Ankle Equinus



Ankle Equinus





EQUINUS



Anatomy

Gastrocnemius muscle originates on the femur and crosses three joints (knee, ankle, STJ).

Soleus muscle originates on the tibia/fibula and crosses two joints (ankle, STJ).

Plantaris muscle originates on the femur and crosses three joints (knee, ankle, STJ). Plantaris runs between the gastrocnemius and soleus muscle and inserts on the medial aspect of the posterior calcaneus. This muscle is absent 7% of time.

The triceps surae muscle is referred to the two heads of the gastrocnemius muscle and the soleus muscle.


Silfverskiold Test

▪ Tests for gastrocnemius equinus

Passive dorsiflexion is measured with the knee extended and again with the knee flexed. If the amount of dorsiflexion increases with knee flexion, there is an equinus due to a tight gastrocnemius, because the gastrocnemius crosses the knee joint and the soleus does not.


Types/Causes


Muscular

Spastic equinus


CP (hyperreflexia, +babinski, +clonus)


Duchenne’s (post muscle contractions, weak/atrophic muscles, absent reflexes)

Congenital equinus


Birth history, childhood diseases

Note: Toe walking for the first 3 to 6 months of ambulation is a normal variant.

Acquired


Improper casting with the foot plantarflexed

Repetitive use of high-heel shoes

Iatrogenic


Osseous

Talotibial exostosis


Clinically there is a hard and abrupt end ROM upon dorsiflexion.

Stress lateral x-ray may aid diagnosis.

Pseudoequinus


Apparent equinus due to cavus foot type



GAIT AND PHYSICAL EXAM

Biomechanics: Look for STJ ROM, ankle joint ROM, rigid vs flexible deformity.








Equinus



























Uncompensated


Partially Compensated


Fully Compensated


Hypertrophic calves


Early heel off


Forefoot supinatus


STJ supinated


STJ pronation


STJ pronation


Walking plantarflexed


Mild HAV


Heel valgus, HAV deformity


Smaller steppage gait



+ + + most pathological


RF inverted



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Nov 20, 2018 | Posted by in ORTHOPEDIC | Comments Off on Ankle Equinus
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