Equinus Contracture

Equinus contracture is when your ankle is too stiff to bend your foot upward as far as it should. Healthcare providers also call it ankle equinus, equinus deformity or just equinus.

Knowing what the words in equinus contracture mean can help you understand it better. Equine is a word that means like or related to a horse. A contracture is the medical term for a body part being stiffer than normal and unable to move as far.

Normally, your foot can move up, toward your shin. This helps you keep your balance and push off when you walk. It also absorbs impacts from moving.

Equinus makes your ankle stiffer and less flexible than it should be. Your foot won’t be able to move as far. You might walk on your toes with your heels off the ground. This can make your leg look a bit like a horse’s. A horse holds all its weight on the front of its hoof and doesn’t have a heel that touches the ground.

Symptoms of ankle equinus

Mild tightness in your ankle isn’t usually a problem. And it’s normal for kids to lose some ankle flexibility as they develop. Equinus matters most when it causes symptoms or changes how you walk.

Your ankle being stiffer than usual is the main symptom of equinus contracture. But you probably won’t be able to notice this in yourself. A loved one might point out that you’ve started walking differently. If your child has equinus, you might notice them toe walking.

Most people with equinus can’t feel the stiffness. Your body will compensate automatically, and symptoms somewhere else are often what you’ll notice first.

Over time, the changes to your posture and how you move put extra pressure on other parts of your feet and legs. This can lead to pain and other symptoms that are more noticeable. You might have:

• Heel pain, especially with your first few steps in the morning
• Plantar fasciitis
• Achilles tendon pain or swelling near your heel
• Ankle, knee, hip or back pain
• Calf or foot cramps
• Bunions
• Hammertoes
• Tripping or feeling unsteady on your feet
• Toe walking (in children)

Equinus causes

Ankle equinus usually happens when your calf muscles or Achilles tendon are tighter or shorter than they should be. You might be born with naturally tight tendons and muscles.

Anything that changes how you hold your foot and ankle can lead to equinus. If you’re not using your ankle joint’s full range of motion often, your muscles and Achilles tendon can stiffen up over time. Some common causes of this tightness include:

• Wearing high heels often
• Wearing a cast
• Using crutches

Health conditions and injuries that affect your ankles can lead to equinus, including:

• Neurological issues: Conditions like cerebral palsy that affect how your brain interacts with your muscles can cause ankle equinus. It can also develop as a result of a stroke, brain injury or spinal cord injury.
• Neuromuscular disorders: Health conditions like muscular dystrophy and Charcot-Marie-Tooth disease can cause equinus. 
• Injuries or arthritis: Anything that damages your ankle joint can affect how well you can move it. A piece of bone from a broken ankle may make it hard to move, even after you recover.
• Compartment syndrome: Extra pressure in and around the muscles in your leg and ankle can damage them and lead to equinus.
• Diabetes: Diabetes can damage the tissue in your muscles and tendons and create extra stiffness.
• Clubfoot: Clubfoot and other congenital conditions your baby is born with can affect how well they can move their ankles.

How doctors diagnose this condition

A healthcare provider will diagnose equinus with a physical exam and some tests. Because most people don’t know they have equinus or any extra tightness in their ankle, there’s a good chance your provider will diagnose it when you visit them for issues like foot or ankle pain.

Your provider will ask about your health history. Let them know if you’ve had any injuries or if you have any health conditions that affect your joints.

Your provider will examine your foot and ankle. They’ll measure how far your ankle bends up with your knee straight, and again with your knee bent. If your ankle moves farther with your knee bent, the tightness is more likely to be in your upper calf muscle. They may have you stand and walk. This is called a gait analysis.

Your provider might order X-rays to take pictures of your ankle. This can show any current or past injuries or issues that might affect how much your ankle can move.

How is it treated?

Your healthcare provider will suggest equinus treatments based on the cause. For example, if you develop equinus from wearing a cast or needing crutches, it may go away on its own once you’ve recovered enough to use your foot and ankle like normal. You might have to change the kinds of shoes you wear, or avoid certain types.

Your provider will recommend treatments for specific health conditions. They’ll tell you what to expect based on your unique needs and circumstances.

Some ankle equinus treatments include:

• Physical therapy to strengthen your muscles and increase your flexibility and range of motion
• Wearing a splint that gently holds your foot in a more flexed position
• Botulinum toxin injections to relax tight muscles that don’t respond to other treatments

It’s rare to need surgery. Your provider will usually only suggest it if you have an old fracture, a congenital issue or a neurological condition that affects how much you can move your ankle. They might recommend surgery if you have severe symptoms and other treatments haven’t helped after several months.

When should I see my healthcare provider?

Visit a healthcare provider if you have foot or ankle pain that lasts more than a few days in a row. Or if you have pain in your knees, hips, back or any muscles.

You probably won’t notice ankle equinus in yourself. But talk to a provider if a loved one points out that you’re holding your body or moving in a way that’s noticeably different. Some of the causes can be subtle, and the sooner you get changes checked out, the better.

What can I expect if I have this condition?

It depends on what causes it. Most people are able to manage pain and other issues with nonsurgical treatments. But there’s always a chance that equinus could come back. This is more likely if you have a chronic condition and not a temporary injury.

Talk to your healthcare provider. They’ll help you set realistic goals and expectations. Even if you experience symptoms again, you should be able to manage them once you find the right combination of exercises, stretches and other treatments.