Ankle Equinus Contracture

An ankle equinus contracture occurs when the ankle cannot bend upward normally because the calf muscles or Achilles tendon are too tight. This makes it hard for the heel to touch the ground when walking. Children with ankle equinus may walk on their toes, have an unusual gait, or feel pain or stiffness in their legs. With early diagnosis and proper treatment, most children can improve ankle motion and walk more comfortably.

What Causes Ankle Equinus Contractures?

Ankle equinus can develop for several reasons, including:

• Tightness in the calf muscles or Achilles tendon
• Habitual toe walking
• Neuromuscular conditions, such as cerebral palsy or muscular dystrophy
• Prolonged immobilization after injury or surgery
• Differences in muscle strength or tone
• Growth spurts that cause the bones to grow faster than the muscles can stretch

In some children, equinus develops without a clear underlying condition. The condition can develop in a single foot (unilateral) or both feet (bilateral).

What Are the Symptoms?

Symptoms of ankle equinus contractures may include:

• Walking on toes or difficulty keeping heels on the ground
• Stiffness or tightness in the calf muscles
• Tripping or balance problems
• Pain in the feet, ankles, or legs with activity
• Difficulty wearing certain shoes
• Limited ankle movement

Some children may compensate by bending their knees or arching their feet when they walk.

When Should My Child See a Specialist?

You should consider seeing a pediatric orthopedic specialist if:

• Your child consistently walks on their toes
• Your child cannot place their heels flat on the ground
• Walking looks stiff or awkward
• Your child complains of leg or foot pain
• Toe walking continues past age 2–3

Early evaluation helps determine whether the condition is flexible or is becoming a fixed contracture.

How Are Ankle Equinus Contractures Diagnosed?

Diagnosis begins with a physical exam to measure ankle motion and assess muscle tightness. The specialist may look at:

• How your child walks
• Range of motion of the ankle
• Muscle strength and balance

Imaging tests are usually not needed but may be ordered if another condition is suspected.

How Are Ankle Equinus Contractures Treated?

Treatment depends on:

• Your child’s age
• Severity of the contracture
• Underlying cause
• How long the problem has been present

Treatment goals focus on:

• Increasing ankle flexibility
• Improving walking pattern
• Preventing long-term foot and leg problems
• Supporting normal development

Nonsurgical Options

Many children improve with nonsurgical treatment, which may include:

• Stretching programs for the calf and Achilles tendon
• Physical therapy to improve flexibility and strength
• Night splints or ankle-foot orthoses (AFOs) to maintain stretch
• Serial casting to gradually lengthen tight tissues
• Activity modification and gait training

These treatments are often very effective, especially when started early.

Surgical Options

Surgery may be considered if nonsurgical treatments do not improve ankle motion or if the contracture is severe. Surgical options may include:

• Lengthening of the Achilles tendon
• Lengthening of the calf muscles

These procedures help restore ankle motion and allow the heel to contact the ground normally.

What Are the Risks of Surgery?

When surgery is needed, potential risks may include:

• Infection
• Overcorrection or undercorrection
• Weakness in the calf muscles
• Need for additional procedures as your child grows

Your child’s surgeon will discuss all risks and expected outcomes in detail.

What Does Recovery From Treatment Involve?

Recovery depends on whether treatment is nonsurgical or surgical. It may include:

• Temporary casting or bracing
• Physical therapy to rebuild strength and motion
• Gradual return to full activities

Parents play an important role in helping children follow stretching and bracing programs.

How Long Does Recovery Take?

With nonsurgical treatment, improvement may be seen over weeks to months.

After surgery, the initial recovery period typically lasts 6–8 weeks, followed by continued therapy and strengthening exercises.

What Is the Outlook for My Child?

The outlook for children with ankle equinus contractures is very good. With early treatment and consistent follow-up, most children regain normal ankle motion and develop a smooth, comfortable walking pattern.