It is generally accepted that Diabetes is a serious metabolic disease that puts its sufferers at risk for a number of health problems, especially of the foot and ankle. While Diabetic Peripheral Neuropathy is a chemically damaging aspect of the disease there are mechanical aspects that also play a role in the foot of a diabetic patient. One such condition is the development of an Equinus deformity.

A Radiograph from truelok.net that shows an Equinus deformity perfectly.

         This deformity gets its name from the root word equus, which is the family of horse like animals…which if you notice, all stand on their toes! Toe-walking is a symptom of the Equinus deformity and is due to tight calf muscles, specifically the Gastrocnemius, which contributes to the formation of the Achille’s Tendon. Due to the attachment onto the Calcaneus (Heel bone) the Achille’s Tendon pulls the back of the foot upward when tight, which leads to the patient putting more weight onto the front of their foot in toe-walking. 

A diagram demonstrating the mechanics of the foot and ankle joints from oandp.com

         This displacement of weight causes the foot to compensate which causes other deformities like Plantar Fasciitis, Hallux Limitus, Metatarsalgia, and Tendonitis in a few places in the foot. In the Diabetic foot conditions like ulcers under the metatarsals and even Charcot foot are a major cause of concern for the Podiatric patient and physician.

Fortunately, there are plenty of options for the treatment of this deformity and many are quite simple yet effective.

-       Stretching exercises can help patients with the tension in their Achille’s Tendon.

-       Orthotics or Heel inserts may also help elevate the back of the foot and reduce tension on the tendon.

-       Surgical intervention in the form of an Endoscopic Gastrocnemius Resection (EGR) is a minimally invasive option that is usually very successful in the treatment of Equinus deformity.

        Equinus deformity is a common problem and you should be evaluated for this condition by your Podiatrist when seeking the cause of your foot pain!

Picture of Silfverskiold test from podiatrytoday.com

        A simple tool called the Silfverskiold Test is used to determine the amount of movement in the patient’s  dorsiflexion (pointing the toes upward) of the foot both with the leg extended and flexed as shown below. A marked decrease in dorsiflexion with an extended leg indicates excessive tension in the Achille’s Tendon and a possible candidate for EGR.