Toe walking in kids and adults - Equinus foot deformity

An equinus foot deformity is a condition of the foot and ankle where the foot is held in a downward position.
There is a loss of the upward range of motion of the ankle joint.
that means it becomes difficult to pull the foot up toward the shin bone.
Equinus may be either congenital , present at birth.
or acquired if it develops later in childhood or in an adult.
This condition is found equally in men and women,
and it can occur in one foot, or both.
Equinus posturing in gait, or toe walking, can be due to either true equinus
where the ankle is in plantarflexion.
or ‘apparent equinus’,
where the heels are off the ground but the ankle movements are normal.
The apparent equinus is seen as compensating for a problem elsewhere,
such as the hip or knee,
or because of limb length discrepancy.basic types of true equinus:
gastrocnemius equinus .
soleus equinus .
gastroc/soleal equinus .
osseous equinus .
causes:
cerebral palsy .
stroke .
head Trauma.
post-surgical injury.
excess bone in the anterior ankle because of a fracture or osteoarthritis of the ankle.
Bony block between the talus and distal tibia .
Prolonged positioning in equinus.
Leg length discrepancy .
Trauma, burns and limb lengthening .
wearing high-heeled shoes.
Diabetes mellitus.
Congenital Foot Deformities such as: Clubfoot.
In a standard Silfverskiold test, there is normal dorsiflexion with the knee extended and flexed to 90 degrees.
With pure gastrocnemius equinus,
ankle dorsiflexion is limited with the knee extended
but with knee flexion ,
there is normal dorsiflexion.
In the findings of soleus equinus,
ankle dorsiflexion is also limited with the knee both flexed and extended.
If the ankle dorsiflexion range is limited in both knee extended and flexed positions
and there is a sudden or ‘hard’ quality to the end of range,
suspect an osseous equinus.
In mild to moderate cases, We can initiate a comprehensive stretching program.
Stretching exercises are the mainstay of treatment of equinus
and utilization of a physical therapist is essential.
Common stretches includ:
the runner’s stretch.
the soleus stretch.
calf wedge stretching block .
the band stretch.
as well as foam rolling .
If leg length discrepancy is present,
a full-length shoe lift may be used in conjunction with stretching until the leg length discrepancy can be addressed.
Serial casting can be used in the most severe of cases in children to improve joint range of motion.
The casting process uses series of consecutive casts - typically changed weekly .
most children walk on the cast.
Over the course of wearing the cast ,a prolonged and progressive stretch occurs until the desired range of motion is reached.
The duration of serial casting depends on the severity of range lost, diagnosis, and age.
Older children will typically wear casts longer than young children.
total treatment time around 4 weeks to 6 months.
Surgical treatment.
surgical correction for equinus must focus on the underlying etiology.
In osseous equinus,
this requires resolution of the osseous impingement through exostectomy or joint arthroplasty.
In cases in which osseous impingement is the presumed source of equinus,
it is important to realize that soft tissue adaptation may have occurred, resulting in a concomitant soft tissue equinus.
At the time of tibiotalar exostectomy,
it is worthwhile to evaluate the presence of soft tissue contractures and release them as needed.
achilles tendon lengthening.
lengthening surgery options include.
gastrocnemius recession.
This procedure targets only the gastrocnemius muscle
and helps to loosen the muscle fibers attached to the cord.
It is used for gastrocnemius equinus only.
The second method is called the percutaneous tendon lengthening.
In this procedure, small incisions are made in the tendon through the skin using stab wounds.
The surgeon then holds the foot and stretches the tendon by performing a forced dorsiflexion of the ankle.
The cut areas move apart elongating the tendon.
The third method is known as Z-plasty, and it is the most common.
The surgeon makes a Z-shaped incision in the tendon,
stretches it to a particular length,
and then joins the tendon back together.
in cheldren younger than two years of age,
The tenotomy corrects the equinus.
It is a complete cut through of the Achilles tendon, not a tendon lengthening.
it is performed percutaneously through a very small incision.
In infants the tendon heals sufficiently in 3 weeks.
An external fixator may be required to perform gradual correction of an equinus deformity if the skin and soft tissue over the tendon was poor .
such as an equinus secondary to burns.
which makes open correction a less appealing option.
The Ilizarov external fixator uses threaded rods connecting the tibial components to the forefoot and hindfoot components.
These are adjusted at a rate of 3 to 4 mm to correct 1 degree of dorsiflexion per day.
#toewalking #equinus #anklecontracture #contraction

[@mogesyitbarek4301]

how much surgery will be important having toe walking patient secondary to cerebral palsy ?

[@LuisAlbani-cj6xu]

I have tendon Achilles lengthening surgery it's been 5 years I still using crutch

[@jacquelinelowe7535]

Promo-SM 😢

[@asifkhan325]

My child is 7 years old and he is cp with equinus foot deformity.and he walks on his toe.I am from India.please guide me.❤

[@jalisamoore8633]

My child too recently got diagnosed with Equinus foot deformity. I am starting with an orthotic in his shoe called LittleSteps Orthotics. You can look it up. It is known to help kids get off their toes and has been pretty successful.