Patient Education

Equinus (tight calf muscles and Achilles tendons)

Equinus (tight calf muscles and Achilles tendons)

You have been diagnosed with equinus, a condition that develops slowly over time and can be the underlying cause of pain in many areas of the foot, leg and ankle.

With equinus, the short calf muscle/Achilles tendon causes a decrease in dorsiflexion (upward motion of the foot at the ankle joint), forcing the other foot joints to become overworked.

Equinus is often seen in patients who have been athletic for many years, in patients who are overweight and often in children during phases of rapid leg growth. Some children are also born with equinus causing early gait abnormalities like toe walking.

Common Foot problems associated with Equinus:

Plantar fasciitis: Equinus causes the heel to lift too soon while walking. When the heel pops up off the ground, the sudden tug or pull on the plantar fascia causes inflammation and pain where it attaches to the bottom of the heel.

Stress fracture: Equinus shifts the body weight forward, overloading the forefoot. This overload causes the bones to weaken and fracture over time. Also, when plantar fasciitis goes untreated, the heel bone can also fracture under the constant stress.

Ankle sprain: Since equinus limits ankle motion, a sudden shift in body weight or unevenness in the walking surface can result in an ankle sprain. Patients with equinus are also more likely to have repeated ankle sprains during recovery of their original sprain if the equinus is not treated.

Flat Feet: One of the ways the body compensates for equinus is for the arch to lower in height. The foot appears flat. This process, called pronation, results in a lowering of the arch and an internal twisting of the leg with every step. If flat feet are treated with arch supports without treating the equinus, the arch support removes the natural compensation for the equinus and the heel will often pop up out of the shoe while walking.

Tarsal Tunnel Syndrome: In some cases, the pronation caused by equinus results in a nerve entrapment (pinch) just below the ankle. Treating the equinus helps remove the pinching forces.

Bunions/ Hammertoes: The pronation associated with equinus causes a twist in the alignment between the foot and the leg. The twist causes the tendons which move and stabilize the toes to pull abnormally and the toes begin to drift out of their normal alignment. Given enough time, the misalignment becomes stiff, painful and permanent.

Hallux Rigidus: This condition is a painful degeneration of the joint where the great toe bends at its attachment to the foot. Equinus shifts the body weight forward toward the toes while walking and standing, thereby increasing the pain and stiffness felt by these patients.

Treatments for Equinus:

  1. Stretching Program: The main treatment for equinus involves a dedicated Achilles and calf stretching program. The good news is that stretching is free, involves no drug interactions or allergic reactions and is the main cure for equinus. The bad news is that the patient must take responsibility for performing the stretching program. The program takes three months to complete and must be performed five times per day to be most effective. Once the stretching program is completed, the patient will need to perform maintenance stretching throughout life before and after exercising in order to prevent recurrence of the equinus and recurrence of the symptoms.

  2. Night splint: Night splints have been proven in double-blind randomized clinical trials to treat plantar fasciitis. The splints are worn for 30-60 minutes daily at the end of the day when the activities of the day are over. Usually worn when watching TV, reading or check emails, the devices keep the Achilles tendon at a constant, gentle stretch. This method sends a message to the brain to reset the muscle memory of the calf muscle to a more loose position. Night splints work best when used together with a dedicated Achilles stretching program.

  3. Pro-Stretch: The pro-stretch device is used for patients with severe equinus or who engage in high levels of athletic activity. The pro-stretch device increases the force of the stretching program for those tough to treat patients.

  4. Surgery: Surgical Achilles or calf lengthening is usually reserved for severe cases, cases where the patient fails to stretch as recommended, or may be combined with other surgical techniques during reconstructive surgery.

    This information is intended solely for the use of Foot & Ankle Center of Frisco/Plano patients.