Everyone at one point or another has tiptoed across a room, whether as a child sneaking a snack or a new parent trying not to wake the sleeping baby. Equinus of the foot and ankle refers to that exact position. This position consists of, while walking, the ball of the foot is touching the ground and the heel is still lifted. Serious clinical symptoms may result from a constant prolonged equinus position of the foot and ankle.
Since normal walking requires at least 10 degrees of ankle dorsiflexion (the position which the toes are pointing upward), it is very important that ankle accommodates the motion. In a medical sense, equinus is defined as the inability to dorsiflex the ankle past 90 degrees. The lack of motion may be coming from a muscular or bony source. There are three types of muscular equinus including spastic, congenital and acquired. Spastic muscular equinus may stem from a neuromuscular condition while congenital equinus refers to prolonged toe walking in children. It is important to note that toe walking in children is normal in the first three to six months of walking. Finally in acquired equinus, continued use of high-heels or improper casting may result in a reduced range of ankle motion. Osseous or boney equinus may come from physical bony obstruction or a cavus foot.
The lack of motion stresses and strains the tendons, muscles and bones. Symptoms such as calf cramping, arch and Achilles tendon pain may present as the first signs. The stress on the arch and Achilles may lead to plantar fasciitis or retrocalcaneal tendonitis. With this compromised gait, or walking pattern, the tendency to shorten walking strides or simply walk on the toes can occur. Secondary signs may be present in the knees, hips or even back.
There are many options to treat equinus. Conservative treatment such as stretching, particularly the calf muscles, will be very important if the equinus stems from a muscular nature; however, may be to no avail in a patient with a bony or osseous equinus. Other conservative treatments range from bracing to adding a heel lift to accommodate the lack of flexibility in the ankle. Surgical treatment may be an option when conservative methods have not achieved the proper results.
While occasionally walking on your tip toes across the room will not lead to muscular or an osseous equinus, it is important to listen to your feet. If you notice any changes in your foot health please consider making an appointment with Dr. Gary N. Friedlander or Dr. Jay C. Larson at Sole Foot and Ankle Specialists in Glendale, Arizona.