- Discussion:
- see:
role of ankle and subtalar joint in gait:
- normally, during the transition from foot flat to heel off, the foot dorsiflexes as the body moves forward;
- gait consequences of equinus contracture:
- patient may adopt a toe to toe gait pattern or a toe to heel gait pattern (premature forefoot loading)
- reduced propulsion
- excessive knee hyperextension
- excessive foot pronation which allows more dorsiflexion to occur at the
subtalar joint;
- reduced stride length of the opposite limb
- reduced gait velocity
- external rotation
-
diff dx:
-
anterior ankle impingement
-
leg length descrepancy:
-
hyperpronation of the foot:
-
clubfoot
-
ankle equinus in CP:
- immobilization after trauma
- Heel Cord Stretching:
- patient should be standing and facing wall w/ the feet internally rotated (which keeps heel flat on floor during stretch and which locks the subtalar joint);
- this ensures that dorsiflexion motion occurs only at ankle joint;
- care must be take to invert subtalar joint and forefoot before applying dorsiflexion stress;
- this locks calcaneus under talus, ensuring that dorsiflexion occurs only at the ankle joint rather than dorsiflexion does not occur at the midfoot;
- Orthotics:
- with a fixed equinus deformity, patients may do well with a heel-lift shoe insert;
Operative Treatment:
- Baumann procedure:
- consists of intramuscular lengthening (recession) of the gastrocnemius muscle in the deep interval between the soleus and gastrocnemius muscles;
- goal of the procedure is to increase ankle dorsiflexion when ankle movement is restricted by a contracted gastrocnemius muscle;
- procedure is indicated when the results of the Silfverskiold test are positive.
- Vulpius procedure
-
Biomechanics and Orthotics of the Foot in Athletes. S.C. Graves MD, T.H. Badwey MD, and K.O. Graves PT.
Operative Techniques in Sports Medicine, Vol 2, No 1 (Jan), 1994 pages 2-8.
