefoot pressures. The consequences can be profound, causing conditions such as plantar fasciitis, bunion and hammertoe deformities, since tension and stability become compromised. In this episode we discuss the pathology in detail including conservative and surgical treatments.
Equinus, or a tight heel cord, is a major contributor to foot pathology. In some cases it is subtle and the body can compensate to the point where it is unnoticeable. However over years the compensatory motion that is "borrowed" from other joints becomes apparent as either pain in areas such as the Achilles insertion or the plantar fascia, or structural changes such as collapse of the arch or bunions.
Because it is such an influential force across the entire foot, the Achilles tendon is usually examined along with specific pathologies that may be the 'presenting complaint.' Patients are often unaware of the tightness in the heel cord. This is where careful and deliberate clinical evaluation is essential. Treatment of a specific pathology while ignoring the primary causative condition will lead to reoccurrence.
Calf stretching is part of comprehensive rehabilitation for many foot and ankle conditions. Stretching is best when performed with frequency, repetition and force. Gravity is one way to achieve stretch, but tensioned bands, belts, even a pillowcase can be more effective at helping stretch this strong structure. The benefits of stretching cannot be overemphasized. It is especially important as we age, become less active or mobile.