1. A limitation of passive ankle joint dorsiflexion to less than 90°
2. At least 10° of dorsiflexion past 90° is required for normal gait.
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.
▪ 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.
CP (hyperreflexia, +babinski, +clonus)
Duchenne’s (post muscle contractions, weak/atrophic muscles, absent reflexes)
Birth history, childhood diseases
Note: Toe walking for the first 3 to 6 months of ambulation is a normal variant.
Improper casting with the foot plantarflexed
Repetitive use of high-heel shoes
Clinically there is a hard and abrupt end ROM upon dorsiflexion.
Stress lateral x-ray may aid diagnosis.
Apparent equinus due to cavus foot type
Toe walking/early heel off/short stride length
Plantar fasciitis/arch pain
Retrocalcaneal tendinitis (possible calcifications in Achilles tendon)
Calcaneal apophysitis (young patients)
Abducted angle of gait
GAIT AND PHYSICAL EXAM
Biomechanics: Look for STJ ROM, ankle joint ROM, rigid vs flexible deformity.
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