Treatment of Equinus in

Equinus foot (pes equinus) is a deformity in which the foot stays in permanent plantar flexion, and the child cannot fully place the heel on the floor. ICD-10 lists it under Q66.8 (other congenital foot deformities), but it is also common as an acquired form against a background of spasticity in CP. It is one of the most frequent associated deformities in cerebral palsy — present in more than 50% of children with the diplegic form. In Huizhou we distinguish three variants. First — isolated idiopathic equinus (toe walking) in a child without neurological disorders: here the modified Ponseti protocol works — a series of bandages to gradually move the foot to neutral at 5–7 day intervals, with a possible minimally invasive percutaneous Achilles tenotomy. Second — equinus on a background of CP spasticity: here parallel work with a neuro-rehabilitation specialist on the core program is mandatory, while locally we apply biomechanical insoles with a heel lift, nighttime orthoses to hold the foot in neutral, medical massage, and physiotherapy. Third — fixed severe forms in older children: here surgical Achilles tendon lengthening at a specialized clinic is discussed, after which the child returns to us for a recovery program. The combined expertise of the Yuncheng Orthopedic Research Institute (Assoc. Prof. Liu Hejian) and the Huizhou neuro-rehabilitation team allows us to work with equinus at any level — from isolated toe walking to a severe form in tetraplegia. Early presentation and a systematic approach nearly always produce a functional result: the child places the heel down, walks without the characteristic abnormal gait, and can run.