If the ankle joint is not flexible and the movement of the foot from the toes to the tibia (dorsal flexion) is restricted, the condition is called equinus. Equinus is a consequence of tension in the Achilles tendon or calf muscles (soleus muscle and/or gastrocnemius muscle) and can be congenital or acquired. This condition is found in both men and women and can occur in one or both feet. When both feet are involved, the range of motion of one foot may be more limited than in the other. This limited muscle flexibility and freedom of movement can lead to injury. Gastrocnemius equinus contracture (Figure 1) occurs when tightness in the outer calf muscle (gastrocnemius) results in limited dorsal flexion of the ankle (movement through the ankle joint itself). To compensate for this oppression and have the foot placed on the ground, compensatory movement often occurs in the joint in front of the ankle, the transverse tarsal joint composed of the heel-to-sag joint and the calcaneal cuboid joints (Figure 2). The characteristic of gastrocnemius equinus contracture is that it corrects (that is, the movement of the ankle becomes full) when the knee is bent because the pressure is taken from the gastrocnemius muscle when it adheres above the knee joint. Sometimes one or both of these calf muscles can become too tense, which can lead to equine contracture or deformity. In this case, it usually becomes difficult to move the foot upwards, which is also known as dorsal flexion restriction. This anatomical problem can lead to impaired gait and lead to various problems over time, including: chronic pain, ulceration, or other types of mechanical degradation of the foot or ankle.
To diagnose equinus, the foot and ankle surgeon assesses the range of motion of the ankle when the knee is bent (bent) and stretched (stretched). This allows the surgeon to determine if the tendon or muscle is tense and assess whether the bone is interfering with ankle movement. X-rays can also be ordered. In some cases, the foot and ankle surgeon may refer the patient for neurological evaluation. Equinus is often due to tension in the Achilles tendon or calf muscles. For some, it may be congenital (present at birth) or a hereditary trait. For others, this tightness is acquired and is the result of being in a plaster or on crutches or often wearing shoes with high heels. Other causes include diabetes or one leg shorter than the other. If a bone or bone fragment (for example.
B, after an ankle injury) blocks the movement of the ankle, the patient may have equinus. Rarely, equinus can be caused by spasms in the calf muscle, which may be a sign of an underlying neurological disorder. Congenital contracture of the gastrocnemius muscle (disorder) There are several possible causes of impaired range of motion of the ankle. It is often due to tension in the Achilles tendon or calf muscles (soleus muscle and/or gastrocnemius muscle). In some patients, this oppression is congenital (present at birth) and is sometimes a hereditary feature. Other patients acquire tightness because they are in a cast, stand on crutches, or often wear high-heeled shoes. In addition, diabetes can affect the fibers of the Achilles tendon and cause tightness. Sometimes the equinus is connected to a bone that blocks the movement of the ankle. For example, a fragment of a bone broken after an ankle injury or bone block can interfere with and restrict movement. Equinus can also result from the fact that one leg is shorter than the other. More rarely, equinus is caused by spasms in the calf muscle. These seizures may be signs of an underlying neurological disorder.
Equinus contractures are the inability to move the foot to a neutral position (a right angle to the lower leg), either due to tension of the muscles and/or tendons in the calf, scarring of the ankle joint capsule and other restrictive structures, or a bone spur in the front of the ankle that restricts normal ankle movement. It is named after horses (horses) that run essentially “on their toes”. In general, it is believed that isolated gastrocnemius contracture develops from one of the many causes: the largest calf muscles are called gastrocnemius and soleus. The gastrocnemius is the larger and longer of the two, which arises above the knee joint before connecting to the soleus below in a way that naturally makes the gastrocnemius more susceptible to oppression in humans. When these muscles run together to form the foot, they eventually connect to form a tendon called the Achilles tendon, which fits into the heel. The main function of this “gastroc-soleal complex” in humans is to control movement through the ankle joint and plant the foot to promote the rejection of force. Instead of stepping on their toes, most people naturally and unconsciously compensate for an underlying equinus by developing greater (excessive) upward movement in other nearby joints such as the transverse tarsal joints. Many gastrocnemius contractures are subtle and patients are often asymptomatic. However, if it is present, over time, this problem often leads to significant and progressive metatarsal compensation, which leads to repeated overloading of various bone structures and soft tissues of the foot, both when standing and walking.
The presence of such a disease can therefore predispose to the development of certain foot diseases such as plantar fasciitis, acquired deformity of the flat foot in adults, inflammation of the metatarsal or achilles tendon disease. Calf muscle contracture, or “equinus,” can occur due to isolated tightness of the gastrocnemius muscle, or the result of tension in these two muscles together, and it is important to distinguish these two causes, as treatment to resolve the problem and avoid long-term consequences can be significantly different. and even the daily splint can sometimes be effective in preventing or relieving this condition, often the problem remains refractory for such management and surgery may be necessary to release these tissues in a way that allows the restoration of normal ankle/foot upward movement (dorsal flexion). If the problem is isolated from the narrowness of the gastrocnemius tendon, surgery to release this contracture is called gastrocnemius recession or “wandering” procedure. If indicated, surgery can be very effective in resolving the various clinical conditions a patient might have that are associated with tightness of this muscle and do not respond to non-surgical treatment. Before considering surgery, a regular calf stretching program (with a right knee, as shown in Figure 3) should be recommended for at least a few months, as this non-surgical measure can lead to the resolution of symptoms in many cases. In some cases, surgery may be needed to correct the cause of equinus if it is related to a tendon or narrow bone that blocks ankle movement. The foot and ankle surgeon determines the type of procedure that is best for each patient. .