What is ankle motion restriction (ankle equines)?
Ankle equinus is a condition in which the upward bending motion (dorsiflexion) of the ankle joint is limited. Those with ankle equines have a restriction in flexibility in bringing the top of the foot toward the front of the leg. Equinus can occur in one or both feet. When it involves both feet, the limitation of motion is sometimes worse in one foot than in the other.
What causes ankle equinus?
There are many causes that may exist singularly or in conjunction:
The gastrocnemius and soleus muscles (calf muscle) join and insert into the calcaneous (heel bone) as the Achilles’ tendon. These structures can become tight for various reasons and result in reduced flexibility. Pain will be present at the back of the ankle and/or lower leg with ankle dorsiflexion on examination.
- Congenital (present at birth) – inherited muscular tightness, various forms of talipes/club foot or neurological conditions such as cerebral palsy.
- Acquired – prolonged periods of ankle postural changes, such as wearing a plaster cast or high heels; diabetes; inadequate stretching after physical activity; contractures following a stroke.
An abnormality of the bones that form the ankle (talus and tibia) can restrict ankle joint range of motion. This causes repeated compression of the tibia against the talus during dorsiflexion. This typically presents as pain at the front of the ankle.
Causes of this may include:
- Ankle joint arthritis
- Chronic ankle sprains
- Spurring of the tibia or talus
- Congenital abnormality of the talus or tibia
When there is a lack of ankle joint dorsiflexion the body finds ways to compensate and gain the required movement from other joints. These compensations can lead to conditions such as:
- Pain in the forefoot(balls of the feet) due to the increase in pressure.
- Morton’s Neuroma
- Hammer or clawed toes
- Arthritis in the midfoot
- Medial tibial stress syndrome (shin splints)
- Stress fractures in the forefoot
- Tarsal tunnel syndrome
- Sinus tarsi syndrome
- Callous, corns or ulcers on the forefoot
Treatment of ankle equinus
A biomechanical assessment will determine the cause of the ankle equinus. The cause determine the appropriate treatment approach and plan. Treatments aim to reduce the cause, prevent the body’s biomechanical compensation, provide symptomatic relief and provide long term resolution. Typical treatment options may include a combination of:
- Activity modification. An initial change to your exercise regime or daily activities may be needed to avoid the condition getting worse. The introduction of a low impact alternate activity may also be of benefit such as swimming.
- Strengthening/Isometric loading. It is important that strength is addressed for this condition so that the affected area can tolerate more load. This is done initially with isometric loading to load up the affected area in a pain-free way.
- Heat or Ice. This condition may respond better to either heat or ice. Try heat prior to exercise and Ice afterwards.
- Anti-inflammatory. Non-steroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, naproxen, or aspirin, will help with pain and swelling as per GP instructions.
- Orthotic Therapy: A custom orthotic device placed in the shoe can help address possible causative factors.
- Adequate footwear. Supportive footwear may also be recommended to stabilise the foot and ankle.
- Massage. Deep tissue massage can help with symptoms of Ankle Equines.
- Dry needling. Dry Needling stimulates a neuromuscular reflex in a trigger point to relax the muscles.
- Night Splint. A splint may be used to hold the calf muscles in a lengthened position to reduce tightness.
Surgery for ankle equinus
In cases that are non-responsive to conservative treatment, surgical intervention may be required.