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What is an ankle equinus?
Symptoms
Causes
Diagnosis
Treatment
FAQs

Having tight calf muscles can have a profound effect on the biomechanics of the feet and ankles, leading to a condition called ankle equinus that can predispose you to a range of foot problems and other issues. Given that having an ankle equinus has been associated with over 96% of biomechanically-related foot and ankle pathologies, it is a condition our Brisbane podiatrists pay very close attention to, to help set you up to stay healthy and active on your feet.

What Is An Ankle Equinus?

Ankle equinus, which is the technical term for calf tightness, is characterised by limited movement and flexibility at the ankle joint, particularly when trying to move the foot and toes upwards (dorsiflexes), towards the shins. The term "equinus" actually originates from the Latin word for "horse," as those with tight calf muscles may exhibit a walking pattern similar to a horse as they don’t have sufficient movement available in the ankle. 

Ankle equinus is a relatively common condition that can affect people of all ages, from children to the elderly. In podiatry, we think of an ankle equinus as more of a clinical finding and a biomechanical characteristic of your feet, as opposed to a condition in itself. This is because calf tightness and limited dorsiflexion is a cause or contributing factor to many foot injuries or foot problems.

Symptoms Of An Ankle Equinus

The key characteristic of an ankle equinus is the restricted range of motion when trying to move the feet and toes upwards, which can make everyday activities like walking, running, or squatting difficult. It also puts us at risk of catching our toes or shoes on the ground and tripping or falling. Other effects of an ankle equinus include:

• Gait (walking) abnormalities: due to the limited ankle movement, people with ankle equinus often develop an altered gait pattern. They may walk with a shortened stride or try to compensate by lifting the foot higher from the hip to avoid trying to lift the foot up at the ankle.
  

• Heel lift: when attempting to stand or walk, those with an ankle equinus might involuntarily lift their heels off the ground early in the walking cycle. This can lead to increased pressure on the forefoot for longer periods, which can contribute to other pains and problems.
  

• Foot problems: the altered foot position resulting from calf tightness can lead to various foot-related issues, such as plantar fasciitis (inflammation of the tissue on the bottom of the foot), metatarsalgia (pain in the ball of the foot), the development of bunions and more.
  

• Balance and stability issues: reduced movement at the ankle can also affect a person’s balance and stability, increasing the risk of falls, especially on uneven surfaces or during certain activities.
  

• Achilles tendon pain: having an ankle equinus can contribute to the strain and overuse of the Achilles tendon, potentially leading to conditions like Achilles tendinitis or tendinopathy.
  

• Difficulty with activities: activities that require significant ankle movement, such as climbing stairs, squatting, or running, may become challenging due to the limited movement at the ankle.
  

• Muscle imbalances: calf tightness can lead to muscle imbalances in the lower leg and foot, potentially affecting overall lower limb function.
  

What Causes An Ankle Equinus?

Ankle equinus can result from several factors, with the most common being from tight calf muscles. Tight calf muscles, specifically the gastrocnemius and soleus muscles, which are located at the back of the lower leg and are responsible for pointing the foot downward (called plantarflexion) and pushing the body forward during walking or running. When these muscles become excessively tight, they can restrict the ankles ability to freely and easily point the toes upwards, leading to the condition known as ankle equinus.

The reason behind this muscle tightness can be congenital (present at birth), an inherited trait, or arise from circumstances like having their foot and ankle in a cast or regularly wearing high-heeled shoes. Other causes of ankle equinus include structural abnormalities, where anatomical variations like bone spurs or joint contractures, limit ankle mobility. Neurological conditions can also contribute to an ankle equinus, such as nerve injuries or neuromuscular disorders that lead to muscle weakness, leaving a person without sufficient strength and function to point their toes upwards.

Diagnosing An Ankle Equinus

Our podiatrists can confidently and efficiently diagnose an ankle equinus based on your assessment with us, where we assess the range of motion available at your ankle joint, the tightness in your calves, and any resulting restrictions in being able to move your foot upwards at the ankle joint. We’ll explain what your assessment findings mean, as well as the impact that it is having on your feet or gait, including the relationship to any other pains or symptoms you’re experiencing. 

Treating Tight Calf Muscles And An Ankle Equinus

Home treatment

If you’re experiencing calf muscle tightness, there are several home remedies you can try that focus on stretching and strengthening the calf muscles to increase flexibility and help restore normal ankle movement. It’s important to note that these are most effective for mild cases of ankle equinus caused by calf muscle tightness, and it’s always important to seek professional help from your podiatrist to help properly resolve the issue. You can try:

• Calf stretches: regular stretching of the calf muscles is crucial for supporting and improving flexibility. Some effective calf stretches include:
  
• Calf foam rolling: using a foam roller on the calves can help release tension and tightness in the muscles. Sit on the floor with your legs extended, and place the foam roller under your calves. Roll back and forth slowly, focusing on any areas of tightness or discomfort.
  
• Heat and ice: applying heat pads or warm towels to the calves before stretching can help relax the muscles. After stretching or any physical activity, applying ice packs to the calves can reduce inflammation and soreness.
  
• Good footwear: wearing supportive footwear with good qualities can help maintain proper foot and ankle alignment, reducing strain on the calf muscles.

Podiatrist treatment

At your appointment with our Brisbane podiatrists, we’ll start by performing your assessment to help us understand the potential causes of your ankle equinus and the impact it is having on your gait, which includes analysing your gait, testing for muscle imbalances, assessing your joints, analysing your foot posture and alignment, and more. We’ll then create a tailored treatment plan based on your unique results that addresses the cause of your equinus. This may include:

• Custom foot orthotics: our podiatrists can prescribe custom foot orthotics that will work to add the right support to the foot and ankle, including around the heel, to best support an ankle with equinus. We’ll also create your orthotics in a way that accommodates the compensations (and any painful effects) that have resulted from the equinus, helping to optimise your gait and everyday function.
  
• Footwear recommendations: in some cases, your existing footwear may be leaving your feet in an unsupported position that may be further complicating your gait when you have calf tightness. If that’s the case, we can recommend other footwear, both casual and sports-specific, that will best support your feet and ankles as well as your general comfort and foot health.
  
• Footwear modifications: in some cases, where the cause of your equinus is fairly fixed in place, modifying your existing footwear may be recommended to best help support your feet and gait, and optimise your movement.
  
• Temporary heel lifts: to help you get some much-needed relief from any pain associated with your equinus in the short-term, we may use a 4mm or 6mm heel lift inside your shoes to give your heel a stable platform and reduce pressure through the ankle, Achilles tendon and posterior leg muscles.
  
• Strengthening and stretching program: these exercises will target not only the gastroc and soleus muscles, but also any muscle imbalances through the feet and legs to help restore and optimise your gait.
  
• Night splints: in severe cases, night splints may be recommended to help reduce the severity of ankle equinus. We most often see this in children who have predisposing factors that mean that more conservative measures are less likely to be effective.
  

In very few cases, where a conservative approach to managing ankle equinus has failed and it is having a significant impact on your mobility and quality of life, we may refer you to an orthopaedic surgeon to discuss the possibility of ankle surgery. This may involve lengthening the Achilles tendon, reconstructing the ankle, repairing damaged structures or treating a tarsal coalition, if that is the cause of the equinus. Ankle surgery is always a serious procedure and should generally only be attempted where first-line measures have failed or your condition is further complicated by other factors.

Frequently Asked Questions (FAQs)

Can an ankle equinus be prevented?

While ankle equinus may not always be preventable, certain measures can help reduce the risk of developing or worsening it. Regular stretching exercises targeting the calf muscles and Achilles tendon can help maintain ankle flexibility and prevent tightness. Avoiding prolonged periods of immobilisation and wearing supportive footwear with a good heel height (not too tall) and cushioning can also help promote healthy ankle function and alignment. Avoiding high-impact activities that may exacerbate ankle tightness or strain can also contribute to preventing ankle equinus.

Is ankle equinus related to other foot or ankle conditions?

Yes, ankle equinus has been associated with over 96% of biomechanically-related foot and ankle pathologies. This includes plantar fasciitis, Achilles tendonitis, muscle strains, stress fractures, shin splints, various causes of knee pain, diabetic foot ulcer, bunions, hammertoes and other toe conditions, ankle sprains and ankle instability, Morton’s neuroma, calluses on the feet, and many more. You can see the full list here.

What are the risks of an untreated ankle equinus?

Untreated ankle equinus may increase the risk of foot and ankle injuries, such as sprains, strains, and stress fractures, especially during activities that require full ankle mobility. Altered gait mechanics due to ankle equinus can also contribute to overuse injuries in other parts of the lower extremities, including the knees, hips, and lower back. Chronic pain, foot deformities, and difficulty performing daily activities may also result from untreated ankle equinus.

How long does it take to recover from an ankle equinus?

The recovery time for ankle equinus varies depending on factors, such as the severity of the equinus and your adherence to all of the aspects of your treatment. With appropriate management, including stretching exercises, physical therapy, and orthotics, improvement in ankle flexibility and function can typically be observed within a few weeks to months. A full recovery may take longer, and ongoing maintenance through stretching and strengthening exercises may be necessary to prevent recurrence and maintain optimal ankle mobility.

Can ankle equinus recur after treatment?

Yes, ankle equinus can recur, particularly if the underlying causes or contributing factors are not addressed adequately or if preventative measures are not maintained. Failure to continue with stretching exercises and other rehabilitative strategies can lead to a return of ankle tightness and limited range of motion over time. Additionally, factors such as excessive physical activity, improper footwear, or new injuries to the foot or ankle may increase the risk of recurrence.