Equinus Management for Better Orthotic Outcome
When a patient has equinus as a component of their lower extremity pathology , it is critical to address the equinus before orthoses treatment . Conservative treatment for equinus takes approximately eight to twelve weeks . The author uses The Equinus Brace™ ( figure 7 ) due to several factors that make this brace uniquely qualified for the conservative treatment of equinus . The brace is the only one on the market that extends above the knee to lock the knee into full extension . Maintaining the knee in full extension is critical to stretch the gastrocnemius muscle . The brace also provides for controlled dorsiflexion of the ankle with three settings of 0 °, 10 ° and 20 °. Finally , the brace comes with a 60 ° toe wedge for the hallux . The wedge dorsiflexes the hallux to engage the Windlass mechanism thereby supinating the subtalar joint and inverting the hindfoot . The eliminates dorsiflexion from occurring through the midfoot while directing the force through the hindfoot . Recommended therapy
is treatment one hour per day for four weeks at each setting of the brace . It is important to evaluate deformity correction with goniometer measurements during treatment . Once the deformity is corrected , most patients will require maintenance therapy . Several factors necessitate ongoing treatment to prevent recurrence , such as anatomy , aging and decreased activity level ( figure 8 ).
An often-overlooked component of equinus therapy is the role of shoe drop . Shoe drop is the difference in the height of heel compared to the forefoot . For example , if the heel of a shoe is 26 mm thick and the forefoot is 10 mm , the shoe drop would be 16 mm . Stretching a patient for one hour per day while wearing a shoe with a high shoe drop eight to ten hours per day , counteracts the stretching . Most patients with an unresolved equinus deformity are unable to switch to a 0mm drop shoe without aggravating the Gastrocsoleal complex . Recommending
DEFORMITY EVALUATION TECHNIQUE
Photos : Courtsey of Dr . DeHeer
Figure 5 — Ankle joint dorsiflexion with the knee fully extended evaluating for Gastrocnemius equinus
Figure 6 — Ankle joint dorsiflexion with the knee flexed evaluating for Gastronemius-Soleal equinus
Current Pedorthics January / February 2017 47