Equinus

Question 1

Define ankle or talipes equines

Answer 1

• Sagitta plane deformity in which there is < than 10 degrees of DF at the AJ when the STJ neutral and MTJ max. Pronated at both axes
• may be Ossetia (very rare, congenital , significant trauma or significant OA) or muscular (gastric and/to soleus)

Question 2

Outline the aetiology of ankle equines

Answer 2

• ongenital muscle shortage of part or all of triceps surae
• issues blockage of DF due to breaking of tibia or altered anatomy of talus (e.g. Eostosis)
• tight hamstrings or iliopsoas requiring compensatory DF at AJ
• posterior muscle contracture: spastic paralysis (UMNL e.g. Stroke or cerebral palsy); tonic mm spasm (in response to pain e.g. Sore AJ or STJ, can be overcome with constant force); dynamic mm imbalance (LMNL e.g. Polio affecting ant group, resulting in unopposed post contracture
• prolonged bed rest or wearing high heeled shoes
• excessive pronation of STJ and MTJ

Question 3

Outline the pathomechanics of compensated ankle equinus

Answer 3

• if inadequate AJ DF in midstance as body passes over foot, foot remains planted, DF is achieved via STJ pronation
• foot may ‘break’ at MTJ which will also be unlocked, to allow DF of Ffoot on the Rfoot
• midfoot collapse over time
• active propulsion diminished, or abolished requiring lifting of the foot which may lead to overuse of leg muscles. (Inefficient gait)

Question 4

Signs and sx. Of uncompensated ankle equinus

Answer 4

B- bouncy type gait, early heel lift, toe walking (if severe/kids)
I- increased WB in Ffoot may lead to HK on ball of feet and clawing of lesser digits
S- secondary hamstring contracture
P- proximal compensation. Recurvatum of knee, forward postural position, inc lordosis of lower back, and abd/add gait

Question 5

Signs and sx. Compensated ankle equinus

Answer 5

“Chopen”
C- collapsed midfoot/break
H: HAV
O: one of the most destructive of pathologies (Esp. If long term and left untreated)
P: postural fatigue
E: excessive pronation of foot during gait
N: neuromas

Question 6

Outline treatment for ankle equinus

Answer 6

• stretching of tight structures: stretching ( 5x 30 second stretches a day), casting (rolf says this ain’t shit)
• orthodox to control pronation
• heel lifts if symptomatology in triceps surae (e.g. If pt. has grand final on weekend: not for long term rx.)
• surgical lengthening

Question 7

what are the pronation induced pathologies associated with compensated equinus?

Answer 7

• HAV (adductor hallucis has mechanical advantage)
• neuromas (unstable foot means bones crunch and grind)
• postural fatigue (floppy foot is harder to DF/PF esp. in propulsion

Question 8

what sort of assessment do we do for suspected equinus cases?

Answer 8

• AJ ROM is assessed with patient prone
• With knee extended
  STJ neutral or slightly supinated ( to limit the amount of motion there)
• Repeat with knee flexed (to determine contribution of soleus v. gastrocnemius)
• If tight in extension and not flexion : the tightness is mostly from gastroc not soleus
  -If tight in both scenarios then its soleus or both or a bony block.
  -If endpoint is spongy then is muscular
  -If the endpoint is hard then it’s a bony block

Question 9

outline the treatment options for equinus

Answer 9

• Stretching of tight structures
• Casting [rolf says this is stupid]
• Heel lifts if symptomatology in triceps surae i.e. if patient needs to do a grandfinal over the weekend or something emergency style then add a heel lift in their shoe/to their orthotic or change shoes. NOT A LONG TERM SOLUTION
• Surgical lengthening [obviously last line]

Question 10

outline the “ideal measurement criteria “ (from FPI lecture)

Answer 10

• WB
• multiplanar
• multisegmental
• reliable
• valid
• requiring minimal manipulation to subjective position