EquinusEquinus, , PesPes CavusCavus and and DropfootDropfoot
-- Video Gait Analysis Video Gait Analysis --
Craig A. Camasta, DPM, FACFASCraig A. Camasta, DPM, FACFASAtlanta, Georgia, USAAtlanta, Georgia, USA
EquinusEquinus = “Toe Walker”= “Toe Walker”
Soft TissueSoft TissueStatic Static –– fixed contracturefixed contractureDynamic Dynamic –– spastic, hypertonicspastic, hypertonic
BoneBoneProcurvatumProcurvatum, Post, Post--TraumaticTraumaticRemodeled / Arthritic PostRemodeled / Arthritic Post--ContractureContracture
LocationLocationLeg, Ankle, FootLeg, Ankle, Foot
Bone v. Soft Tissue v. CombinationBone v. Soft Tissue v. Combination
CavusCavus = High Arch= High Arch
Forefoot Forefoot PlantarflexedPlantarflexed on on RearfootRearfootNormal Ankle ROMNormal Ankle ROMFamilial TendencyFamilial TendencyInherited Neuromuscular Inherited Neuromuscular DxDx((CharcotCharcot--MarieMarie--Tooth)Tooth)
DropfootDropfoot
Weak Weak DorsiflexionDorsiflexion
Nerve InjuryNerve InjuryCVACVACrush/LacerationCrush/Laceration
Neuromuscular Neuromuscular DxDxCMTCMT
EquinusEquinus vs. vs. CavusCavus
EquinusEquinus = Ankle or Above = Ankle or Above CavusCavus = Below Ankle= Below Ankle
PesPes CavusCavus = Forefoot = Forefoot EquinusEquinus“Pseudo “Pseudo EquinusEquinus””
DropfootDropfoot (spinal injury)(spinal injury)
DropfootDropfoot + + EquinusEquinus (CMT)(CMT)
DropfootDropfoot -- CP Nerve InjuryCP Nerve InjuryPrePre TPTT/STJ FusionTPTT/STJ Fusion
EquinusEquinus ContractureContracture
GastrocnemiusGastrocnemiusCrosses KneeCrosses KneeTight With Knee ExtensionTight With Knee Extension
GastroGastro--SolealSolealTight With Knee FlexionTight With Knee Flexion
Static vs. Hypertonic/SpasticStatic vs. Hypertonic/SpasticClonusClonusHyperHyper--reflexiareflexia
EquinusEquinus AssessmentAssessment
Testing For Testing For EquinusEquinus……Observation Stance & GaitObservation Stance & GaitManual AssessmentManual AssessmentTEST WITH FOOT “NEUTRALIZED…”TEST WITH FOOT “NEUTRALIZED…”
1. Reduce Deformity & Maintain Position1. Reduce Deformity & Maintain Position2. 2. DorsiflexDorsiflex Forefoot While Pulling Down HeelForefoot While Pulling Down Heel
HubshireHubshire ManeuverManeuverPatient may need to step forward…Patient may need to step forward…
Toe Raise Toe Raise Heel Inversion?Heel Inversion?Arch Reduction?Arch Reduction?
Neutralized Neutralized DorsiflexionDorsiflexion
Neutralized Neutralized DorsiflexionDorsiflexion
HubshireHubshire & Toe Raise& Toe Raise
HypertoniaHypertonia & & EquinusEquinus
Heel Cord LengtheningHeel Cord Lengthening
When is it INDICATED?When is it INDICATED?Heel Pitch InclinedHeel Pitch Inclined
Never IndicatedNever Indicated
Heel Pitch Flat or Heel Pitch Flat or DeclinatedDeclinatedAlways IndicatedAlways Indicated
TAL vs. TAL vs. GastrocGastroc RecessionRecession
TALTALGastroSolealGastroSoleal EquinusEquinusLongLong--standing Deformitystanding DeformitySevere ContractureSevere ContractureOlder PatientsOlder Patients
GastrocnemiusGastrocnemius RecessionRecessionGastrocnemiusGastrocnemius EquinusEquinusLesser Degree of Lesser Degree of EquinusEquinusYoung PatientsYoung PatientsEasier RecoveryEasier Recovery
TendoAchillesTendoAchilles LengtheningLengthening
Many Approaches…Many Approaches…
TenotomyTenotomyOpen or Open or PercutaneousPercutaneous
PercutaneousPercutaneousSeries of StabsSeries of Stabs18 Ga. Needle18 Ga. Needle
Open Frontal “Z”Open Frontal “Z”ControledControled LengthLength
GastrocGastroc RecessionRecession
Many Approaches…Many Approaches…
Limited Open Limited Open TenotomyTenotomyContained SystemContained System
Open Open TenotomyTenotomyTongue / GrooveTongue / Groove
CompensationCompensation
Ability of Limb to Accommodate DeformityAbility of Limb to Accommodate DeformityAvailable ROMAvailable ROMPlane of DeformityPlane of Deformity
SagittalSagittal primaryprimaryTransverse & Frontal secondaryTransverse & Frontal secondary
Beyond Available ROM Beyond Available ROM
RESIDUAL DEFORMITYRESIDUAL DEFORMITY
EquinusEquinus CompensationCompensation
FullyFully--Compensated Compensated Heel Contacts GroundHeel Contacts Ground
UnCompensatedUnCompensatedHeel FloatingHeel Floating
Compensated Compensated EquinusEquinus
PesPes ValgusValgusHammertoes / HAVHammertoes / HAVGenuGenu RecurvatumRecurvatum
Increased Pressure ForefootIncreased Pressure ForefootDiabetic Diabetic TrophicTrophic UlcersUlcers
Foot CompensationFoot Compensation
PesPes PlanovalgusPlanovalgus -- Hammertoes / HAVHammertoes / HAV
Foot CompensationFoot Compensation
Diabetic Ulcers …Diabetic Ulcers …
Foot CompensationFoot Compensation
NeuropathicNeuropathic -- CharcotCharcot ArthropathyArthropathy
Manual ReducibilityManual ReducibilityEliminate Eliminate EquinusEquinus
17 F Clubfoot 17 F Clubfoot SxSx Age 1Age 1
17 F Clubfoot17 F Clubfoot
17 F Clubfoot17 F Clubfoot
EquinusEquinus: Stance & Gait: Stance & GaitCompensated Compensated EquinusEquinus
PesPes PlanovalgusPlanovalgus / Abducted Gait/ Abducted GaitEarly HeelEarly Heel--Off Off Forward Leaning Posture / Forward Leaning Posture / GenuGenu RecurvatumRecurvatumProlonged Limb Support in Gait Prolonged Limb Support in Gait Lack of Full Knee Extension in GaitLack of Full Knee Extension in Gait
Compensated Compensated EquinusEquinus
Stance / PostureStance / Posture
Gait AnalysisGait Analysis
Compensated Compensated EquinusEquinus ::GenuGenu RecurvatumRecurvatum
Gait Gait -- Compensated Compensated EquinusEquinus
Compensated (?) Compensated (?) EquinusEquinusComfortComfort Forced StanceForced Stance POY 3 TALPOY 3 TAL
POY 6
EquinusEquinus--Compensated FlatfootCompensated Flatfoot7 / F Severe 7 / F Severe PesPes planovalgusplanovalgus / Vertical Talus/ Vertical Talus
Compensated Compensated EquinusEquinus Gait Gait -- CVACVA
EquinusEquinus--Compensated FlatfootCompensated Flatfoot
Gait Gait -- Compensated Compensated EquinusEquinus
EquinusEquinus FlatfootFlatfootPO Y2 TN Fusion / TALPO Y2 TN Fusion / TAL
EquinusEquinus Flatfoot GaitFlatfoot Gait
GastrocGastroc / Evans / Medial Arch/ Evans / Medial Arch
9 9 yoyo F F EquinusEquinus / Vertical Talus/ Vertical Talus
TAL & Spring Ligament TAL & Spring Ligament PlicationPlication
Young’s Young’s TenosuspensionTenosuspension
TAL Repair + ResultTAL Repair + Result
Pre and Post Reduction of Pre and Post Reduction of EquinusEquinus
Spastic Spastic EquinusEquinus & Gait& Gait
Spastic Spastic EquinusEquinus –– M GravisM Gravis
Spastic GaitSpastic Gait
PrePre--OpOp PostPost--Op TA, TP, AchillesOp TA, TP, Achilles
Compensated Compensated EquinusEquinus -- MVAMVA
EquinusEquinus: Stance & Gait: Stance & Gait
UnCompensatedUnCompensated EquinusEquinusPesPes EquinusEquinus or or EquinoVarusEquinoVarus
or or EquinoAdductoVarusEquinoAdductoVarusIncreased Angle & BaseIncreased Angle & BaseResidual Knee FlexionResidual Knee FlexionLateral Ankle InstabilityLateral Ankle InstabilityCircumductoryCircumductory GaitGaitShortened Limb Support in GaitShortened Limb Support in GaitLLD LLD –– longer leglonger leg
Combination DeformitiesCombination DeformitiesTalipesTalipes equinovarusequinovarus = clubfoot= clubfoot
Bony Bony EquinusEquinus –– Residual DeformityResidual Deformity
Uncompensated Uncompensated EquinusEquinus –– PesPesValgusValgus
Gait Gait -- Uncompensated Uncompensated EquinusEquinus
Spastic Spastic EquinusEquinus -- CVACVA
23 Year Post MVA, CP Nerve 23 Year Post MVA, CP Nerve Paralysis, Paralysis, DropfootDropfoot EquinovarusEquinovarus
PostPost--Op TAL / AJC Op TAL / AJC
Pre and Post GaitPre and Post Gait
Pre and Post With ShoePre and Post With Shoe
Uncompensated Uncompensated EquinusEquinus –– Brain TumorBrain TumorPrePre--OpOp XX--RayRay Post TAL/AJCPost TAL/AJC
Pre and Post Pan Pre and Post Pan TalarTalar ArthrodesisArthrodesis
Before & After Before & After
Uncompensated Uncompensated EquinusEquinus GaitGait
BeforeBefore AfterAfter
Uncompensated Uncompensated EquinusEquinus –– 1.5 Year 1.5 Year Post MVA, Talus AVN, Flap/GraftPost MVA, Talus AVN, Flap/Graft
Pre and Post Pre and Post -- TAL/AJC, TAL/AJC, PanTalarPanTalar ArthrodesisArthrodesis
Pre and Post Y 1 & GaitPre and Post Y 1 & Gait
EquinusEquinus -- Surgical Principles Surgical Principles
Assess Bone & Soft TissueAssess Bone & Soft TissueStaged ApproachStaged Approach
TAL, AJCTAL, AJCBone ResectionBone Resection
One StageOne StageMore Bone ResectionMore Bone ResectionLoss Limb Length…Loss Limb Length…
52 M 52 M EquinusEquinus + + CavusCavus
Gait AnalysisGait Analysis
EquinusEquinus ??
PesPes CavusCavus ??
DropfootDropfoot ??????
Combination Deformity …Combination Deformity …
EquinusEquinus
GastrocnemiusGastrocnemius or or GastroSolealGastroSolealAssess With Foot NEUTRALIZEDAssess With Foot NEUTRALIZED
TAL vs. TAL vs. GastrocGastroc RecessionRecession
CompensatedCompensatedHeel on GroundHeel on Ground
UncompensatedUncompensatedToe WalkerToe Walker
DropfootDropfoot & & EquinusEquinus & & CavusCavus
All Limited All Limited DorsiflexionDorsiflexion……DropfootDropfoot
Weakness of Weakness of DorsiflexionDorsiflexionEquinusEquinus
Primary Deformity At / Above AnklePrimary Deformity At / Above AnkleCompensation Above (Compensation Above (genugenu recurvatumrecurvatum) & Below ) & Below Ankle (Ankle (pespes valgusvalgus, HAV, HT), HAV, HT)
CavusCavusPrimary Deformity Below Ankle (foot)Primary Deformity Below Ankle (foot)Compensation Distal (toes) & Proximal (ankle)Compensation Distal (toes) & Proximal (ankle)
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