Diabetic foot is among the most common complications of patients with diabetes. One of the known causes of foot ulceration is ankle equinus, which increases the pressure on the plantar surface during ambulation. Conversely, equinus contracture can be caused by a complicated wound, and it may be due to prolonged immobilization. In this paper, we reviewed the pathogenesis of both conditions and their clinical considerations. Poor glycemic control in patients with diabetes may result in angiopathy and neuropathy as an underlying condition. An ulcer can be precipitated by an injury, improper foot care, or increased biomechanical loading as seen in elevated plantar pressure following equinus contracture. Equinus contracture may be a direct effect of hyperglycemia or can arise in combination with another pathway, for example, involving the activation of transforming growth factor β. Static positioning resulting from any prior foot wound may develop fibrotic changes leading to contracture. Wound healing promoting factors can also result in overhealing outcomes such as hypertrophic scarring and fibrosis. The body’s repair mechanism during the healing cascade activates repair cells and myofibroblasts, which also serve as the main producers and organizers of the extracellular matrix. Considering this intricate pathogenesis, appropriate interventions are essential for breaking the vicious cycle that may disturb wound healing.

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Introduction Swelling is a common complication following a foot and ankle surgery, and is one of the most prevalent complaints that patients present at the clinics. While it affects patients’ satisfaction, the relevance between the swelling and clinical outcome remains unclear. Material and Methods This study assessed volume of foot and ankle swelling in 112 patients with history of ankle fusion, the patients’ Foot Function Index (FFI) score, and patients’ satisfaction. The relationships between swelling volume and early outcomes were analysed with Pearson’s correlation coefficient and a scatter plot. Results The mean of swelling volume increase was 120.0 ± 96.2 ml (range 5 ~ 400 ml); pre-operative FFI score mean was 73.7 ± 4.8 % (range 68 % ~ 81 %), 3 months post-operative FFI score mean was 32.8 ± 5.0 % (range 22 % ~ 56 %) and satisfaction scale’s median was 1 (satisfied). In the correlation analysis, while the meaningful Pearson’s correlation coefficient was found with satisfaction scale, swelling volume showed a weak correlation of Pearson’s correlation test with FFI scores (R value = 0.190; p value = 0.045). Conclusions This study revealed that the swelling of the foot and ankle following ankle fusion surgery are not associated with functional clinical outcome. However, because it affects the patients’ satisfaction, we emphasize the need to identify the problem and management of the swelling, while assuring them that the swelling does not correlate with the early functional outcome.

Running had been known producing a posterior muscle tightness in lower extremity, particularly calf muscles, resulting in a relative equinus deformity. Numerous study reported the association between equinus deformity and foot pain, partially due to the increased plantar pressure of forefoot. This study was directed to find a relation between running intensity and increased forefoot plantar pressure. Subjects were divided into two groups according to running intensity as classified as runner or non-runner. Forefoot plantar pressures data were obtained using a foot imprinter and analyzed into numerical values. Ankle maximum dorsiflexion was also examined in an extended knee to detect the calf tightness. Mean forefoot plantar pressure value was Grau 2.89 (range 2-4) in runner group, and Grau 2.15 (range 1-4) in non-runner group (p=0.004). Ankle maximum dorsiflexion was also limited in runner group (16.05±1.98⁰) compared with 19.30±1.38⁰ in non-runner group (p<0.001). There was an association found between running intensity and plantar pressure elevation. Considering the potential damaging effects to the foot, it is recommended for runners or treating physician to look into this problem as well as to make sure that regular calf stretching is advocated.

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