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I saw a 10 year old boy the other day with suspected structural equinus. His Dad has passed on a congenital bone abnormality which he decribed as growing extra bones. He could not remember the name but thought it was "bony estontosis" (may be exostosis). After palpating some of the growths they seem to be extensions of the bones, rather than separate entities. Anyway, the boy has had x-yars showing a very deep AJ socket. He was unable to perform the linge test at all. Overall strength is good, and plays footy. Cavus foot type. I have presribed some stretches and dad is considering orthoses - my question is: would orthoses corrected to zero and with a minimal arch fill help and how could I address the equinus conservatively. Would raising the heels help?
As far as I know (someone step in if they know otherwise), there is *no* way an orthotic will ever facilitate an increased sagittal ROM at the ankle joint where a bony equinus exists. If anything, they may even worsen the problem, particulary if you supinate the STJ further.
You really can't assess this child properly without looking at the weight-bearing lateral x-ray of the ankle and hindfoot. This should show you if there is a significant bony impedement to ankle dorsiflexion (ie the anterior portion of the tibial plafond).
Generally, a bony equinus is easily resolved with an anterior ankle joint arthroplasty (to remove the excess bone off the tibia), which can be done as a day surgery and should resolve this problem in the long term.
Structural equinus in 10 yr old
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