Can the presence of equinus contracture be established by physical exam alone?

The condition in which ankle dorsiflexion is restricted is known as equinus contracture (EC). Equinus contracture is purported to be associated with a number of clinical conditions. However, there are no data to support or re fute a clinician's ability to diagnose EC by clinical exam. We prospectivel y evaluated the maximum ankle dorsiflexion with the knee fully extended in 68 people (34 patients with isolated fore- or midfoot pain and 34 asymptoma tic subjects) both by clinical exam and by a custom-designed ankle goniomet er. We compared the likelihood of agreement of the clinical impression (equ inus, no equinus) to the maximum ankle dorsiflexion measured with the instr ument at two different numerical definitions of EC (less than or equal to5 degrees and less than or equal to 10 degrees of maximum dorsiflexion). When all subjects were included and equinus defined as less than or equal to5 d egrees of ankle dorsiflexion, a clinician's ability to detect the equinus w hen it is truly present is 77.8%. If equinus is defined as less than or equ al to 10 degrees, this ability increases to 97.2%. Alternatively, if equinu s is not present, as defined by less than or equal to5 degrees, then a clin ician's ability to correctly diagnose no equinus is 93.8%. If equinus is de fined to less than or equal to 10 degrees, this ability decreases to 68.8%.