Is it possible to cure foot drop, equinus foot deformity, and ankle joint stiffness due to the tightening of the Achilles tendon without surgery?

Question

Hello doctor,

I had a fall from a four-storeyed building two years ago and had an injury of the common peroneal nerve causing denervation. My ankle was fractured and kept in a plaster cast for one month. After removing the plaster, I was diagnosed with foot drop and stiffness in my ankle joint due to the tightening of the Achilles tendon. Currently, my muscle power grade is 3/5, and I am under galvanic stimulation. In addition, I have persistent equinus foot deformity due to the tightening of the Achilles tendon. So I could not attain a full range of motion. What can I do to avoid surgery?

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Good to see that you are recovering from the CPN (common peroneal nerve) injury, but the Achilles tendon tightness needs to be assessed to rule out soleus and gastrocnemius muscle contracture. Either way, you are not likely to succeed without surgery. You can try corrective casts with forced dorsiflexion, but this will be an uncomfortable and prolonged process and affect your galvanic stimulation.

Thank you.

Answer 2

Hello.

Welcome back to icliniq.com.

Yes, the assessment is important to deal with the contracture, as gastrocnemius contracture is a much more minor procedure and easily made. The assessment is done by the silfverskiold test.

Thank you.

Answer 3

Hello,

Welcome back to icliniq.com.

The nerve recovery usually takes two years, progressing 1 mm per day from the injury site, and the further the distance from the injury, the longer the recovery period. Muscles have innervation proximally, so they recover faster than skin. You already have two years of recovery, so the recovery you expect is from muscle hypertrophy and depends on the recruitment and exercise hypertrophy principle. Still, all muscle fibers are never recruited or recovered. Therefore, power will always be less than the opposite side.

1. What is the heel-to-ground distance indicative of equines with the knee kept straight?

2. How are you judging the improvement, any goniometric measurements?

3. Have you seen any orthopedic surgeon confirm that you only have tendon Achilles tightness and not gastrocnemius alone?

Thank you.

Answer 4

Hello,

Welcome back to icliniq.com.

Then you need night splints, and it will take some time to see the improvement objectively with replicable measurements. If you are improving, continue the treatment; otherwise, surgical lengthening is the only clear option.

I hope I was helpful to you.

Thank you.