16: Short Gastroc-Soleus Complex - Feilmeier

Question 1

define equinus

Answer 1

Definition of muscular gastrocnemius or gastro-soleal equinus is limitation of dorsiflexion due to tight posterior muscle group

Question 2

what is normal AJ dorsiflexion?

Answer 2

Consensus among the majority of experts is that at least +10 degrees of ankle dorsiflexion with knee extended is needed for normal gait with limited foot compensation

3-15 deg with knee extended and 10-20 deg with knee flexed is the range of reported normal dorsiflexion

Question 3

effects of STJ position on measuremnt of ankle dorsiflexion

Answer 3

Dorsiflexion of the foot in pronated position increased measured dorsiflexion up to 10 deg when compared to STJ neutral.

Pronation of the STJ allows pronation of the midtarsal joint and dorsiflexion of the midfoot on the rearfoot which falsely elevates dorsiflexion values—resulting in under diagnosing of equinus.
- Pronation of the foot increases the measured DF by more than 10 degrees

Forefoot motion is minimized by not totally eliminated with the STJ is in neutral

Question 4

how do we test for equinus?

Answer 4

Landmarks are the lateral margin of the foot and the midline of the lateral calf
Must evaluate from the lateral side
Must inhibition of the gastroc-soleus complexavoid pronation of the foot
Holding the foot Neutral to Slightly SUPINATED/varus is the most accurate and reproducible way to measure ankle DF
Patient must be relaxed and not fire anterior muscles- if they are results in reflexive
* watch for firing of TA - needs to be passive

Question 5

silfverskiold test

Answer 5

Assesses for change in dorsiflexion with knee extended (gastroc v soleus)

knee bent = just soleus

Question 6

how does equinus affect gait?

Answer 6

• More rapid entrance and exit into and out of mid-stance
• Reduced step length
• Slower walking velocity
• Increased forefoot pressure
• Pronation of foot to obtain required dorsiflexion (Pronation is Tri-plane and includes dorsiflexion)

Question 7

compensatory mechanisms equinus

Answer 7

Forward torso lean
Pelvic rotation
Hip Flexion
Knee hyperextension
Knee flexion (Chimera, You)
External rotation of leg
STJ & MTJ (oblique axis) Pronation

Question 8

describe STJ and MTJ compensation for equinus

Answer 8

Dorsiflexion of forefoot on rear foot compensates for the lack of ankle joint dorsiflexion

This abnormal amount of motion in the foot leads to tendon, ligament and joint degeneration

Question 9

will stretching help with equinus?

Answer 9

a little (3-8 degrees with aggressive stretching) 
does have a big effect on symptoms, but will not completely resolve equinus

Question 10

what are gastroc recession outcomes?

Answer 10

strength does not return fully (80%) but has good resolution of symptoms

Question 11

pseudoequinus and osseous equinus. Please review these slides carefully as they will be important for you to know, particularly radiographic exams and findings

Answer 11

pseudoeqinus = actually have 10 degree dorsiflecion at ankle but functionally need more because of plantarflexed forefoot (loads earlier due to anterior cavus foot)

osseous equinus is due to impingement of tibiotalar articualtion

• abrupt end dorsal ROM
• not dependent on knee positon
• osseous blcok on radiographes
• charger radiographic view

Question 12

radiographic signs oseeous equinus

Answer 12

lateral projection

• reduced anterior joint space
• squaring of talar neck
• talar lipping and osteophytes

stress dorsiflecionlateral/ charger view
- reduced motion or dorsiflexion