Equinus Flashcards
(14 cards)
What type of plane does ankle equinus deformity affect?
Sagittal Plane
Is ankle equinus boney condition or soft tissue deformity or both?
It is both a boney deformity and soft tissue
What joint does it reduce ROM and what joint are involved and what positions are they in?
It reduces ROM in the ankle joint to less than 10degrees when the STJ is in neutral and MTJ is locked
Why do we need 10 degrees of dorsiflexion?
It starts with the need at the end of 2nd rocker to start the swing phase and eventually clear the toes off the ground (in the third rocker)
What is the aetiology (cause) of equinus?
It can be a combination of factors, firstly starting with a short heel cord both congenital (ie in autism born with toe walking) or acquired; growth spurt, high heels, exercise or sport. (Fixed through combination of stretching and treatment)
Can be a neurological cause; UMNL (cerebral palsy) or LMNL (anterior compartment has no dorsiflexion)
Bony Block, injury or OA
What are the clinical observation for equinus?
Leg extended
STJ in neutral to prevent Dorsiflexion and push the foot upwards.. How much Dorsiflexion? Normal is 10degrees and equinus is less than this
What does clinical observation for equinus look like without the gastrocs and with the soleus?
Patient is prone
Knee flexed
Using the plantar surface of foot heel and 5th met base
Normal is 10 degrees less than that is equinus
What is the Compensation for equinus?
STJ Pronation to get dorsiflexion movement
Other possibly Compensations for equinus?
Shorter Stride - decreased need for dorsiflexion at ankle
Flexed Knee gait - relative increase in muscle length
Abducted gait - out toe resulting medial roll off
Genu Recurvatum (knee hyper extension) the forward or backward pushing of the knee results in increased ankle ROM
What does the clinical picture of equinus look like?
Everted calcaneus
Abducted and dorsiflexed forefoot
Calcaneo-Cuboid Break
Pronation throughout the whole gait cycle
C shaped lateral border
Helbing’s sign
Tight achillies alleviated by stretching gastrocs and soleus.
What are the signs of full comp. Equinus?
Rear foot strikes Everted Pronated throughout stance phase A propulsive gait Banana foot Very destructive foot type
What are the signs of compensated equinus?
Early heel lift Bounce in gait Short stride Out toe gait Flexed knee gait As pronated as can be, may have little eversion so looks eversion so looks inverted foot type
Uncompensated equinus (true telapies) what are the signs?
No pronation or other compensations
Toe walker
Heel sags from plantar flexed position on full weight bearing
(Not enough dorsiflexion in subtalar joint)
Talipes equinus
What is the treatment for equinus?
Determine diagnosis
Increase ROM at ankle - exercises
Increase ROM surgery tendoachillies lengthening (also termed Z plasty) - in cerebral palsy patients they cut the achillies to allow for more ROM and add in more stretching, achillies is stitched back together to allow sliding.
