ISAKOS Congress 2021

2021 ISAKOS Biennial Congress Paper


Calcaneal Positioning In Equinus Immobilization Of The Ankle Joint. A Comparison Of Common Orthoses Used In The Treatment Of Acute Achilles Tendon Ruptures

Rasmus Kramer Mikkelsen, MD, København S, Copenhagen DENMARK
Sanja Somodi, MD, Copenhagen DENMARK
Per Hölmich, DMSc, Prof., Copenhagen DENMARK
Kristoffer W. Barfod, MD, PhD, VIRUM DENMARK

Hvidovre Hospital , Copenhagen, DENMARK

FDA Status Cleared


The aim of the study was to four different orthoses ability to place the foot in equinus using true lateral radiographs.



Orthoses are an important part of both conservative and operative treatment of acute Achilles tendon rupture as they can be used to position the foot in equinus and protect the torn tendon from strain in the healing phase.
The aim of the study was to test four different orthoses ability to position the foot in equinus.


The study was performed as a cross-sectional study. 15 healthy study participants underwent radiographic examination with 11 true lateral radiographs of the right ankle and foot, one with the ankle joint in neutral position; one of a circular equinus cast (CEC); three of an adjustable equinus boot (AEB) with the foot in 30°, 15°, and 0° of plantar flexion, respectively; three of a fixed angle orthosis with 1, 2, and 3 wedges with a plateau (WWP); and three of a fixed angle orthosis with 1, 2, and 3 wedges without plateau (WWOP). The primary outcome was the Achilles Relief Distance (ARD). Secondary outcomes were the tibiocalcaneal angle (TCA), the tibiotalar angle (TTA), and the tibio- 1st metatarsal angle (1MTP). All measurements were performed by a radiologist. 


The mean (SD) ARD was 11 mm (7) in CEC, 23 mm (6) with 3 WWP, 11 mm (5) with 3 WWOP, and 15mm (5) using AEB in 30° of plantarflexion. The mean (SD) TCA was 86° (7,8) in CEC, 76° (7,3) with 3 WWP, 90° (6,9) with 3 WWOP, and 84° (6,6) using the AEB in 30° of plantarflexion. CEC, AEB, and WWOP showed statistically significantly larger equinus than WWP.


CEC, AEB, and WWOP produced significantly greater plantarflexion compared to WWP.

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