Achilles Tendon Conditions
Ankle Equinus and Contraction
Ankle Equinus is a condition that is known to create many conditions and deformities of the foot and ankle. Someone with equinus lacks the flexibility to bring the top of the foot toward the front of the leg. People with equinus develop ways to compensate for their limited ankle motion, and this often leads to other foot, leg or back problems. The most common methods of compensation are flattening of the arch or picking up the heel early when walking, placing increased pressure on the ball of the foot. Other patients compensate by toe walking, while a smaller number take steps by bending abnormally at the hip or knee.
There are several possible causes for the limited range of ankle motion. Often, it is due to tightness in the Achilles tendon or calf muscles (the soleus muscle and/or gastrocnemius muscle). In some patients, this tightness is congenital (present at birth), and sometimes it is an inherited trait. Other patients acquire the tightness from being in a cast, being on crutches or frequently wearing high-heeled shoes. In addition, diabetes can affect the fibers of the Achilles tendon and cause tightness. Sometimes equinus is related to a bone blocking the ankle motion.
Depending on how a patient compensates for the inability to bend properly at the ankle, a variety of foot conditions can develop, including:
Surgical Treatment Options
Various surgical procedures have been described for correction of gastrocnemius equinus. Some procedures have consisted of proximal release of the muscular heads of the gastrocnemius and distal recession
of the gastrocnemius aponeurosis. The distal gastrocnemius recession should be performed for correction of nonspastic gastrocnemius equinus. There are many companies that offer minimally invasive options with small incisions. These procedures improve the range of motion back to a normal limit with immediate weightbearing and driving.
This procedure and return to normal function with two small stab incisions on each side of the leg, thus providing better cosmesis, direct visualization, and earlier return to function than the open approach. This makes this procedure
ideal for children, people who want to wear clothing that exposes their legs for cosmetic reasons, patients with diabetes, and other patients with mild peripheral vascular disease. We have shown that the endoscopic gastrocnemius recession procedure can provide successful results with a low rate of complications. This procedure can be done solely or adjunctively with other procedures.