Equinus

Description


Horses and humans have a few things in common. We’re both mammals,
we both love to eat oats (although we favor oats in cookie format
while horses seem to like the grain in a rather less embellished
form) and we’re both very, very stubborn. However, humans don’t
really much care for grass as a food staple, and we have no tails
to speak of. Also, we walk rather differently than horses. While
they put weight entirely on their toes (the hoof is essentially
one big toe), human feet are designed rather differently. So, when
our feet start behaving in a more equine way, it can start causing
serious problems.

Equinus may occur in one or both feet, and is a condition in which
the ankle doesn’t bend upward properly. The normal range of motion
for ankles is to lift about 10 degrees upward when you’re standing
on a flat surface (i.e. when your feet are at a 90 degree angle to
your leg). If you’ve got equinus, you may not be able to lift your
ankle up that much, or at all. In very severe cases, your foot may
even pull downward, making it difficult or even impossible for you
to stand with your foot perpendicular to your leg.

Equinus may be caused by several different things, although the
causes may be grouped into two categories: soft tissue or bone
problems. Soft tissue problems usually center around tightness in
the muscles and tendons that pull the foot downward: the calf
muscles and Achilles tendon. Basically, these muscles may pull the
foot back and downward (toward the heel) so strongly that they
overcome the strength of the muscles pulling the foot back up. These
tight muscles, tendons or ligaments may simply be congenital
(present at birth), inherited (part of natural genetic variation), a
symptom of a neurological disorder (like cerebral palsy) or may be a
result of some external cause. Injuries (or surgery) may lead to
scarring, which can tighten the tissue. Or, calves may tighten when
they’re in a contracted position for a long time, such as when you
wear high heels all day long (you know-those times when you really
wish you’d brought those old, comfortable sneakers to work), or if
you wear a cast that points your toe downward.

The causes aren’t always due to tight tissue, though. Sometimes
there are bones blocking the ankle that keep it from moving upward
fully. This may be due to a bone fragment blocking the joint
(generally a result of trauma), or bones may become deformed by
arthritis or tumor growth.

Symptoms


People with equinus are likely to have problems lifting up one or
both feet (they may find it either difficult or impossible to do
so). In severe cases, the foot may be permanently bent downward
(toward the heel). This condition may sound kind of obvious, but
people may be unaware that they have equinus. Milder forms of the
condition may simply cause people to adjust their gait (usually they
raise the heel up earlier than normal in the walking process, might
make their arches flatter, walk on their toes, or change the way
their hips or knees move) in order to make up for their inability to
properly lift their foot. Because this changes where stress occurs
on the foot (often the ball of the foot is hit the hardest), it can
lead to a whole host of other problems.

For instance, if you develop equinus, you may begin to experience
pain in the heel or arch (also called plantar fasciitis), painful
ankles, an inflamed Achilles tendon (tendonitis), problems like
calluses or even ulcers on the ball of your foot (particularly if
you have diabetes), arthritis in the middle of your foot, or
deformities such as bunions or hammertoes. There may also be
problems further up your leg: you may experience shin splints, or
cramps in your calves.

Diagnosis


Despite the name of this condition, it’s totally unnecessary to see
a veterinarian when you develop equinus. Your podiatrist, while
probably not intimately familiar with horse feet, has plenty of
experience dealing with the human variety, and is well trained in
diagnosing such conditions. When you go in to see the podiatrist, he
or she will likely see how far you can move your foot up and down,
both while your knee is bent and while it’s straight. (This helps to
determine where the problem lies: bone, muscle, or tendon.) The
podiatrist may push slightly against your foot as you try to move it
(but never fear-podiatrists don’t do such things to make the
examination more difficult for you-this method helps to determine
the true strength of the muscles).

You may also need to undergo some X-rays or other imaging process so
that your podiatrist can fully understand what’s happening inside
your foot. If he or she suspects your equinus may be due to an
underlying neurological condition, you may be referred to a
specialist for a neurological examination.

Treatment


Once you’ve been evaluated, your podiatrist can discuss what’s
caused your particular brand of equinus and talk about the treatment
options that are best for you. Because equinus is often caused by
tight calf muscles, adopting a regimen of calf-stretching may
improve your condition. You can also help relieve stress on the calf
muscle by wearing a splint at night to keep the muscle in the proper
position. Some shoe inserts can also provide relief. Because the
Achilles tendon is likely to be under some strain, lifting up the
heel somewhat may prove helpful. Heel cups may be used to accomplish
this, or wearing shoes with moderate heels might work as well for
you (although you’ll want to discuss proper heel height with your
podiatrist). Orthotics (prescription shoe inserts) might also be
useful in correcting the way your foot bears weight. If a
neurological condition is at the heart of your problem, that can be
addressed separately.

If you come in to the office with a number of secondary symptoms
(such as hammertoes, tendon pain, bunions, etc.), your podiatrist
may treat these as well. Common treatments include (unmedicated)
pads to relieve pressure (in the case of calluses), medications or
treatments to reduce inflammation, and so on.

Surgery may be necessary if you’re still finding yourself with a
foot that behaves more like a horse’s than a human’s, even after
more conservative treatment. Surgery may be used to lengthen tight
muscles or tendons, or may be the best way to remove a blockage of
bone, if that’s the cause of your equinus. Whatever the treatment
method, your podiatrist can discuss the options with you to get your
foot to act fully human again.