Equinus or spastic equinovarus is a foot deformity that most commonly occurs secondary to cerebral stroke (CVA) or cerebral palsy, but may also be a congenital deformity. The pathology causes gait abnormality in patients and is a very real handicap when it comes to mobility. Learn more about the condition, its diagnosis and the different treatment options available.
There are several treatment options available to reduce the effects or provide relief for patients with equinus deformity.
Treatment options for equinus deformity secondary to brain injury
- Botulinum toxin Type A injection: Botulinum toxin acts at the neuromuscular junction by temporarily inhibiting transmission of a mediator, acetylcholine. The effect is a real reduction in spastic muscle tone. In the treatment of equinus deformity, botulinum toxin reduces spasticity of the gastrocnemius-soleus complex (the posterior calf muscle) in patients over two years of age. Injection sessions deliver a clinical improvement during 15 days after administration and should be repeated every three to six months.
- Drug treatments: muscle relaxants such as baclofen, dantrolene and tizanidine are used for the same therapeutic purposes as botulinum toxin. Their tolerance profile is different however. They relax the spastic muscles in the leg to allow the patient to place the foot flat on the ground. This type of treatment needs to be reassessed on a regular basis to check its efficacy, adjust the dosage and check for side effects.
- Orthoses: can be used to facilitate walking by keeping the foot in a position that forms a right angle with the leg.
Dedicated treatments for congenital equinism
- Functional treatment: this technique involves daily rehabilitation by specialist physiotherapists, in combination with splints and bandages to maintain the foot in the corrected position. The treatment must continue for close to three years.
- Prof. Ponseti’s orthopedic method: the foot deformity is treated with weekly plaster casting of the foot to correct the ligament stiffness, stretch the myotendinous junction and relax hypertonic muscles. After the fifth plaster casting, a small operation, an Achilles tenotomy, is needed to lengthen the Achilles tendon. Post-tenotomy, the foot is stabilized in an orthopedic plaster cast.
- Surgical intervention: surgery may be necessary to treat congenital equinism if the deformity is not corrected using the Ponseti method by plaster casts or splints. Surgery is possible from eight months old. The surgeon lengthens the retracted structures that are preventing correction of the deformity (ligaments, tendons etc.). It entails one or two incisions, and afterwards the foot is held in place with a pin and plaster cast for 45 days.
- Splints and walking orthoses: these are used both after surgery and for patients that did not require surgery. Splints and orthoses stabilize the position of the foot and make walking easier.
Despite the efficacy of these treatments, some residual defects are impossible to prevent in patients with congenital equinism:
- 1 foot smaller than the other (a difference of 1, 2 or even 3 shoe sizes),
- slimmer calf on the affected foot,
- weak calf muscle.
The severity of equinus deformity varies.
The chief causes of equinus deformity are cerebral stroke (CAV) in adults, and cerebral palsy in children.
Worldwide, more than 100,000 children are born with equinus deformity.