{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T17:33:59Z","timestamp":1791048839864,"version":"4.1.0"},"reference-count":41,"publisher":"MDPI AG","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAPMA"],"published-print":{"date-parts":[[2010,5]]},"abstract":"<jats:p>Equinus is characterized by reduced dorsiflexion of the ankle joint, but there is a lack of consensus regarding criteria for definition and diagnosis. This review examines the literature relating to the definition, assessment, diagnosis, prevalence, and complications of equinus. Articles on equinus and assessment of ankle joint range of motion were identified by searching the EMBASE, Medline, PubMed, EBSCOhost, Cinahl, and Cochrane databases and by examining the reference lists of the articles found. There is inconsistency regarding the magnitude of reduction in dorsiflexion required to constitute a diagnosis of equinus and no standard method for assessment; hence, the prevalence of equinus is unknown. Goniometric assessment of ankle joint range of motion was shown to be unreliable, whereas purpose-built tools demonstrated good reliability. Reduced dorsiflexion is associated with alterations in gait, increased forefoot pressure, and ankle injury, the magnitude of reduction in range of motion required to predispose to foot or lower-limb abnormalities is not known. In the absence of definitive data, we propose a two-stage definition of equinus: the first stage would reflect dorsiflexion of less than 10\u00b0 with minor compensation and a minor increase in forefoot pressure, and the second stage would reflect dorsiflexion of less than 5\u00b0 with major compensation and a major increase in forefoot pressure. This proposed definition of equinus will assist with standardizing the diagnosis and will provide a basis for future studies of the prevalence, causes, and complications of this condition. (J Am Podiatr Med Assoc 100(3): 195\u2013203, 2010)<\/jats:p>","DOI":"10.7547\/1000195","type":"journal-article","created":{"date-parts":[[2014,4,1]],"date-time":"2014-04-01T09:53:54Z","timestamp":1396346034000},"page":"195-203","source":"Crossref","is-referenced-by-count":37,"title":["Static Ankle Joint Equinus"],"prefix":"10.3390","volume":"100","author":[{"given":"James","family":"Charles","sequence":"first","affiliation":[{"name":"School of Health Sciences, University of South Australia, Adelaide, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheila D.","family":"Scutter","sequence":"additional","affiliation":[{"name":"School of Health Sciences, University of South Australia, Adelaide, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Buckley","sequence":"additional","affiliation":[{"name":"School of Health Sciences, University of South Australia, Adelaide, Australia."},{"name":"Nutritional Physiology Research Centre and Australian Technology Network Centre for Metabolic Fitness, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","reference":[{"key":"R1","series-title":"J Biomech","first-page":"726","volume":"39","year":"2006","unstructured":"Mattingly B, Talwalkar V, Tylkowski C, et al: Three-dimensional in vivo motion of adult hind foot bones. .J Biomech39::726. ,2006. .16439242"},{"key":"R2","series-title":"J Bone Joint Surg Br","first-page":"94","volume":"71","year":"1989","unstructured":"Lundberg A, Svensson OK, Nemeth G, et al: The axis of rotation of the ankle joint. .J Bone Joint Surg Br71::94. ,1989. .2915016"},{"key":"R3","series-title":"J Biomech","first-page":"585","volume":"32","year":"1999","unstructured":"Leardini A, O\u2019Connor JJ, Catani F, et al: A geometric model of the human ankle joint. .J Biomech32::585. ,1999. .10332622"},{"key":"R4","series-title":"J Biomech","first-page":"111","volume":"32","year":"1999","unstructured":"Leardini A, O\u2019Connor JJ, Catani F, et al: Kinematics of the human ankle complex in passive flexion: a single degree of freedom system. .J Biomech32::111. ,1999. .10052915"},{"key":"R5","series-title":"J Rehabil Res Dev","first-page":"335","volume":"38","year":"2001","unstructured":"Digiovanni C, Holt S, Czerniecki J, et al: Can the presence of equinus contracture be established by physical exam alone. .J Rehabil Res Dev38::335. ,2001. .11440265"},{"key":"R6","series-title":"JAPMA","first-page":"17","volume":"87","year":"1997","unstructured":"Sobel E, Caselli MA, Velez Z: Effect of persistent toe walking on ankle equinus: analysis of 60 idiopathic toe walkers. .JAPMA87::17. ,1997. ."},{"key":"R7","series-title":"J Bone Joint Surg Br","first-page":"65","volume":"88","year":"2006","unstructured":"Orendurff MS, Rohr ES, Sangeorzan BJ, et al: An equinus deformity of the ankle accounts for only a small amount of the increased forefoot plantar pressure in patients with diabetes. .J Bone Joint Surg Br88::65. ,2006. .16365123"},{"key":"R8","series-title":"J Bone Joint Surg Am","first-page":"962","volume":"84","year":"2002","unstructured":"DiGiovanni CW, Kuo R, Tejwani N, et al: Isolated gastrocnemius tightness. .J Bone Joint Surg Am84::962. ,2002. .12063330"},{"key":"R9","series-title":"Arch Phys Med Rehabil","first-page":"7","volume":"84","year":"2003","unstructured":"Perry J, Burnfield JM, Gronley JK, et al: Toe walking: muscular demands at the ankle and knee. .Arch Phys Med Rehabil84::7. ,2003. .12589614"},{"key":"R10","year":"1977","unstructured":"Root M, Orien W, Weed J: Normal and Abnormal Function of the Foot, Clinical Biomechanical Corp, Los Angeles. ,1977. ."},{"key":"R11","series-title":"Foot Ankle Int","first-page":"202","volume":"27","year":"2006","unstructured":"Meyer DC, Werner CM, Wyss T, et al: A mechanical equinometer to measure the range of motion of the ankle joint: interobserver and intraobserver reliability. .Foot Ankle Int27::202. ,2006. .16539903"},{"key":"R12","series-title":"Br J Sports Med","first-page":"36","volume":"38","year":"2004","unstructured":"Woods C, Hawkins RD, Maltby S, et al: The Football Association Medical Research Programme: an audit of injuries in professional football: analysis of hamstring injuries. .Br J Sports Med38::36. ,2004. .14751943"},{"key":"R13","series-title":"Physiotherapy","first-page":"94","volume":"91","year":"2005","unstructured":"Jaberzadeh S, Scutter S, Nazeran H: Mechanosensitivity of the median nerve and mechanically produced motor responses during Upper Limb Neurodynamic Test 1. .Physiotherapy91::94. ,2005. ."},{"key":"R14","series-title":"JAPMA","first-page":"564","volume":"95","year":"2005","unstructured":"Martin RL, McPoil TG: Reliability of ankle goniometric measurements: a literature review. .JAPMA95::564. ,2005. ."},{"key":"R15","series-title":"J Bone Joint Surg Br","first-page":"696","volume":"7","year":"1989","unstructured":"Backer K: Passive ankle mobility: clinical measures compared with radiography. .J Bone Joint Surg Br7::696. ,1989. ."},{"key":"R16","series-title":"JAPMA","first-page":"418","volume":"96","year":"2006","unstructured":"Evans AM, Scutter SD: Sagittal plane range of motion of the pediatric ankle joint: a reliability study. .JAPMA96::418. ,2006. ."},{"key":"R17","series-title":"Physiother Can","first-page":"300","volume":"40","year":"1988","unstructured":"Chesworth BM, Vandervoort AA: Reliability of a torque motor system for measurement of passive ankle joint stiffness in control subjects. .Physiother Can40::300. ,1988. ."},{"key":"R18","series-title":"Aust J Physiother","first-page":"175","volume":"37","year":"1991","unstructured":"Moseley A: Measurement of passive ankle dorsiflexion: procedure and reliability. .Aust J Physiother37::175. ,1991. .25026482"},{"key":"R19","series-title":"J Biomech","first-page":"69","volume":"26","year":"1993","unstructured":"Allinger TL, Engsberg JR: A method to determine the range of motion of the ankle joint complex, in vivo. .J Biomech26::69. ,1993. .8423170"},{"key":"R20","series-title":"Phys Ther","first-page":"1047","volume":"74","year":"1994","unstructured":"Mayhew TP, Rothstein JM, Finucane SD, et al: Performance characteristics of the Kin-Com dynamometer. .Phys Ther74::1047. ,1994. .7972366"},{"key":"R21","series-title":"Arch Phys Med Rehabil","first-page":"1340","volume":"81","year":"2000","unstructured":"Harvey LA, Batty J, Crosbie J, et al: A randomized trial assessing the effects of 4 weeks of daily stretching on ankle mobility in patients with spinal cord injuries. .Arch Phys Med Rehabil81::1340. ,2000. .11030499"},{"key":"R22","series-title":"Clin Biomech","first-page":"514","volume":"16","year":"2001","unstructured":"Moseley AM, Crosbie J, Adams R: Normative data for passive ankle plantarflexion-dorsiflexion flexibility. .Clin Biomech16::514. ,2001. ."},{"key":"R23","series-title":"J Rehabil Res Dev","first-page":"471","volume":"38","year":"2001","unstructured":"Weaver K, Price R, Czerniecki J, et al: Design and validation of an instrument package designed to increase the reliability of ankle range of motion measurements. .J Rehabil Res Dev38::471. ,2001. .11732825"},{"key":"R24","series-title":"Spinal Cord","first-page":"559","volume":"41","year":"2003","unstructured":"Harvey L, Byak A, Ostrovskaya M, et al: Reliability of a device designed to measure ankle mobility. .Spinal Cord41::559. ,2003. .14504613"},{"key":"R25","series-title":"JAPMA","first-page":"573","volume":"94","year":"2004","unstructured":"Scharfbillig R, Scutter SD: Measurement of foot dorsiflexion: a modified Lidcombe template. .JAPMA94::573. ,2004. ."},{"key":"R26","series-title":"Gait Posture","first-page":"295","volume":"24","year":"2006","unstructured":"Rao S, Saltzman C, Yack HJ: Ankle ROM and stiffness measured at rest and during gait in individuals with and without diabetic sensory neuropathy. .Gait Posture24::295. ,2006. .16293415"},{"key":"R27","series-title":"Foot Ankle Clin North Am","first-page":"363","volume":"12","year":"2007","unstructured":"DiGiovanni CW, Langer P: The role of isolated gastrocnemius and combined Achilles contractures in the flatfoot. .Foot Ankle Clin North Am12::363. ,2007. ."},{"key":"R28","series-title":"JAPMA","first-page":"479","volume":"92","year":"2002","unstructured":"Lavery LA, Armstrong DG, Boulton AJ: Ankle equinus deformity and its relationship to high plantar pressure in a large population with diabetes mellitus. .JAPMA92::479. ,2002. ."},{"key":"R29","series-title":"Foot Ankle","first-page":"215","volume":"14","year":"1993","unstructured":"Grimston SK, Nigg BM, Hanley DA: Differences in ankle joint complex range of motion as a function of age. .Foot Ankle14::215. ,1993. .8359768"},{"key":"R30","series-title":"Phys Ther","first-page":"827","volume":"79","year":"1999","unstructured":"Gajdosik RL, Vander Linden DW, Williams AK: Influence of age on length and passive elastic stiffness characteristics of the calf muscle-tendon unit of women. .Phys Ther79::827. ,1999. .10479783"},{"key":"R31","series-title":"Exp Gerontol","first-page":"317","volume":"43","year":"2008","unstructured":"Kim J, Kwak H, Leeuwenburgh C, et al: Lifelong exercise and mild (8%) caloric restriction attenuate age-induced alterations in plantaris muscle morphology, oxidative stress and IGF-1 in the Fischer-344 rat. .Exp Gerontol43::317. ,2008. .18313875"},{"key":"R32","series-title":"Metabolism","first-page":"1465","volume":"57","year":"2008","unstructured":"Muellenbach EA, Diehl CJ, Teachey MK, et al: Interactions of the advanced glycation end product inhibitor pyridoxamine and the antioxidant \u03b1-lipoic acid on insulin resistance in the obese Zucker rat. .Metabolism57::1465. ,2008. .18803954"},{"key":"R33","series-title":"Recent Prog Horm Res","first-page":"1","volume":"56","year":"2001","unstructured":"Ulrich P, Cerami A: Protein glycation, diabetes, and aging. .Recent Prog Horm Res56::1. ,2001. .11237208"},{"key":"R34","series-title":"J Foot Ankle Surg","first-page":"272","volume":"36","year":"1997","unstructured":"Grant WP, Sullivan R, Sonenshine DE, et al: Electron microscopic investigation of the effects of diabetes mellitus on the Achilles tendon. .J Foot Ankle Surg36::272. ,1997. .9298442"},{"key":"R35","series-title":"Clin Biomech","first-page":"532","volume":"20","year":"2005","unstructured":"Giacomozzi C, D\u2019Ambrogi E, Uccioli L, et al: Does the thickening of Achilles tendon and plantar fascia contribute to the alteration of diabetic foot loading?. Clin Biomech20::532. ,2005. ."},{"key":"R36","series-title":"Diabet Med","first-page":"125","volume":"16","year":"1999","unstructured":"Duffin A, Donaghue K, Potter M, et al: Limited joint mobility in the hands and feet of adolescents with Type 1 diabetes mellitus. .Diabet Med16::125. ,1999. .10229305"},{"key":"R37","series-title":"J Diabetes Complications","first-page":"352","volume":"18","year":"2004","unstructured":"Komatsu W, Gabbay M, Dib S: Early subclinical limited axial and large joint flexibility in type 1 diabetes mellitus adolescents. .J Diabetes Complications18::352. ,2004. .15531185"},{"key":"R38","series-title":"Phys Ther","first-page":"352","volume":"80","year":"2000","unstructured":"Salsich GB, Mueller MJ, Sahrmann SA: Passive ankle stiffness in subjects with diabetes and peripheral neuropathy versus an age-matched comparison group. .Phys Ther80::352. ,2000. .10758520"},{"key":"R39","series-title":"JAPMA","first-page":"280","volume":"91","year":"2001","unstructured":"McPoil TG, Yamada W, Smith W, et al: The distribution of plantar pressures in American Indians with diabetes mellitus. .JAPMA91::280. ,2001. ."},{"key":"R40","series-title":"Cochrane Database Syst Rev","first-page":"CD007343","volume":"3","year":"2008","unstructured":"Kelly B, MacKay-Lyons M, Ruggles T, et al: Botulinum toxin type A and serial casting versus botulinum toxin type A or serial casting in treating equinus gait of children with cerebral palsy. .Cochrane Database Syst Rev3::CD007343. ,2008. ."},{"key":"R41","series-title":"Br J Sports Med","first-page":"824","volume":"40","year":"2006","unstructured":"De Noronha M, Refshauge KM, Herbert RD, et al: Do voluntary strength, proprioception, range of motion, or postural sway predict occurrence of lateral ankle sprain?. Br J Sports Med40::824. ,2006. .16920769"}],"container-title":["Journal of the American Podiatric Medical Association"],"original-title":[],"link":[{"URL":"https:\/\/japmaonline.org\/view\/journals\/apms\/100\/3\/1000195.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/meridian.allenpress.com\/japma\/article-pdf\/100\/3\/195\/1404230\/1000195.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/japmaonline.org\/downloadpdf\/journals\/apms\/100\/3\/1000195.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/japmaonline.org\/downloadpdf\/journals\/apms\/100\/3\/1000195.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T10:11:49Z","timestamp":1783505509000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1930-8264\/100\/3\/195"}},"subtitle":["Toward a Standard Definition and Diagnosis"],"short-title":[],"issued":{"date-parts":[[2010,5]]},"references-count":41,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.7547\/1000195","relation":{},"ISSN":["8750-7315","1930-8264"],"issn-type":[{"value":"8750-7315","type":"print"},{"value":"1930-8264","type":"electronic"}],"subject":[],"published":{"date-parts":[[2010,5]]}}}