Understanding And Managing Equinus Deformities

Start Page: 58
66
Author(s): 
Stephen L. Barrett, DPM, MBA, FACFAS

1. DiGiovanni CW, Kuo R, Tejwani N, Price R, Hansen ST Jr., Cziernecki J, Sangeorzan BJ. Isolated gastrocnemius tightness. J Bone Joint Surg Am. 2002; 84-A(6):962-970.
2. Subotnick SI. Equinus deformity as it affects the forefoot. J Am Podiatry Assoc. 1971; 61(11):423-427.
3. Hill RS. Ankle equinus. Prevalence and linkage to common foot pathology. J Am Podiatr Med Assoc. 1995; 85(6):295-300.
4. Barrett SL, Whiting T. What role does eqinus play in heel pain? Podiatry Today. 2008; 21(11):44-54.
5. Riddle DL, Pulisic M, Pidcoe P, Johnson RE. Risk factors for Plantar fasciitis: a matched case-control study. J Bone Joint Surg Am. 2003; 85-A(5):872-877.
6. Bowers AL, Castro MD. The mechanics behind the image: foot and ankle pathology associated with gastrocnemius contracture. Semin Musculoskelet Radiol. 2007; 11(1):83-90.
7. Erdemir A, Hamel AJ, Fauth AR, Piazza SJ, Sharkey NA. Dynamic loading of the plantar aponeurosis in walking. J Bone Joint Surg Am. 2004; 86-A(3):546-552.
8. Lavery LA, Armstrong DG, Boulton AJ. Ankle equinus deformity and its relationship to high plantar pressure in a large population with diabetes mellitus. J Am Podiatr Med Assoc. 2002; 92(9):479-482.
9. Holstein A. Hallux valgus--an acquired deformity of the foot in cerebral palsy. Foot Ankle. 1980; 1(1):33-38.
10. Grady JF, Saxena A. Effects of stretching the gastrocnemius muscle. J Foot Surg. 1991, 30(5):465-469.
11. Evans A. Podiatric medical applications of posterior night stretch splinting. J Am Podiatr Med Assoc. 2001; 91(7):356-360.
12. DiGiovanni CW, Langer P. The role of isolated gastrocnemius and combined Achilles contractures in the flatfoot. Foot Ankle Clin. 2007; 12(2):363-379, viii.
13. Digiovanni CW, Holt S, Czerniecki JM, Ledoux WR, Sangeorzan BJ. Can the presence of equinus contracture be established by physical exam alone? J Rehabil Res Dev. 2001; 38(3):335-340.
14. Barrett SL, Jarvis J. Equinus deformity as a factor in forefoot nerve entrapment: treatment with endoscopic gastrocnemius recession. J Am Podiatr Med Assoc. 2005; 95(5):464-468.
15. Carl T, Barrett SL. Cadaveric assesment of the gastrocnemius aponeurosis to assit in the pre-operative planning of two portal endoscopic gastrocnemius recession (EGR). The Foot. 2005; 15(3):137-140.
16. Barrett SL, Pignetti TT. Endoscopic decompression for intermetatarsal nerve entrapment--the EDIN technique: preliminary study with cadaveric specimens; early clinical results. J Foot Ankle Surg. 1994; 33(5):503-508.
17. Barrett SL, Walsh AS. Endoscopic decompression of intermetatarsal nerve entrapment: a retrospective study. J Am Podiatr Med Assoc. 2006; 96(1):19-23.
18. Barrett SL. Endoscopic plantar fasciotomy. Clin Podiatr Med Surg. 1994; 11(3):469-481.
19. Barrett SL, Day SV. Endoscopic plantar fasciotomy: two portal endoscopic surgical techniques--clinical results of 65 procedures. J Foot Ankle Surg. 1993; 32(3):248-256.

   For further reading, see “What Role Does Equinus Play In Heel Pain?” in the November 2008 issue of Podiatry Today, “Pertinent Pointers On Equinus Procedures” in the June 2007 issue or “Key Insights On The Role Of Equinus In Foot Pain” in the May 2007 issue. To access the archives, visit www.podiatrytoday.com.

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Neal M. Blitz, DPM, FACFASsays: May 14, 2011 at 7:41 pm

I am not sure that endoscopic gastroc recessions should be termed "gastroc recessions." They are really gastrosoleal recessions.

Anatomically, the gastroc muscles form an muscular-free aponeurosis that inserts onto the soleus aponeurosis and together form the Achilles. The muscular free portion of the gastroc is termed the "gastroc run-out." In some cases, there is no run-out and the gastroc muscle inserts directly on the soleus aponeurosis.

Nonetheless, if you transect deep to muscle, then both the gastroc and soleus aponeurosis have been transected.

The clinical effect is unclear, but the anatomy is the anatomy.

Neal M. Blitz, DPM, FACFAS
Chief of Foot Surgery & Associate Chairman of Orthopaedics
Bronx-Lebanon Hospital Center
----
References:

Blitz NM, Eliot DJ. Anatomical Aspects of the Gastrocnemius Aponeurosis and its Muscular-Bound Portion. A Cadaveric Study. Part II. J Foot Ankle Surg 47(6):533-40, 2008

Blitz NM, Rush SM. The Gastrocnemius Intramuscular Aponeurotic Recession. A Simplified Method of Gastrocnemius Recession. J Foot Ankle Surg 46(2):133-8, 2007

Blitz NM, Eliot DJ. Anatomical Aspects of the Gastrocnemius Aponeurosis and its Insertion. A Cadaveric Study. J Foot Ankle Surg 46(2):101-8, 2007

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