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Forefoot equinus

Discussion in 'Biomechanics, Sports and Foot orthoses' started by mike weber, Jun 25, 2009.

  1. Members do not see these Ads. Sign Up.
    Ian wrote that he had a forefoot equinus in a post about what orthotics your wearing.

    Did some googling and other search stuff on Forefoot equinus did not find much does anyone have a good discription and how it effects mechanics of the foot or good journal articles etc

    Michael Weber
  2. Graham

    Graham RIP

    Might want to search: Anterior equinus
  3. Griff

    Griff Moderator

    Hi Michael,

    Think of it as an anatomical plantarflexion of the forefoot on the rearfoot

    So in my case (quite a rigid/stiff foot also) I have to use quite a bit of my TCJ dorsiflexion just to get plantigrade while standing. I therefore have not much left functionally i.e. What you see with me on the couch is not what you get when weight bearing. It's not too much of a problem running, but without heel raises (or a shoe with a decent pitch) I get calf discomfort just from everyday life. I suppose the best way to describe it is that's it's a bit like I'm always walking up a hill (as far as my TCJ and posterior muscles are concerned). I also struggle to do squats in the gym and can't ski for toffee.

    Hope this makes sense-apologies for being brief, I'm at an airport and typing this on my phone. When I get back home to my laptop on Sunday night I will post up some pictures to illustrate what I am explaining

    Last edited: Jun 25, 2009
  4. Thanks Ian Look forward to the photos.

    As It sometimes goes after reading the post I then had a patient with a large but flexiable forefoot equinus with cronic plantarfascia and Gastroc pain.

    Got me thinking if it could be a developing forefoot positional change ie supinatus.

    But still could not find much when looking up Anterior equinus also.

    Michael Weber
  5. Griff

    Griff Moderator

    Hi Michael,

    Attached are the photos as promised - apologies for the delay

    Pic 1 - Illustrating the discrepancy between the forefoot and rearfoot in the sagittal plane (assessed in this picture with the patient prone and knee flexed to 90 degrees - i.e. plantar surface of foot facing the ceiling)

    Pics 2/3 - A double knee bend performed with and without a heel raise. Patient is asked to keep heels on the floor and bend knees until they can not move any further forward (improvement usually expected with a heel raise).

    Should probably be mentioned that you will also usually see a failed Lunge test in these patients in my experience. [Certainly in my case - tibial angle approx 15-20 degrees and distance from wall approx 4-5cm]


    Attached Files:

  6. Thanks again Ian,

    Picture tells a 1000 words.

    Do you know of any research that looks into the loads placed on the plantarfascia and Triceps surea muscles with regard to level of deformity could be and intersting paper.

    Off to pubmed now to look into things.

    Thanks again Ian for your time.

    Michael Weber
    Last edited: Jun 30, 2009
  7. Griff

    Griff Moderator


    I am not aware of any such research, although I'm sure someone will correct me if I'm wrong.

    I suspect form a methodology point of view it may require (amongst other things) a bit of thinking with respect to the grading of 'deformity'. I guess as long as you could show reliability and validity of the measurements then maybe you'd have a goer.

  8. No still nothing,

    All info on tailpes and cerebral palsy patients.

    It seems to me that this sagittal plane postion will have a huge bearing on loads of the plantarfascia and posterior muscle groups. Which may not be considered enough by the profession and as you can tell me with all my questions.

    The patient I assessed had a flexiable pes cavoid foot type ie large FF valgus and planatflexed 1st ray and even more forefoot equinus than the pictures.

    I was able to dorsiflex the forefoot on the rearfoot with some force, but during gait the minium dorsiflexion of the ankle and pull on the plantarfascia is much greater than normal.

    so this patient will most likely require heel lifts combined with orthotics, stretching, massage.

    but is the deformity a developed or genetic in this flexiable pes cavoid footype ?

    so is mobilisation important and a slow reduction in the height of the heel lift ?

    Hope someone can help or send me an article which will answer my questions.

    Michael Weber
  9. Ive just found some notes that K Kirby put about the Midtarsal joint explaining some of Nesters and His thoughts on the midtarsal joint motion explains a few of my questions will go and read again, get my head around the MTJ a bit more.

    But I still think there a study in there Might look into it Ian thanks for your time and if anyone can add to my reading please feel free.

    Thanks Michael Weber
  10. LHM

    LHM Member

    Hi Michael
    I have had similar difficulty obtaining literature om forefoot equinus. Having been told I have bilateral forefoot equinus (by a university lecturer many moons ago, have no recollection of how he came to the conclusion, but my feet are the same shape as those pictured by Ian), I can share some of my experience with you, however it is quite subjective as I have great difficulty assessing myself!
    A good place to start with literature may be with idiopathic/habitual toe walker (afraid I have no titles to hand), although this tends to be paediatric based.

    I can attain heel contact, with notable forefoot abduction and navicular drop. If I walk with heel contact for long periods I do get plantar heel pain. I wonder if the action of calcaneal plantarflexion may cause problems due to the bony alignment in the foot.
    I do have forefoot supinatus. As Ian mentions, barefoot lunge test is impossible with my toe to the wall.

    As a distance runner I find my worst symptoms are extensor tendon overuse anterior ankle with running up hill, I believe due to their mechanical disadvantage against my tight Gastroc and soleus.
    I am a forefoot striker when I run and strike with 5th MPJts. I am prone to more injuries when I run at a slower pace and think I would be a fab sprinter if God had blessed my legs with a few more inches! My centre of pressure tracks laterally with running, much more so than walking, however visually my colleagues think my feet grossly pronate.
    I tip toe walk a lot when I'm tired.

    From an orthotic point of view, I blister like a trooper around 1st MPJt and any medially supportive devices I have tried cause problems.
    I find a long, cushioning heel raise bliss and for running prefer a low density eva laterally posted platform under my mets and MPJts.
    I have not found the holy grail of running shoe yet, but am surprisingly comfortable in a platform shoe!! I find the dorsal prominence of my midfoot can niggle a bit with laces.

    I do have excellent balance standing on one foot, I think, due to my hard working ankles, but surfing is difficult as I land on the board on my toes, which has a spring board effect!!!

    I know if I stretch my posterior muscle groups and work on core stability my heel contact time does improve and other symptoms reduce, but heel pain increases.

    I don't think I've ever had a comprehensive assessment (but as I have a tendancy to be non compliant with treatment I feel I shouldn't waste my colleagues precious time!)

    Having been on Boot Camp this year, I feel I have been enlightened why my orthoses seem to help, by increasing heel contact time (using 6mm poron) and moving my propulsion to the transverse MTJt axis.

    I'm not a regular poster, so I hope you can follow my highly unscientific anecdotal evidence!
    My husband says I have Devil's feet!

  11. Craig Payne

    Craig Payne Moderator

    I have a whole book on Forefoot equinus written by an orthotist. It took me a long time to get hold of. I forgot the title (will try and look for it tomorrow). It alleges that a forefoot equinus is the root of all evil that can go wrong with the foot. I have read it several times and did not get it. This thread has inspired me to dig it out and read it again....will report back.
  12. thanks for your response everyone

    It does seems a bit a forgotten area, especially when considering different gait patterns associated with the foot type and the effect of this foot type on direction of force, joint movement, when muscles are required to work, the mechanic changes with occur, load levels etc.

    Looking forward to your report back Graig

    Michael Weber

    Michael Weber
  13. Stanley

    Stanley Well-Known Member


    A bigger factor for the need for the heel lift is the relatively long femur. You do have a large enough tibial angle, but it is not enough to move the center of mass forward enough with the long femur bringing it so far posteriorly.


  14. Griff

    Griff Moderator


    I'm not sure I follow you - what difference does femoral length make to an increased dorsiflexion stiffness or lack of sagittal range at the TCJ?


    Last edited: Jul 2, 2009
  15. CraigT

    CraigT Well-Known Member

    I have never heard of this as a 'deformity' before... could you also say short tibia? well... then also fibula I guess... am I understanding this correctly?
    So therefore you are saying that the heel lift balances this?

    From my experience the FF equinus also can be managed well if you ensure that an orthotic has maximum support and contour though the cuboid region. I have always looked at this as decreasing the length of the pronatory lever arm that is created by early 5th MTPJ contact. (In conjunction with a lift.)
  16. Craig Payne

    Craig Payne Moderator

    I dug the book out and spent a bit of time relooking at it ... I still don't get it.

    The book is:
    Control of the Foot/Ankle Complex: Orthotic Recommendations. John Glancy. 2000

    Its all about FFD - functional forefoot drop and how this causes everything.
  17. craig wrote


    Looks like to the research lab after summer for me.

    Im also a bit confused by what stanley wrote as well.

    They was I was looking at it is the level of deformity will effect the load on the soft tissue. ie the more of a deformity the longer the posterior muscle and plantarfascia must be to allow better function

    not sure the length of bone plays anyroll in this...

    Michael Weber
    Last edited: Jul 2, 2009
  18. Stanley

    Stanley Well-Known Member

    Hi Ian,

    Sorry about not making myself clear enough. If the ankle is maximally dorsiflexed in stance, the superior part of the tibia will usually be anterior to the ankle. The femur will protrude backwards. Where the hip ends up will determine where the trunk is. Therefore the longer the femur, the more posterior the center of mass will be in a knee bend. I have attached a crude drawing to help understand this.
    To compensate, the back has to flex more, or a heel lift has to be applied.
    By the way, I didn't learn this in school, rather in the gym. If you are familiar with weightlifting, compare the pictures of Rigert vs. Vardanian in the bottom of the snatch, and you will see what I mean.

    I hope this serves to unconfuse you.



    Attached Files:

  19. Petcu Daniel

    Petcu Daniel Active Member

    I've found this: John Glancy, Orthotic Control of Ground Reaction Forces During Running (A Preliminary Report): http://www.oandplibrary.org/op/1984_03_012.asp

    Maybe of any help (at least from historical point of view!)

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