Pediatric Equinus Flashcards
What is equinus
Limitation of the normal ankle joint dorsiflexion with the subtalar joint maintained in its neutral position
Normal ROM at birth
75 degrees of DG
Normal ROM at age 3
20-25 degrees DF
Normal ROM age 10
15 degrees FD
Normal ROM age 15 to adulthood
10 degrees DF
What happens to forefoot DF if the STJ is pronated
Pronated STJ allows the MTJ to be unlocked = excessive forefoot DF
What is a normal silfverskoid test
- normal DF with knee extended
- normal DF with knee flexed
What is pure Gastroc equinus
No DF with knee extended
Normal DF with the knee flexed
What is Gastroc-soleus equinus
No ankle DF with the knee bent and extended
.What is the most common form of equinus
Congenital Gastroc
What is Gastroc equinus
Limited DF with STJ neutral and knee fully extended
What is congenital soleus equinus
Limitation with the knee flexed
What is congenital Gastroc-soleus equinus
- limitation with the knee flexed less than 10 degrees
- sponges at end ROM when compared to boney equinus
- WB stress lateral films to rule out boney block
What is spastic equinus
- commonly associated with cerebral palsy, hyperkinesia
- marked limitation in both knee extended and flexed
- increased achillles reflex and ankle clonus
What is compensatory equinus
Excessive subtalar pronation causes shortening of gastric-soleus complex
What is ankle equinus (bone block equinus)
Abutment of the tibia on the talus
What is athletic equinus
Anatomy driven; fibril increase in volume decreasing elasticity
What is traditional equinus
Rapid growth without muscle components equally lengthening
How does the body compensate for equinus
- subtalar joint pronates
- abduction of the foot to reduce need for ankle DF
- early heel off
- genu recurvatum
- knee flexion during gait
What happens during gait in compensated equinus
- max pronation with calcaneal eversion
- unrestricted STJ ROM without significant RF varus; allows the MTJ to unlock to allow for forefoot DF
- rocker bottom at extreme, with long term repercussions
Describe partially compensated equinus gait
- low degree of STJ pronation and high degree of RF varus; MTJ cannot unlock, the gait abducts, early heel off, flexed knee during gait, genu recurvatum
Describe the gait in uncompensated equinus
- extreme muscle shortage with no heel contact
- relatively rare and need to rule out idiopathic toe walking
What happens during Gastroc-soleus complex equinus gait
- tightness of the gastrocnemius muscle limits normal advancement of the tibia relative to the foot during the midstance phase of gait
- for tibial advancement, when ankle joint dorsiflexion is limited, compensatory movements at joints proximal or distal to the ankle may occur, including the subtalar and midtarsal joints
Equinus pathomechanics
- Gastroc/soleus tightening
- plantar aponeurosis tightening - related to STJ pronation, MTJ supination, 1st ray dorsiflexion
- cavus foot - increased pressure at heel strike, increased Achilles tension
- trauma - single or repetitive
- obesity - overweight children have an increased prevalence of flatfoot
Pediatric neurological roots
- common in cerebral palsy
- duchennes
- Becker’s
Describe idiopathic toe walking
Noted in children with cognitive delays
- vision evaluation
- botulinum treatment vs stretching
What is calcaneal apophysitis/sever’s disease
Overuse syndrome thought to be auger by repetitive micro trauma due to increased traction of the calcaneo-Achilles apophysis
What are the symptoms associated with calcaneal apophysitis/sever’s disease
Pain near lower posterior calcaneus close to Achilles attachment into secondary growth plate of the calcaneus
What are some surgical options for equinus
- Baumann Gastroc Recession - open release of the sheath
- Edoscopic Gastroc Recesson - direct visualization with a scope
- Tendo Achilles Lengthening - percutaneous vs. open; weakening
- Advancement of the Achilles Tendon in Spastic Patients - Murphy procedure
