Why It Is Important To Evaluate Shoe Heel To Toe Drop In Patients With Equinus

The role of equinus in lower extremity pathologies is well documented in the literature. In fact, Foot and Ankle Clinics of North America dedicated its entire December 2014 edition to “The Gastrocnemius.”¹ Much of the literature has been directed to the surgical and non-surgical management of equinus, conditions associated with equinus, and the evaluation of equinus. Little attention has focused on the role of shoe gear on equinus with the exception of the anecdotal literature on high heels.

Recently while lecturing in Ohio, my fellow Podiatry Today DPM Blogger, Nicholas Campitelli, DPM, led a profound discussion on the surgical treatment of equinus. He discussed the role of shoe heel to toe drop in our everyday shoe gear and equinus. Certainly, women’s shoe gear has a higher heel to toe relationship than most men’s shoe gear but even most men’s dress shoes have a significant heel to toe drop. Additionally, the vast majority of running shoes still have heel to toe drops of 12 to 16 mm.

The foot and ankle community’s attention to treating equinus is commonplace, but what about the 12-plus hours a day the patient is wearing a 12 to 16 mm heel to toe drop? This elevation of the heel relative to the forefoot must negatively influence the treatment of equinus. Is time to include patient education about heel to toe drop in shoe gear in the comprehensive management of equinus?

I believe it is an important conversation to have with our patients. For example, when treating a patient with plantar fasciitis non-surgically with gastroc soleus stretching, part of that treatment should include shoe evaluation and education. Consider an 8 mm heel to toe drop shoe a compromise zone for heel to toe shoe drop. This is a good starting point for most equinus patients with an eventual transition to a 4 mm or 0 mm heel to toe drop.

The role of shoe gear in the treatment of equinus is something that we have not appreciated and have undertreated. One must evaluate shoe heel to toe drop in patients with equinus and include it as part of the treatment plan.

Reference

1. Myerson MS, Barouk P. The gastrocnemius. Foot Ankle Clin N Am. 2014; 19(4):603-858.