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Ankle equinus

Discussion in 'Diabetic Foot & Wound Management' started by Charlotte Darbyshire, Jan 31, 2011.

  1. Charlotte Darbyshire

    Charlotte Darbyshire Active Member


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    I was wondering whether any forum users advocate testing for ankle equinus as part of their screening and risk catagorisation for diabetic patients.
     
  2. fronny

    fronny Active Member

    I don't currently do this as a specific check (but hopefully should spot it on initial assessment). It's a risk factor for high plantar pressure/ulceration, but I assume most practitioners would spot this when looking at the whole package and record/monitor/treat accordingly.
     
  3. I would have said early heel lift would be much more important than testing ankle equinus.

    Then the next question becomes does an early heel lift lead to an increase in friction and shear forces acting on the forefoot ?

    As we know these forces are thought to be the most important force behind breakdown and ulceration in diabetic patients.

    I would say an early heel lift should lead to greater shear and friction forces acting on the forefoot, so, early heel lift rather than ankle equinus or as we maybe should refer to it as increase dorsiflexion stiffness of the ankle should be important for you to look for.
     
  4. Griff

    Griff Moderator

    I agree with Mike, probably a good shout to check the ankle dorsiflexion stiffness in a diabetic screening as standard, particularly given the suggestion of joint stiffening associated with chronic hyperglycaemia.
     
  5. Charlotte:

    Any loss of sensory function of the skin of the plantar forefoot, any presence of gastrocnemius/soleus/ankle equinus, and any presence of plantarly prominent metatarsal heads should be considered as risk factors for developing plantar forefoot ulcerations in the diabetic patient. I would not consider the gait finding of an early heel off in a diabetic patient, without also plantar skin sensory loss, to be a risk factor for developing plantar forefoot ulcerations. Many diabetic patients that eventually develop forefoot ulcerations may not have an early heel off during gait. Of course, in-shoe pressure analysis may be one of the best predictors of plantar forefoot ulceration in the neuropathic diabetic patient.
     
  6. PodGov

    PodGov Member

    I think the point being made was that if early heel lift is determined; it may in the presence of gastroc/soleus/ankle equinus be an additional predisposing factor to forefoot ulceration.
     
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