What is Equinus?

Equinus is a condition in which the upward bending motion of the ankle joint is limited. Someone with equinus lacks the flexibility to bring the top of the foot toward the front of the leg. Equinus can occur in one or both feet, and may be worse in one foot than the other.

People with equinus often develop compensatory walking patterns, which can lead to other foot, leg, or back issues. Common compensations include arch flattening, early heel lift during walking, toe walking, or altered gait involving the hips and knees.

Causes

Limited ankle motion can stem from several causes, including:

  • Tightness in the Achilles tendon or calf muscles (congenital or acquired)
  • Prolonged casting, crutches, or frequent high heel use
  • Diabetes-induced changes in tendon structure
  • Bone block or bone fragment following an injury
  • Leg length discrepancies
  • Muscle spasms related to neurologic disorders

Foot Problems Related to Equinus

Depending on compensation patterns, equinus can contribute to a variety of foot and leg conditions, including:

  • Plantar fasciitis (heel/arch pain)
  • Calf cramping
  • Achilles tendonitis
  • Metatarsalgia
  • Flatfoot
  • Midfoot arthritis
  • Pressure sores
  • Bunions and hammertoes
  • Ankle pain
  • Shin splints

Diagnosis

Many patients are unaware they have equinus until they seek treatment for related foot issues. Diagnosis includes evaluating the ankle’s range of motion in both flexed and extended knee positions. X-rays and neurological evaluations may also be conducted as needed.

Non-Surgical Treatment

Treatment focuses on symptom relief and addressing the underlying equinus. Options include:

  • Night splints: Hold the foot in a stretched position overnight
  • Heel lifts: Reduce tension on the Achilles tendon
  • Custom orthotics: Improve foot alignment and balance muscle function
  • Physical therapy: Stretching exercises for calf muscles

When is Surgery Needed?

If conservative treatment fails, surgery may be considered to release a tight tendon or remove a bone block. The surgical approach depends on the individual’s condition and anatomy.