Equinus

[pando]

Hello wonderful people,

While generally happy with my progress, I have felt uncomfortable with my affected foot. Recently I’ve done a lot of research on foot problems, and concluded I have a certain amount of equinus bothering me. Hopefully I am not turning into a horse, but Equinus (pointed feet, like a horse) is a condition caused by a shortening of tendons (contracture, though I feel that is too strong a word) the most common being the Achilles tendon (compounded by tight Gastroc and Soleus (calf) muscles). So I have been doing calf stretches, and noticing a certain improvement. With equinus, the forefoot strikes the ground too early, too often. It therefore takes most of my effort to keep my toes up and away from the ground (dorsiflexion).

On my team, opinion is split 50/50 ; my Radiologist and Yoga teacher think it’s certainly an issue (to a degree). My physio and Chinese Dr. are very doubtful it is an issue. Therefore, this week I’m seeing a chiropractor who is going to take a look at my foot, and next week a podiatrist who will finally settle the matter. Either way, I will continue with my stretches (Ronald (my stroke half) is in dire need of stretches from head to toe). I thought I’d post this story now, since a lot of mystery (to me, at least) is about to unfold.

Does anyone here have experience with equinus, or shortening of Achilles tendon? I realize that foot drop causes similar symptoms, and there are several mechanisms which can cause foot drop. My senior physio established that I don’t have foot drop, but noticed my ankle was very stiff, and the reason is now clear to me. If anyone has experience of this problem, and can advise I would be most grateful.

Good luck to all, and hope there is all-round progress in abundance,
ciao, Roland

ps. I am going back to my watercolours by the end of the week
(waiting for a new palette)

[pando]

Thanks for yr reply, Nige

I don’t have a weakness in my foot in the way you describe… at least, not much during the thick of the day, but towards evening I notice the foot is exhausted from dorsiflexion. That’s because I am ensuring the toes don’t snag a carpet edge or something and trip me over. If I relaxed my foot the toes definitely would scrape the ground.

“Stand on the inside of their foot” so the foot was going into classic inversion? i.e. Calcaneus (heel bone) did not follow on in a straight line from the Achilles tendon? I was wondering about that when I got up this morning!

I’m sure I only have a limited amount of equinus… but best caught early where a bit of stretching can restore full freedom of movement. Of course, I could be barking up the wrong tree, but the pros will let me know if I’m imagining it. I have not tried an AFO ; but I gather strapping one on for an hour each evening could, in time, help. Again, the pros will advise. I know what you mean about the duvet pulling toes down, but I can straighten them so they point to ceiling (unless I’m on my side, and I do sleep on my side).

Yes, my foot has changed over time. Maybe I have more feedback (still lacking overall) from my foot proprioceptors, so that it feels like more problems… or I really have a bit of tendon shortening (2 months in bed in hospital in 2022) or my ankle is stiff, and I have gone cuckoo & am seeing horses (equinus). Like I said, the judges on my team have reached a split verdict. The problem remains, however.

On Saturday I went to Tyntesfield (national trust) and walked 0.7 km (checked it on Google Earth). Was more pleased with walking (thanks to my awareness of my forefoot, and my calf stretches of late. I am aware of the danger of obsessing over equinus, and need to keep the big picture in mind…

Thanks Nigel, your experience runs right across the board,
Ciao, ciao, Roland

[pando]

ps. in a scientific paper I read that Equinus foot deformity EFD is the most common deformity following a stroke

Physical therapy interventions for the correction of equinus foot deformity in post-stroke patients with triceps spasticity: A scoping review - PMC.

I guess many stroke survivors do not know they have it to some degree. Whether they then overcome EFD depends on their recovery & level of activity… that’s the most common scenario, probably.

[pando]

Another update, since I saw the chiropractor today ; yes, I do have equinus, she says, to a moderate degree. Next Wednesday I will see a podiatrist, and see what she says, which should be the same.

I’m happy to have diagnosed myself, because I have been working on corrective stretches for some time, by now…

[Mrs5K]

Good to hear you seem to be getting some answers & making some positive progress.

Best wishes

Ann

[Mich-mm]

Hello @pando I’m very keen to know how you are doing i too have equinos i have an appointment with an orthapaedic surgeon on the 4th. My PT won’t allow me to stand until i see the surgeon! And so i go backward!

[Mich-mm]

Hello again @pando,I had an appointment today with an orthopaedic surgeon,a Doctor. May who works out of the Nelson outpatient clinic on Kingston road here in London,however I believe he operates at st.george’s hospital.he has assured me that the efd I have can be corrected by cutting the Achilles tendons he says he has a 90%success with this type of op.I don’t know when I will have the op yet but at least a few months.plese do let me how you are doing.

[ManjiB]

Hey Roland - this is news to me.

Until I read your post, I had never heard of Equinus foot deformity even if it is the most common deformity following stroke

Just confirms my long held belief that stroke medical condition is way behind on all fronts.

Hope you are keeping well with your YouTube channel. I haven’t had a chance to visit recently

Ciao.

[pando]

Not standing is the biggest evil you can do, in my humble opinion
Calf stretches should be top of your list
Roland

[pando]

Hi Manji,

I’ve just returned from a holiday in Kos
Equinus, like all things stroke related, is the devil.
I did calf stretches at the beach, with good results !

ciao, Roland

[Mich-mm]

I agree Roland @pando but as i say my physiotherapist came to the appointment too, and he said it was pointless to wear my splints which were custom made for me by the physiotherapist at RHN, and which stretch my lower legs interestingly my private physiotherapist thinks I should consider orthotics despite what the surgeon says!

[pando]

Hi Mich-mm,
Cutting Achilles tendon is a drastic measure. I have fought contracture for almost 3 years & I still have to guard against it. I cannot make a judgement call on your specific case by what I have read, but I hope you find a solution. There are many who consider me a living miracle, but they exaggerate : I have worked incessantly however. Hard work helps, as long as you’re full of inspiration and ingenuity. Good luck,

Roland

[Mich-mm]

Agreed @pand,roland but I’m completely unable to convince the physiotherapist.are you suggesting that surgery is not a good option?if so why?

[pando]

I have not had surgery so cannot advise from experience. Just based on theoretical knowledge which one can look up. I have been to specialists to fit orthotics but I rejected them based on advice that 50% of people reject them.

For all the help offered from my brilliant team, nobody has come up with solutions that surpass my own research and intuition ; I mean, who else can feel your body better than yourself ?

ciao, R