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osseus equinus surgery

Posted by josh s on 5/06/03 at 13:42 (117921)

Hi Doctors,

I have bilateral ankle equinus that appears on lateral stress x-rays to be caused by bone on bone contact betwixt the talar neck and the tibia. On the x-ray the right ankle has about 5 deg. dorsiflexion before collision. The left ankle has about 3 deg. and appears on x-ray to have a slight gap between talus and tibia. Neither ankle has responded to stretching. There does not appear to be lipping on the talar neck sometimes associated with bony equinus. My podiatrist figures it is just the way my bones are built. Walking with heel lifts is getting old and I'd like to investigate surgical options.

Is there any known surgery for this type of condition?

Thanks.

Re: osseus equinus surgery

Ed Davis, DPM on 5/06/03 at 17:57 (117947)

Josh:
That type of surgery is not uncommon since such osseus blocks can occur with dorsiflexion injuries -- front end auto collisions, falling into holes.

Osseus blocks to dorsiflexion really need to be removed surgically since that lack of motion causes too many problems to deal with. The only reasonable non-surgical option is heel lifts or simply using high heels -- eg. cowboy boots (consider moving to Texas).
Ed

Re: osseus equinus surgery

josh s on 5/08/03 at 11:07 (118097)

Thanks for the reply Dr. Ed,

I just want to make sure I made it clear that on X-ray it does not appear that any lipping or bony callous is responsible for the equinus. It appears that it is simply the shape of my tibia and talus that is responsible for the lack of ROM. Do your comments still apply in this case? Would an orthopedist or a podiatrist be best for this type of procedure.

Thanks again,
Josh

Re: osseus equinus surgery

Ed Davis, DPM on 5/08/03 at 21:11 (118137)

Josh:
That scenario is uncommon so it is worth a second opinion. Do the stress dorsiflexion views definitely show bone to bone contact? How long has the limitation of motion been present? A foot and ankle orthopedist subspecialist or podiatrist could be consulted. A general orthopedist may have limited experience in the area.
Ed

Re: osseus equinus surgery

josh s on 5/09/03 at 16:03 (118196)

Thanks Dr. Ed

The right foot was certainly bone on bone. The left foot looked like it had several milimeters to go. This is consistent with my experience stretching - on the right side I can't get any kind of stretching sensation usually. In Root's biomechanics text he mentions such scenarios, but not their treatment. I'll seek a second opinion. If not that scenario any ideas what it may be? Thanks again.