Equinus Deformity (Subscribe)  

Summary: Contractures of the triceps surae commonly are treated by surgical lengthening of the gastrocnemius aponeurosis or the Achilles tendon. Although these procedures generally relieve contractures, patients sometimes are left with dramatically decreased plantar flexion strength (i.e., decreased capacity to generate plantar flexion moment). The purpose of this study was to examine the trade-off...

Toe walking has multiple etiologies ranging from idiosyncratic habit to profound neuromuscular disease. The spectrum of management options extends from mere observation to operations that may involve the lengthening of multiple tendons in the same lower extremity. In dealing with this entity, the underlying pathophysiology for each case must be...

Gastrocnemius recessions have been performed as open or endoscopic procedures. Most of the literature describes the outcomes of these procedures in children with specific neurologic limitations. We report an alternative approach to endoscopic gastrocnemius recessions in neurologically healthy pediatric and adolescent patients whose gastrocnemius equinus could not be corrected nonoperatively....

Results A prevalence of 12% of Idiopathic Toe Walking (ITW) was found. Nine percent had ITW and severely restricted ROM of the ankle joint. Children with ITW had three times higher chance of severe ROM restriction of the ankle joint. Participants with ITW and stiff ankle joints had a decreased ROM...

normally, during the transition from foot flat to heel off, the foot dorsiflexes as the body moves forward;
gait consequences of equinus contracture:
  - patient may adopt a toe to toe gait pattern or a toe to heel gait pattern (premature forefoot loading)
  - reduced propulsion
  - excessive knee hyperextension
  - excessive foot pronation which...

Ankle Equinus in Cerbral Palsy

most common problem;
- in those w/ diplegia, it is bilateral & almost always flexible in child under three years;
- diff dx: toe walking
Exam:
- it is essential that the ankle and hindfoot be held in varus while the amount of dorsiflexion is measured;
...

This search finds articles in all Medline journals in which Equinus Deformity is a major subject

Natural History
Initially toddlers walk on toes 3-6/12
- Graduate to strike on flat of foot
- Finally dev N heel-toe gait
- Mature gait pattern by 3yrs
Idiopathic TW
- N bilateral
- usually from birth
- never see adults with toe walking
- so what is the natural history?
- Do we need to operate...

main causes of toe walking are idiopathic toe walking and cerebral palsy
- history may include continuous toe walking vs normal gait followed by delayed toe walking by age 2 yrs;
- idiopathic toe walking is often caused by a congenitally short heelcord or an overactive calf muscle;
- heel...