Caitlin Whyte (Host): Welcome to the Health Exchange with Speare Memorial Hospital. I'm Caitlin Whyte. And joining me today is Dr. Dennis Claire. We'll be discussing equinus, a condition often linked to foot pain and mobility issues.

Well, Doctor, we are so happy to have you on our show, the first of our series. To start us off, can you tell us what is equinus? and why is ankle flexibility so important for overall foot health and movement?

Dr. Dennis Claire: Well, it's something that doesn't come up and oftentimes this doesn't come up in conversation with a patient. It's sort of a background scenario that can lead to many foot problems. But equinus is the contracture of the muscle group behind the leg, which connects to your achilles tendon and plantar fascia, which leads to an overall plantar flexion or downwards position of the foot, which increases the deforming force on the foot itself.

Host: And what are the most common causes of equinus? Are we talking genetics, lifestyle, or injuries? How does equinus typically show up in people's daily lives?

Dr. Dennis Claire: Well, it is multi-factored. So, it can be there genetically, usually associated with some kind of neuromuscular condition. It can be there from prior injury or surgery where there's limited ankle dorsiflexion. And the most common reason it's there for most people and why this is such a common driver of foot pathology is from, essentially, underuse or misuse, meaning our foot is almost always in a plantar flexed position because all shoe wear has a little bit of a heel to it, and we almost never naturally stretch our foot in a dorsiflexion or upward position. Our ancestors used to do deep squats a lot, sitting or squatting deeply on the floor, and walking on uneven surfaces. And we almost always are in shoes on hard, flat surfaces and always using our foot in a plantar flexion position. So, it's an acquired equinus.

 Now, pediatric patients can have fairly severe equinus as part of a normal growth scenario where, during phases of rapid growth, like toddler age or puberty, oftentimes the long bones grow very quickly and the soft tissue is essentially catching up. So, that'll result in a more dramatic toe walking in those two age groups as well.

Host: Wow. Are there any other symptoms or movement issues that should raise red flags?

Dr. Dennis Claire: It's interesting in foot problems, in that almost any foot problem could partly be the result of equinus. So, it seems like it's this big blanket problem. But it does relate to, like I mentioned before, just increased loading or increased pressure in parts of the foot that create this deforming force.

Host: Now, what other conditions can equinus lead to or worsen if it's left untreated? And what are the main treatment options?

Dr. Dennis Claire: Like I mentioned, there's so many different problems that can arise from equinus. So, mentioning probably the most common ones: an achilles tendonitis, plantar fasciitis; what we generally call metatarsalgia, which could be almost any pain in the ball of the foot region; everything from capsulitis or plantar plate pathology to even bunions and hammer toes, potentially. All of these things could be fully or at least partly attributed to equinus.

Now, treatment is generally geared towards things that patients can do on their own, which is essentially home physical therapy, although it could be tricky to educate patients about how to do this. Most of the time, we're looking at stretching. Nowadays, we also have the option of myofascial release or using either massage, massage tools, Theraguns, something similar to that, to loosen the posterior muscle group in the leg to minimize the equinus.

There are surgical options too, especially for patients that may have neuromuscular conditions or fairly severe equinus. You can lengthen the Achilles tendon or release some of the fascia that connects the muscle to the achilles tendon. This is a rare situation to have to do something like this. But it has been done in the past. There was even a famous orthopedic study where patients had this fascial release to lengthen the complex or reduce the equinus with improvement in generalized foot pain after the surgery. But generally, that's not something that's done across the board.

In patients with neuropathy, usually diabetic patients with loss of sensation in their feet, often they'll develop diabetic foot ulcers in the front half of their foot. And sometimes doing surgery for equinus or Achilles lengthening surgery or the other fascial release, like I mentioned, can reduce those foot pressures, allowing their ulcers to heal.

Host: And when it comes to our main treatment options, how do you decide between stretching, orthotics, or surgery?

Dr. Dennis Claire: Most of the time, at least in my practice, it's geared towards the therapy side of things. Patients have a lot of agency over being able to control this. And given the right education, the right tools, they can often be very successful with this over the course of anywhere from weeks to months. But most people need a few months of regular home therapy, stretching and myofascial release, or deep tissue massage to the calf muscle complex to reduce the equinus and improve symptoms.

Host: Can equinus be prevented or managed through lifestyle choices? You've mentioned footwear or maybe exercise.

Dr. Dennis Claire: Yes, definitely. So, a lot of people preventatively work on ankle mobilization, stretching, things like that, or just regularly use a Theragun or similar device on tight muscle groups throughout their body, including the calf muscle. So, that's one way of preventing it. Some people that will use flatter shoes, so like I mentioned earlier, pretty much all shoes have a heel that's higher than the toe. In the running shoe world, we call this the drop. So, how many millimeters is the difference between the heel and the forefoot? So if you use a flat or a zero drop shoe, this can sort of naturally stretch that area. So, lifestyle has a lot to play in this, but also the therapy is really the focus.

Host: And my last question, Doctor, is what's one piece of advice you'd give someone who thinks they might have limited ankle motion or equinus?

Dr. Dennis Claire: Certainly seek a professional. Oftentimes this is a condition that's very subtle that may be underaddressed by some providers. And not others, but a Sports Medicine specialist would be good for someone to seek out, especially someone that has experience with runners and weightlifters. A big limitation with ankle dorsiflexion in Olympic weightlifters CrossFitters is that they cannot get a deep enough squat because of their limited ankle mobility. Potentially equinus is an answer. Sometimes there's a bony block in the ankle that disallows them from doing this. A Sports Medicine specialist is who I'd recommend seeing if you think ankle mobility might be an issue. But generally, the equinus manifests itself in different foot pathologies. So, any foot pain would be good to see a Sports medicine specialist and have this ruled out.

Host: That was Dr. Dennis Claire sharing his expertise on equinus and foot health. For more information, be sure to visit spearehospital.com. If you enjoyed this episode, please share it on your social channels and explore our entire podcast library for topics that interest you. I'm Caitlin Whyte. And this is the Health Exchange with Speare Memorial Hospital. Thanks for listening.