In an attempt to get stability in the treatment of equinus, I have been trying to establish a definition. Previous posts have discussed research regarding the definition numbers. The definition standards would be helpful both in diagnostic evaluation and treatment of equinus.
When it comes to the treatment of equinus, the current non-surgical modalities have been effectual at best. I have invented equipment that I believe is a superior non-surgical treatment for equinus. The design process is based entirely on evidence based medicine and the references are readily available — please contact me if you want to see them.
First, I would like to discuss night splints and why they are ineffective. I have had personal experience using night splints during which I realized their flaws first hand.
I developed Posterial Tibial tendonitis in my right ankle from running; the condition was not improving with orthosis. I did not want to stop running because the activity had helped me lose 40 pounds. I had equinus like many of the population, which was worsening with the running. I started using night splints to help. One night, I woke up at 3:00 am to take the splints off and looked down at my legs. I sleep on my side with my knees bent, like most adults; especially when wearing night splints. I realized the night splints were doing nothing. It is well documented that the Gastrocnemius muscle is the muscle that is tight as it crosses the knee, ankles and subtaler joints. My Gastrocnemius muscles were not being stretched at all; a complete waste of time. Additionally, I was not sleeping well due to the night splints. I was ready to burn them.
The proverbial light bulb went off — I would have to have an above the knee extension to lock the knee in extension.The solution I came up with is the EQ/IQ brace.
The EQ/IQ brace, intelligent management for equinus, does not need to be slept in. I recommend using it 30 minutes in the morning and 30 minutes in the evening with 15 minutes spent stretching the Gastroc-Soleus complex and 15 minutes spent stretching the Soleus.
I will discuss features of the EQ/IQ brace from proximal to distal.
There is an above-the-knee extension with a hinge at the knee. The extension allows the knee to be locked into extension to stretch the Glastrocnemius muscle. The hinge can be released to allow for ease of application and isolated stretching of the Soleus. There is also a hinge at the ankle joint which allows the treating physician to set exactly the amount of dorsiflexion desired based on the patient’s biomechanical exam. I estimate 5 degrees the first month increasing to 10 degrees the second month, then if needed, 15 degrees the third month. The hinge goes from -30 degrees to +30 degrees, in 5 degree increments.
We, as treating podiatrists, will measure everything from X-ray angles to forefoot varus position. Yet, we slap on a night splint and tell our patients, “Pull as tight as you can.” This makes not sense to me. We should have more control and precision over the treatment of equinus.
More about the EQ/IQ
I designed the EQ/IQ brace to be ambulatory with a negative heel rocker sole, which allows ambulation with a fixed dorsiflexed position.
The rocker soles can be removed. Three different sizes (5, 10, and 15 degrees) are included with the brace to match the amount of ankle joint dorsiflexion.
There is an adjustable wedge that goes under the hallux to engage the Windlass Mechanism. These wedges come in 35, 50, and 65 degree sizes and Velcro to the foot bed.
I designed varying degrees for the wedges to allow for patients with hallux limitus or rigidus.
The femoral and tibial uprights are adjustable for leg and should be set by the physician
Foot Bed Sizes:
The standard foot beds will fit a small/medium size. However, the foot bed can be replaced by an extended version that will fit a large/extra large size.
Using the EQ/IQ Brace:
I am recommending time periods for wearing the EQ/IQ based upon recommendations for manual stretching, but doubled. Most manual stretching recommendations have the stretches done about 30 minutes per day. I think an hour a day is reasonable from a compliance stand point compared to 6-8 hours at night while disturbing the patient’s sleep.
The ambulatory component of the brace is an important factor. Patients can wear the brace during ther preparations for the day – after dressing the brace is working while they perform typical morning rituals. A similar scenario would play out for the evening stretching.
How to Get the EQ/IQ Brace:
The EQ/IQ brace is being prepared for production in the next few weeks. Treating professionals such as podiatrists, orthopedic surgeons, chiropractors, physical therapists, athletic trainers may pre-order the brace at an introductory discount of $170.00 per brace plus free shipping. Later the price will increase to $200.00 per brace.
To pre-order or get additional information, contact me at 317-660-2115 or you may use the contact/comment form at the Hoosier Foot and Ankle website, available 24/7 for your convenience.