Calf (Gastrocnemius) Release for Equinus Contracture

Equinus contracture/tight calf is typically an associated condition of a primary diagnosis of a bunion and may exacerbate the bunion problem.

In general orthopedic practice it is most commonly seen in flat or cavus feet.

Associated with diabetes mellitus (DM) and has been shown to be an important causative factor in diabetic foot ulcers. It is also common in neuromuscular diseases such as cerebral palsy (CP). Often, CP or DM can be associated with an equinus contracture in the Achilles tendon itself.

In cavus or flatfoot the contracture is often associated with “gastrocnemius” equinus. This technique is most applicable to gastrocnemius equinus (as opposed to Achilles tendon equinus).

Can lead to heel pain syndrome/plantar fasciitis, Achilles insertional tendonitis, Achilles pain in the tendon, and calf pain or tear. Tightness of the calf may also prevent proper reduction in reconstructive surgery for flatfoot or cavus (either osteotomy or fusion).

Equinus contracture is found on clinical examination. If the examination is not done correctly, the condition may go undiagnosed. It is important to follow this guideline in a stepwise fashion

• The patient is seated on an examination table, and the knee is fully extended. (Since the gastrocnemius crosses three joints and the soleus only two, it is important to fully extend the knee to make sure the gastrocnemius is on stretch.)

• Cup the heel with the contralateral hand, placing the thumb on the tarsonavicular (TN) joint. Using the ipsilateral hand around the forefoot, rock the TN joint into varus and valgus until you can find the neutral point of the TN joint. (This is important to prevent total complex dorsiflexion around the TN joint compared with the ankle alone. If the TN joint is everted, apparent dorsiflexion can occur at the TN joint instead of in the ankle.)

• With the knee fully extended and the TN joint locked at neutral, gently dorsiflex the foot. If equinus is present, the ankle will remain in some degree of plantar flexion instead of coming into any amount of dorsiflexion.

• While maintaining the foot in the locked position with gentle dorsiflexion force, have the patient grasp under the knee and pull upward, releasing the tension on the gastrocnemius.

  • If the equinus contracture is a gastrocnemius equinus, the ankle should release and (more) dorsiflexion should be noted.

  • If the dorsiflexion does not increase, then the equinus is not gastrocnemius equinus but rather a rigid “Achilles” contracture, which requires lengthening directly in the tendon.

• The examination can be repeated several times easily in a short time to confirm the diagnosis.

Radiographs

• Obtain weight-bearing films of the ankle.

• Take care to make sure there is no bony block in the ankle preventing dorsiflexion or a capsule contracture that may also prevent dorsiflexion.