EQUINUS CONTRACTURE
Contractures of the limbs can create a difficulty for the patient to ambulate properly with the foot properly planting on the ground. The most common contracture is of the ankle joint- we call this Equinus ( called equinus because of how foot position looks like the anatomy of a horse leg , they walk on the tips of their toes - that’s what a hoof is!).
Take a look at the picture to the right (if you on a desktop). You can see the the angle between the yellow and green lines indicated by the blue arrow should be about 90 degrees ( the yellow line needs to come up a bit) But that’s not enough, for normal walking the foot ( yellow line ) needs to come up another ten degrees. The inability to achieve the foot to at least neutral or 90 degrees to the leg is called an ankle contracture or equinus. You can also see in this this picture that the patient cannot even get his heel to touch the ground. In some cases this deformity can be severe like in the next picture below.
On the left this is a patient who recently suffered a stroke, the resulting muscle imbalance caused one muscle to pull harder than another and create this deformity.
The inability to place the heel on the ground and ‘walk on the toes’ can have serious repercussions to the rest of the body. It can cause other contractors the help the body compensate or throw off the joint positions and cause arthritis. In other situations the equinus can be so bad as to prevent walking altogether. Also a common situation we find is in our diabetic population where contractors occur from glycosilation of tendons which really means hardening and contracture. If this occurs diabetic foot wounds can occur from the infuse of pressure on the front of the foot.
In other cases the contracture of the achilles tendon can deform the ankle and foot because it is such a powerful muscle group. It is a widely held belief that flatfeet are possibly caused by this achilles equinus. When we do surgical correction of the flatfoot we include a lengthening of the achilles tendon in many cases. There are a number of techniques that we used, some as simple as a small incision 4mm long called a Hoke Hemisection, to as complicated as open surgical releases. Ill detail those procedures below.
There is one other very important condition a surgeon must check for. In some patients the inability to dorsiflex their foot is not caused by a tight tendon but by a bone that is positioned improperly. What does dorsiflex or dorsiflexion mean: that is the motion of moving your ankle upwards- ‘your toes to the nose’. The doctor would use this word frequently and you will find it online when researching the topic. Back to the bone position- in some cases either just naturally or after trauma bone can overgrow and restrict a joints motion. In some cases a joint can change its position or ”range of motion” so much that it it will stop proper joint motion. If a doctor does find that this is occurring a bone surgery might be needed; sometimes as simple as shaving a bone or in other rarer cases cutting a bony to straighten it. (BTW when i say simple i don’t really mean simple- every surgery has risks and even the smallest case is never simple because its your body so only have surgery done if you really need it done, if something does not change the way you live or feel sometimes just better to leave it alone. and this does apply to all surgery)