Updated: Aug 13, 2018
Stretching exercises are often recommended by healthcare professionals for lower extremity symptoms and pathologies. As people age, their soft tissues (e.g. tendons, ligaments) become less elastic and often tighten. This puts them at increased risk for developing injuries. Routine stretching can help regain flexibility and length back in these structures, as well as help prevent injuries from occurring.
THE ACHILLES TENDON
The calf muscles consist of two separate muscles: the gastrocnemius and the soleus muscle. These two muscles conjoin in the lower leg to become the Achilles tendon, which is the strongest tendon in the body. When there is tightness of these structures, physicians may use the term equinus. Equinus, from a medical standpoint, is defined as a lack in dorsiflexion (or upwards motion) of the foot onto the leg. For normal gait pattern, the ankle joint must bend a certain amount of degrees for normal walking pattern. When there is not adequate motion at the ankle joint, the body tries to compensate, thus potentially causing further problems in the lower extremity both proximally (towards the hips & back) and distally (towards the foot) (1).
BACK & HIP PROBLEMS AS A RESULT
OF TIGHT CALF MUSCLES
Because equinus causes a backwards shift in one’s center of gravity, there is a forward compensation occurs to shift it back to normal. On clinical examination, a physician may notice certain clinical findings such as hip flexion, lumbar lordosis, genu recurvatum, and tightness in the hamstrings. Patients may experience pain in the lower back, hips, and/or knees, along with excessive fatigue (1).
FOOT PROBLEMS AS A RESULT OF
TIGHT CALF MUSCLES
Distally, when there is lack of ankle joint range of motion, the joints in the foot try to make up for this loss of motion, which can cause them to become hypermobile and/or unstable, leading to significant pathologies, including flatfoot deformity and bunions. In patients with diabetes and peripheral neuropathy (aka loss of protective sensation), a Charcot foot with midfoot collapse and plantar foot ulcerations may develop (1,3).
ACHILLES TENDINITIS & TENDINOSIS
Lastly, tightness of the calf muscles, or Achilles tendon, can cause symptoms and pathology within the tendon itself. The pain is commonly felt along the back of the heel bone (known as insertional Achilles tendinitis) or within the tendon just before it inserts into the heel bone (known as noninsertional Achilles tendinitis).
WHAT TO DO NOW? - TREATING EQUINUS
Of note, many of the above conditions are progressive deformities (i.e. flatfoot deformity, bunions, digital deformities), so treating the underlying equinus will not reverse or cure these deformities and they must be attended to directly. For others, such as Achilles tendinitis and plantar fasciitis, stretching is often an important part of the treatment protocol and can also help prevent them from recurring. Timing of the below treatment options is also crucial to recovery, so they should only be started after being cleared by a healthcare professional.
Serial casting &/or AFO bracing – These are more often done in children who are toe walkers to get them to have a more heel-to-toe gait pattern (1,2).
Heel lifts – These are over-the-counter devices that can be placed in your shoes to slightly elevate your heel, which, takes tension off the Achilles tendon. They should only be used temporarily, though, because over time, the Achilles tendon may accommodate to this shortened length, which will cause shortening of the tendon over time.
Night splint – This is a device that is worn on the lower extremity while you sleep. It holds the foot in a position that keeps the plantar fascia and the Achilles tendon out to length and prevents them from shortening while you sleep. This is often helpful for those that get “first steps of the morning” pain along the bottom of the foot (in the arch or the heel), as well as along the back of the heel or lower leg.
Stretching exercises – Click here to view them.
Surgery – This is considered if the patient has failed conservative care for at least 6 months. Treatment options vary depending on several factors, including the age of the patient and the underlying cause of the tight calf muscles (neurological, muscular, osseous) (1).
DISCLAIMER: The above information is meant for educational purposes only and should not be construed as medical advice. Should you have questions or concerns related to your health, please contact the doctor or your own healthcare professional.
1. Banks, AS, Downey, MS, Martin, DE, Miller, SJ. 2001. McGlamry’s Comprehensive Textbook of Foot and Ankle Surgery Edition 3. Lippincott Williams & Wilkins.
2. Dietz, F., & Khunsree, S. (2012). Idiopathic toe walking: to treat or not to treat, that is the question. The Iowa orthopaedic journal, 32, 184.
3. Greenhagen, RM, Johnson, AR, Bevilacqua, NJ. Gastrocnemius Recession or Tendo-Achilles Lengthening for Equinus Deformity in the Diabetic Foot? Clin Podiatr Med Surg 2012;29:413–424.