1-2-2012 At heel contact, the ankle joint is supinated As the ankle momentarily plantarflexes in heel contact, the ankle

joint pronates As the body moves forward, the ankle begins to passively dorsiflex, which causes supination Subtalar joint is fully pronated halfway through midstance Maximum ankle dorsiflexion occurs as heel leaves the ground Maximum ankle plantarflexion occurs as the toes leave the ground - maximum subta lar joint supination In swing phase,the ankle dorsiflexes so that the toes clear the ground Gastrocnemius crosses 3 joints: knee joint, ankle joint, and subtalar joint The knee flexes from heel contact to midstance At ankle perpendicular, the knee is fully extended From tibia perpendicular to heel-off = the most important stage in the gait cycl e When is equinus important? When you you need maximum dorsiflexion? - tibia perpe ndicular to heel off If you do not have 10 degrees of ankle dorsiflexion, you have compensation 1. Extensor substitution is one method of compensation The EDL extends the MPJs 2. Pronate subtalar joint = tibialis posterior tendon dysfunction 3. Unlocking midtarsal joint - more sagittal plane motion than subtalar joint 4. You increase angle of gait with the hip joint 5. Early heel off 6. Steppage gait - flexion of hip joint so that toes clear the ground 7. Spastic Cerebral palsy - stuck in plantarflexed position, hip flexion 1. Most common equinus is gastrocnemius equinus 2. Soleus + gastrocnemius equinus 3. Bone/osseous ankle block 4. Tibialis posterior equinus Stress ankle dorsiflexion X-ray can tell you the difference in equinus - Charger X-ray Diagnosis of equinus:

1. Knee extended only to perpendicular 2. Knee flexed and you get 10 degrees - gastrocnemius equinus 3. Flex the knee and don't get 10 degrees - order Charger X-ray - lateral stress ankle dorsiflexion - osseous equinus 4. No osseous equinus on X-ray - possible soleus equinus 5. Pseudoequinus 6. Subtalar joint neutral or supinated to prevent midtarsal joint dorsiflexion c ompensation to be captured on our tractograph evaluation - fifth met to fibula Pseudoequinus - plantarflexion of the forefoot on the rearfoot captured on our t ractograph evaluation What is the opposite of equinus? - Calcaneus In newborns: calcaneovalgus Tx for calcaneovalgus: casting (the mother), put on a soft cast like an unna boo t; you do not need to cast for this 45 year old male with calcaneovalgus: ruptured achilles tendon Neglected tendoachilles rupture: calcaneus gait - patient has a fear of falling forward; short shuffling gait, wide base of gait, and no propulsion The picture - chronic subtalar joint instability due to torn calcaneofibular lig ament; Charcot-Marie-Tooth disease Charcot-Marie-Tooth diseaes = cavus foot; lateral stress pronation X-ray; Colman Block test; pseudoequinus - you would not do an achilles tendon lengthening on this patient *Do NOT lengthen the tendoachilles with a cavus foot* Why is the Lisfranc joint involved? - equinus 7. Pseudopseudoequinus - not found in literature