Assistant Professor of Surgery
Ohio College of Podiatric Medicine
When a patient with an equinus deformity presents to the astute
practitioner, the doctor must be able to cubby hole the entity into the
appropriate classification. Dr. Marc Dolce helps us in this regard in this well
thought out presentation. We must first make a distinction between either
muscular or osseous deformities. The osseous equinus usually presents with a
firm and abrupt end range of motion and lateral radiographs typically
demonstrate tibiotalar exostosis. An equinus of a muscular etiology, may be
either spastic or non spastic in nature. Dr. Dolce reminds us that, of course, a
thorough neurological work up is needed to rule out hyper reflexia, hypertonia
as well as clonus.
Patients with non spastic equinus have congenital shortness of the
posterior crural muscles. During gait analysis, the physician will notice an
early heel off. The Silfverskoid test helps to distinguish between the gastroc
equinus and the gastroc soleus equinus.
A pseudo equinus, as its name suggests, is not a true ankle joint
limitation. It is actually a functional limitation secondary to forefoot equinus.
Patients typically have a cavus foot with severely contracted digits and a
neurological component to their problem.
Dr. Dolce gives us a short list of pathology commonly associated with
equinus including genu recurvatum, excessive pronation and hamstring tightness.
He reviews the anatomy of the posterior leg and outlines a complete clinical
evaluation for this condition.
The suitability of the gastroc recession versus the Achilles tendon
lengthening or tibiotalar exostectomy are discussed in detail. This presentation
includes some excellent intraoperative photographs.
