Tippy Toe Syndrome

Ankle joint equinus, “a condition in which the upward bending motion of the ankle joint is limited” happens when the dorsiflexion range of motion (where the toes are brought closer to the shin) in the ankle is reduced. Someone with this problem has an insufficient ability to bring the top of the foot toward the front of the leg.

There are several potential causes of ankle joint equinus. Most often, a tightness in the Achilles tendon or the calf muscle leads to this condition.  It results from being in a cast for an extended period of time, being on crutches, or even from frequently wearing high-heel shoes.  It is also a congenital condition as it can be an inherited trait. Children who learn to walk and continue to walk on their “tippie toes” may have this condition.  Diabetes can also cause the tendon to tighten.  Other causes include bone fragments blocking ankle motion.

Ankle joint equinus can cause individuals to make compensations in their gait patterns such as early heel lift, flattening of the arch, toe walking, excessive subtalar joint pronation (bending the ankle inward), and bending abnormally at the hip or knee. These compensations can then lead to the development of other problems including inflammation of the balls of the foot, ankle sprain, pain, stiffness and weakness of the Achilles tendon, plantar fasciitis (one of the most common causes of heel pain which involves pain and inflammation of a thick band of tissue, called the plantar fascia, that runs across the bottom of your foot and connects your heel bone to your toes”), back pain, and calf muscle strain.

Stretching, moist heat, and heel raise exercises have been used to increase ankle joint dorsiflexion range of motion.

What to do?  From FootHealthFacts.com
Non-Surgical Treatment
Treatment includes strategies aimed at relieving the symptoms and conditions associated with equinus. In addition, the patient is treated for the equinus itself through one or more of the following options:

  • Night splint. The foot may be placed in a splint at night to keep it in a position that helps reduce tightness of the calf muscle.
  • Heel lifts. Placing heel lifts inside the shoes or wearing shoes with a moderate heel takes stress off the Achilles tendon when walking and may reduce symptoms.
  • Arch supports or orthotic devices. Custom orthotic devices that fit into the shoe are often prescribed to keep weight distributed properly and to help control muscle/tendon imbalance.
  • Physical therapy. To help remedy muscle tightness, exercises that stretch the calf muscle(s) are recommended.

When is Surgery Needed?
In some cases, surgery may be needed to correct the cause of equinus if it is related to a tight tendon or a bone blocking the ankle motion. The foot and ankle surgeon will determine the type of procedure that is best suited to the individual patient.

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