AJM Sheet:

1. AJM Sheet: Ankle
Equinus

2. • Charcot arthropathy
• Digital deformities
• Pes plano valgus
• Met primus elevatus
• Plantar fasciitis
Medial column hypermobility
• Diabetic foot ulcerations
• HAV
This sheet is not a work-up because equinus rarely presents as a chief
concern, but rather as a concomitant and underlying deformity. It
may be seen and deemed correctable in the following deformities:

3. History
1. First TAL: Paris on Achilles in the “Iliad”
2. First medically documented procedure:
• Stromeyer on Dr. Charles Little. Dr. Little was a
Prominent physician suffering from cerebral
palsy (CP) who then became an advocate for
surgical correction of equinus.

4. Anatomy
1. Review the
origins/insertions/course/action/ NV
supply of the gastroc and soleus.
2. Review the concept of the “twisting” fibers
within the Achilles tendon.
[White JW. Torsion of the Achilles tendon: its surgical significance. Arch
Surg 1943; 46: 784-7.]
[van Gils CC, Steed RH, Page JC. Torsion of the human Achilles tedno.
JFAS 1996.]

5. Type of
Equinus
1. Muscular Equinus
• Spastic vs. Non-Spastic
• Gastroc Equinus
• Gastroc-Soleal Equinus
2. Osseous Equinus
• Tibio-talar exostosis
3. Pseudoequinus
4. Combination equinus

6. Biomechanic
Compensation for
Equinus (proximal
to distal)
• Lumbar lordosis
• MTJ pronation
• Genu recurvatum
• STJ pronation
• MTJ pronation
• Medial column hypermobility
• Forefoot abduction
• No compensation (toe walking)

7. Testing for
Equinus
1. Silfverskiold test
2. Stress dorsiflexion plain film radiographs
3. WB wall test

8. Ankle
Equinus
Treatment
Conservative Treatment
1. Stretching
2. Heel Lifts
3. Casting
4. Physical Therapy
5. Neuromuscular blockage injections (Botox)

9. Surgical
Correction
for Gastroc
Equinus
1. Neurectomy of motor branches of tibial nerve
2. Proximal recession (Silfverskiold procedure)
• Release of muscular heads of gastroc +/-
reattachment to tibia +/- neurectomy
3. Distal aponeurotic recession
1. Vulpius&Stoffel (1913): Inverted “V” shaped
incision without suture reapproximation
2. Strayer (1950): Transverse incision with proximal
dissection and suturing (absorbable)
3. Baker (1956): Tongue and groove with suturing
(two incisions distal)
4. Fulp&McGlamry: Inverted tongue and groove
with suturing (two incisions proximal)
4. Endoscopic recession

10. Surgical
Correction
for:
Gastroc-Soleal Equinus
1. Sagittal plane “Z” lengthening: equal medial
and lateral portions
2. Frontal plane “Z” lengthening: equal anterior
and posterior portions
3. Hoke Triple Hemisection (1931): 2 medial
cuts/1 lateral cut
4. White slide technique
Percutaneous
1. Similar to the Hoke procedure
2. 1cm 3cm 3 cm