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Anke Equinus Contracture


(see also: role of ankle and subtalar joint in gait)

  • normally, during the transition from foot flat to heel off, the foot dorsiflexes as the body moves forward;
  • gait consequences of equinus contracture:
    • patient may adopt a toe to toe gait pattern or a toe to heel gait pattern (premature forefoot loading)
    • reduced propulsion
    • excessive knee hyperextension
    • excessive foot pronation which allows more dorsiflexion to occur at the subtalar joint;
    • reduced stride length of the opposite limb
    • reduced gait velocity
    • external rotation

diff dx


Silfverskiold test

  • normal ankle dorsiflexion:
    • ankle dorsiflexion with knee extended (= 10 degrees of DF)
    • with flexion of the knee there will be an additional 10 deg of DF (= 20 deg of DF);
  • isolated gastroc contracture: (usually seen in CP)
    • equinus contracture with knee extended (20 degrees of plantarflexion);
    • when the knee is flexed to 90 degrees, ankle dorsiflexion significantly improves (10 degrees of dorsiflexion).

Heel Cord Stretching

  • patient should be standing and facing wall w/ the feet internally rotated (which keeps heel flat on floor during stretch and which locks the subtalar joint);
    • this ensures that dorsiflexion motion occurs only at ankle joint;
  • care must be take to invert subtalar joint and forefoot before applying dorsiflexion stress;
    • this locks calcaneus under talus, ensuring that dorsiflexion occurs only at the ankle joint rather than dorsiflexion does not occur at the midfoot;


  • with a fixed equinus deformity, patients may do well with a heel-lift shoe insert;

Operative Treatment

Baumann procedure

  • consists of intramuscular lengthening (recession) of the gastrocnemius muscle in the deep interval between the soleus and gastrocnemius muscles;
  • goal of the procedure is to increase ankle dorsiflexion when ankle movement is restricted by a contracted gastrocnemius muscle;
  • truly isolates the lengthening to the gastrocnemius muscle
  • procedure is indicated when the results of the Silfverskiold test are positive.

Vulpius procedure

  • superficial gastrocnemius-soleus recession includes an intramuscular lengthening of the soleus muscle


  • distal gastrocnemius tenotomy, 3 cm proximal to the gastrocnemius-soleus aponeurosis;
  • gastroc and soleus are separated to allow the gastrocnemius tendon to retract proximally, which is then sutured to soleus