Evaluation and Treatment of Patients with Equinus Flashcards
Equinus
- a fixed plantarflexed position
- inadequate dorsiflexion available
what does the biomehcnaics community see equinus as
inadequate ankle joint dorsiflexion
to some specialities, equinus is seen as
a fixed plantarflexed position
for eqinus, when is foot function okay
-if the foot reaches a plantigrade position (gets the heel to the floor), foot function is fine
what is the biomechanics community concered about
how the heel is able to reach the floor (compensation)
what amount of dorsiflexion is required at the ankle
10’
if a minimum of 10’ of dorsiflexion is not available, compensation will be required in order for
the heel to remain on the ground in midstance (or in order for the tibia to move forward on the foot)
how is ankle joint dorsiflexion measured
- femoral condyles in frontal plane
- STJ in neutral position
- MTJ maxiamlly pronated
how is the goniometer placed when measuring ankle joint dorsiflexion
ALWAYS placed on the lateral side of the ankle
how do you determine the type of equinus
determine the difference in ROM of the ankle with the knee flexed vs. knee extended will help determine the type of equinus (Silverskiold test)
why would you measure ankle joint dorsiflexion actively
- prevent firing of the gastroc-soleus complex when it is stretched
- may be a problem bc many pts will automatically pronate the STJ
why should ankle joint dorsiflexion be measured passively
- maximum ankle joint dorsiflexion is required during gait at or slightly before heel lift
- extensors should not be firing at this point
how can ankle equinus be classified
- by type
- by etiology
what are the 4 general types of equinus
- gastrocnemius equinus
- soleal equinus
- ankle joint/bony equinus
- pseudoequinus = functional equinus
gastrocnemius equinus is a result of
tight gastrocnemius
what is ankle joint dorsiflexion with gastrocnemius equinus
ankle joint dorsi w/ knee flexed: >10
ankle joint dorsi/ knee extended: <10
how do you compensated for a gastrocnemius equinus
knee flexion
what is ankle joint dorsiflexion with a soleal equinus
ankle joint dorsi w/ knee flexed: <10
a soleal equinus may also have what other influence
gastroc influence
what is ankle joint dorsiflexion with a bony equinus
ankle joint dorsi w/ knee flexed: <10
how do you distinguish btwn a bony and soleal equinus
- Feel of end ROM
- Tightness of Achilles Tendon
- Radiographic findings
Bony vs. Soleal Equinus: Feel of end ROM
- spongy/soleal equinus if end ROM
- bony equinus if abrupt, solid end ROM
Bony vs. Soleal Equinus: Tightness of Achilles tendon
- soleal equinus if taut Achilles tendon
- bony if not taught
Bony vs. Soleal Equinus: Radiographic findings
forced dorsiflexion lateral view
what is pseudoequinus AKA
functional equinus
what is pseudoequinus
the actual ankle joint dorsiflexion may be adquate, but it is being “used up” for purposes other than allowing the tibia to move anteriorly over the foot
what type of foot is pseudoequinus found in
an anterior cavus, or anterior equinus foot type
pseudoequinus can be associated with neuromuscular etiologies such as
- no limitation with measurement but spasticity may cause the patient to function as if equinus were present
- weak extensor group may be overpowered by the posterior group (will eventually lead to posterior tightness)
- weak posterior group may eventually lead to increased calcaneal inclination ankle and pes cavus deformity
pseudoequinus in the anterior cavus foot type, the FF is —on the RF
plantarflexed