Calf Tightness (Ankle Equinus)

Ankle equinus, commonly known as calf tightness, is characterised by limited flexibility in the ankle joint, particularly when trying to move the foot and toes upwards towards the shins. The term "equinus" actually originates from the Latin word for "horse," as affected individuals may exhibit a walking pattern similar to a horse as they don’t have a sufficient range of motion in the ankle. Ankle equinus is a relatively common condition that can affect people of all ages, from children to the elderly.

The primary symptom of ankle equinus is a restricted range of motion when trying to point the ankle upwards, which can make everyday activities like walking, running, or squatting difficult. Other effects of ankle equinus include:

• Gait (walking) abnormalities: due to the limited ankle movement, people with ankle equinus often develop an altered gait pattern. They may walk with a shortened stride or try to compensate by lifting the foot higher from the hip to avoid trying to lift the foot up at the ankle.

• Heel lift: when attempting to stand or walk, individuals with ankle equinus might involuntarily lift their heels off the ground early in the walking cycle. This can lead to increased pressure on the forefoot for longer periods, which can contribute to a range of other pains and problems.

• Foot problems: the altered foot position resulting from calf tightness can lead to various foot-related issues, such as plantar fasciitis (inflammation of the tissue on the bottom of the foot), metatarsalgia (pain in the ball of the foot), the development of bunions and more.

• Balance and stability issues: reduced movement at the ankle can also affect a person’s balance and stability, increasing the risk of falls, especially on uneven surfaces or during certain activities.

• Achilles tendon pain: having an ankle equinus can contribute to the strain and overuse of the Achilles tendon, potentially leading to conditions like Achilles tendinitis or tendinopathy.

• Difficulty with activities: activities that require significant ankle movement, such as climbing stairs, squatting, or running, may become challenging due to the limited movement at the ankle.

• ‍Muscle imbalances: calf tightness can lead to muscle imbalances in the lower leg and foot, potentially affecting overall lower limb function.

Ankle equinus can result from several factors, with the most common being from tight calf muscles. Tight calf muscles, specifically the gastrocnemius and soleus muscles, which are located at the back of the lower leg and are responsible for pointing the foot downward (called plantarflexion) and pushing the body forward during walking or running. When these muscles become excessively tight, they can restrict the ankles ability to freely and easily point the toes upwards, leading to the condition known as ankle equinus.

The reason behind this muscle tightness can be congenital (present at birth), an inherited trait, or arise from circumstances like having their foot and ankle in a cast or regularly wearing high-heeled shoes.

Other causes of ankle equinus include structural abnormalities, where anatomical variations like bone spurs or joint contractures, limit ankle mobility. Neurological conditions can also contribute to an ankle equinus, such as nerve injuries or neuromuscular disorders that lead to muscle weakness, leaving a person without sufficient strength and function to point their toes upwards.

If you’re experiencing calf muscle tightness, there are several home remedies you can try that focus on stretching and strengthening the calf muscles to increase flexibility and help restore normal ankle movement. It’s important to note that these are most effective for mild cases of ankle equinus caused by calf muscle tightness, and it’s always important to seek professional help from your podiatrist to help resolve the issue. You can try:

• Calf stretches: regular stretching of the calf muscles is crucial for supporting and improving flexibility. Some effective calf stretches include:
• Wall stretch: stand facing a wall, with one foot forward and the other foot back. Keep the back leg straight, press the heel into the floor, and lean forward gently to feel the stretch in the calf. Hold for 20-30 seconds and switch legs.
• Runner's stretch: assume a lunge position with one leg forward and the other leg back. Keep the back leg straight and press the heel into the floor. Bend the front knee slightly and lean forward to stretch the calf. Hold for 20-30 seconds and switch legs.
• Achilles tendon stretch: stretching the Achilles tendon can also help with calf tightness. Stand facing a wall, place both hands on the wall at shoulder height, and step one foot back while keeping it straight. Press the heel into the floor and lean forward to feel the stretch in the Achilles tendon and calf. Hold for 20-30 seconds and switch legs.
• Calf foam rolling: using a foam roller on the calves can help release tension and tightness in the muscles. Sit on the floor with your legs extended, and place the foam roller under your calves. Roll back and forth slowly, focusing on any areas of tightness or discomfort.
• Heat and ice: applying heat pads or warm towels to the calves before stretching can help relax the muscles. After stretching or any physical activity, applying ice packs to the calves can reduce inflammation and soreness.‍
• Good footwear: wearing supportive footwear with good qualities can help maintain proper foot and ankle alignment, reducing strain on the calf muscles.

Here at Matt Raden Podiatry, our trusted and experienced podiatrists listen to the concerns, goals and needs of our patients with ankle equinus, and utilise a range of evidence-based treatment methods to help you get the best outcome. Our goal is not only to make you comfortable now, but to understand the root of your foot and ankle problems so you can stay active and do the things you love without being held back by foot pain.

Every appointment starts with a comprehensive assessment to uncover the causes of your ankle equinus restrictions and the impact it is having on your gait, which includes analysing your gait, testing for muscle imbalances, assessing your joints, analysing your foot posture and alignment, and more. We’ll then create a tailored treatment plan based on your unique results that addresses the cause of your equinus. This may include:

• Orthotics (insoles): our podiatrists can prescribe custom foot orthotics that will work to add the right support to the foot and ankle, including around the heel, to best support an ankle with equinus. We’ll also create your orthotics in a way that accommodates the compensations (and any painful effects) that have resulted from the equinus, helping to optimise your gait and everyday function. 
• Heel lifts: to help you get some much-needed relief from any pain associated with your equinus, we may use a 4mm or 6mm heel lift inside your shoes to give your heel a stable platform and reduce pressure through the ankle, Achilles tendon and posterior leg muscles.
• Strengthening and stretching program: these will target not only the gastroc and soleus muscles, but also any muscle imbalances through the feet and legs to help restore and optimise your gait.
• Footwear recommendations: in some cases, your existing footwear may be leaving your feet in an unsupported position that may be further complicating your gait when you have calf tightness. If that’s the case, we can recommend other footwear, both casual and sports-specific, that will best support your feet and ankles as well as your general comfort and foot health.
• Night splints: in severe cases, night splints may be recommended to help reduce the severity of ankle equinus. We most often see this in children who have predisposing factors that mean that more conservative measures are less likely to be effective.

In very few cases, where a conservative approach to managing ankle equinus has failed and it is having a significant impact on your mobility and quality of life, we may refer you to an orthopaedic surgeon to discuss the possibility of ankle surgery. This may involve lengthening the Achilles tendon, reconstructing the ankle, repairing damaged structures or treating a tarsal coalition, if that is the cause of the equinus. Ankle surgery is always a serious procedure and should generally only be attempted where first-line measures have failed or your condition is further complicated by other factors.