Health condition · Clinically reviewed
Equinus contracture, the tight calf that drives forefoot overload — from stretching to gastrocnemius recession.
A limitation of ankle dorsiflexion caused by tightness of the gastrocnemius, soleus or Achilles complex. Drives plantar fasciitis, metatarsalgia, midfoot arthritis and adult acquired flat foot. Modern stratified care: structured stretching; gastrocnemius recession for refractory cases.
Why trust this guide
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Clinically reviewed
Written by our editorial team and reviewed by a registered UK clinician before publication.
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Sourced from guidance
Every claim is checked against BOFAS, NICE and peer-reviewed sources you can see at the end.
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Current for 2026
Reflects current UK foot and ankle guidance on stretching, night splints and gastrocnemius recession.
Key facts
Equinus contracture at a glance.
The essentials, in plain English — what equinus is, how it is measured, and why a tight calf so often turns out to be the missing piece in stubborn foot pain.
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Definition
Less than 5° of ankle dorsiflexion with the knee held in extension is defined as equinus — a limitation of the ankle caused by tightness of the gastrocnemius, soleus or Achilles complex.
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Silfverskiöld test
The Silfverskiöld test differentiates isolated gastrocnemius tightness from a combined gastroc–soleus (Achilles) contracture, and directly guides which surgical procedure fits.
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Underrecognised driver
Equinus is an underrecognised driver of forefoot pathology — pushing load forwards onto the ball of the foot.
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Stretching is first-line
A structured six-month calf-stretching programme is the first-line treatment for the vast majority of patients.
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Surgery for refractory disease
Gastrocnemius recession (Strayer or Baumann procedure) is reserved for refractory cases after a full stretching trial has failed.
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Wider consequences
Contributes to plantar fasciitis, metatarsalgia, posterior tibial tendon dysfunction (PTTD) and midfoot arthritis — treating the calf can settle the foot.
Why this guide matters
Stretching first, surgery last.
Most equinus settles with patient, consistent stretching — this guide sets out that order clearly so nobody jumps to gastrocnemius recession too fast.
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Treat the calf, settle the foot
Equinus quietly drives plantar fasciitis, metatarsalgia and midfoot pain — addressing the calf often unlocks a stalled recovery.
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The Silfverskiöld test guides everything
Isolated gastrocnemius tightness responds to Strayer or Baumann recession; a combined Achilles contracture calls for a different plan.
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Recession is a last step, not a first one
A full six-month stretching programme comes first — surgery is reserved for genuinely refractory equinus with ongoing foot symptoms.
How the diagnosis is made
From tight calf to a clear plan.
The steps a UK GP, physiotherapist or foot and ankle team will normally follow, in order — so you know what to expect and why.
Phase 1 · Recognising
History, dorsiflexion range and the Silfverskiöld test
Phase 2 · Confirming
Standing exam and screen for coexisting foot pathology
Phase 3 · Managing
Stretching first, surgery if refractory
- 01
Recognising
Symptom and activity history
Ball-of-foot pain, plantar heel pain, midfoot pain and a felt sense of a tight calf — often worse on hills, stairs and long walks.
- 02
Recognising
Ankle dorsiflexion range
Passive ankle dorsiflexion is measured with the knee extended and the subtalar joint neutral — less than 5° defines equinus.
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Recognising
Silfverskiöld test
Dorsiflexion is retested with the knee flexed — improvement points to isolated gastrocnemius tightness, no change points to a combined Achilles contracture.
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Confirming
Standing foot examination
Assessment of hindfoot alignment, arch height and forefoot loading pattern — equinus rarely occurs in isolation.
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Confirming
Coexisting flat foot / metatarsalgia
Screen for adult acquired flat foot, plantar fasciitis and forefoot overload — treating equinus is often the missing piece.
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Managing
Structured stretching trial
A monitored, progressive calf-stretching programme over months — the single most important step before surgery is considered.
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Managing
Foot and ankle surgery consultation
For refractory equinus with ongoing forefoot pathology — for consideration of gastrocnemius recession.
Typical timeline: 2–4 weeks from first appointment to a settled plan, plus a six-month stretching trial.
Symptoms
What equinus contracture actually feels like.
The pattern is more telling than any single symptom — a persistently tight calf with foot pain that keeps returning despite good local treatment.
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Tight calf
A persistent felt tightness in the calf — often worse first thing and after prolonged sitting.
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Ball-of-foot pain overlap
Metatarsalgia and forefoot loading pain that goes hand-in-hand with a tight calf.
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Plantar fasciitis coexistence
Classic first-step morning heel pain that keeps recurring — equinus is often the untreated driver.
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Midfoot pain coexistence
Midfoot ache and stiffness, especially in adult acquired flat foot — the calf is overloading the midfoot.
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Aggravated by hills / stairs
Walking uphill, climbing stairs and long descents reliably flare the calf and forefoot.
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Limited dorsiflexion
A visibly restricted ability to pull the foot up towards the shin, especially with the knee straight.
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Recurrent symptoms
Plantar fasciitis or metatarsalgia that keep coming back despite good local treatment — think equinus.
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Red flag
Acute Achilles rupture in a chronically tight calf — sudden pain, palpable gap and inability to push off — needs urgent surgical review.
Treatment
How equinus contracture is treated in the UK.
A staged approach — structured stretching, night splints and physiotherapy first, then gastrocnemius recession (Strayer, Baumann or endoscopic) for genuinely refractory disease.
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Structured calf-stretching programme
A progressive daily programme (Alfredson variant) — the single most evidence-based intervention, done over months not weeks.
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Wall / bent-knee stretching
Straight-knee wall stretches target the gastrocnemius; bent-knee stretches target the soleus — both are needed.
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Night splint
A dorsiflexion splint worn overnight holds the calf on gentle stretch — useful adjunct in stubborn cases.
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Heel lift for symptom relief
A temporary heel lift offloads the calf and forefoot while stretching takes effect — a symptomatic bridge, not a cure.
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Physiotherapy
A tailored programme covering calf loading, ankle mobility and lower-limb strength — the backbone of long-term recovery.
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Gastrocnemius recession (Strayer)
A short open procedure that lengthens the gastrocnemius aponeurosis at the musculotendinous junction — the workhorse operation for isolated gastroc equinus.
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Baumann procedure
A more proximal intramuscular gastrocnemius recession — an alternative technique with slightly different biomechanical trade-offs.
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Endoscopic gastroc recession
A minimally invasive endoscopic version of the recession — offered in some UK centres with a foot and ankle surgical interest.
What this guide is based on
The sources behind every claim on this page.
UK national guidance and specialist society standards, current at the time of last review.
Key references
Guidelines and standards we relied on.
A quiet reminder
This guide is for information, not medical advice.
Your GP, physiotherapist or foot and ankle team knows your history and can tell you which parts apply to you. If in doubt, get seen.
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British Orthopaedic Foot and Ankle Society (BOFAS). Patient information and clinical standards.
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NICE. Musculoskeletal foot and ankle guidance.
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American Orthopaedic Foot & Ankle Society (AOFAS). Clinical guidance on gastrocnemius contracture.
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Silfverskiöld consensus and subsequent expert reviews on gastroc–soleus differentiation.
Red flags
When a tight calf is not just equinus.
Most equinus is mechanical and settles with stretching. These are the situations where a different diagnosis or a surgical complication needs to be considered.
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Acute Achilles rupture
Sudden pain, palpable gap and loss of push-off in a chronically tight calf — needs urgent foot and ankle surgical review.
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Post-op sural nerve injury
Numbness, tingling or burning along the lateral foot after gastrocnemius recession — contact the surgical team.
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Post-op wound complication
Increasing pain, redness, swelling or discharge from the recession wound — same-day review.
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Post-op weakness in push-off
Persistent, functionally limiting weakness after recession — needs surgical review and structured rehab.
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Recurrent equinus
Return of tightness and restricted dorsiflexion after a full stretching or surgical course — reassess the diagnosis and technique.
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Bilateral equinus with neurological cause
Symmetrical equinus in an adult, especially with weakness or spasticity, needs a neurological assessment — not just a foot review.
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Post-stroke spasticity
Equinus from upper motor neuron spasticity follows a different pathway — spasticity management, botulinum toxin and specialist input rather than isolated recession.
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Diabetic foot with equinus and ulcer
Equinus with a plantar or forefoot ulcer in a person with diabetes — urgent diabetic foot team review, as offloading and lengthening may be needed.
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Post-op infection
Fever, spreading redness or systemic upset after any procedure — urgent surgical assessment.
Living with it
A slow condition, but a very manageable one.
Four things that make the biggest difference day to day — stretching, footwear, load management and patient review.
A quiet reminder
Consistency beats intensity, every time.
Small, steady stretches — kept up for months — do more than a heroic week that does not last.
- 01 Rehab
Stretch daily, for months
Structured straight-knee and bent-knee calf stretches, done consistently — the single biggest lever before any surgery.
- 02 Footwear
Support and offload
Supportive footwear with a modest heel lift can offload the calf and forefoot while stretching takes effect.
- 03 Load
Modify hills and stairs
Break up long climbs and descents while symptoms settle — reintroduce gradually as dorsiflexion improves.
- 04 Reviews
Reassess in months, not weeks
A stretching programme should be given a full six months before it is called a failure — reassess with your clinician then.
Frequently asked
Everything we get asked about equinus contracture.
Quick answers on the Silfverskiöld test, stretching, night splints and gastrocnemius recession.
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What is equinus contracture?
Equinus contracture is a limitation of ankle dorsiflexion — typically less than 5° with the knee held in extension — caused by tightness of the gastrocnemius, soleus or Achilles complex. It is an underrecognised driver of forefoot pathology.
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How is gastrocnemius tightness told apart from Achilles tightness?
By the Silfverskiöld test. Passive ankle dorsiflexion is measured with the knee extended and then with the knee flexed — improvement with knee flexion points to isolated gastrocnemius tightness, no change points to a combined gastroc–soleus (Achilles) contracture.
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Why does a tight calf cause forefoot pain?
A tight calf blocks ankle dorsiflexion, pushing load forwards onto the ball of the foot. Over years this can drive plantar fasciitis, metatarsalgia, posterior tibial tendon dysfunction and midfoot arthritis.
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How long should I stretch before considering surgery?
A structured six-month calf-stretching programme is the standard first-line approach. Surgery is only considered for genuinely refractory cases where months of good stretching, physiotherapy and footwear adjustment have not settled things.
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What is a gastrocnemius recession?
It is a short surgical procedure that lengthens the gastrocnemius. The most common technique is the Strayer procedure — a small incision at the back of the calf that releases the gastrocnemius aponeurosis. The Baumann procedure and endoscopic recession are alternatives.
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What is the red flag I should not ignore?
An acute Achilles tendon rupture in a chronically tight calf — sudden pain, a palpable gap and inability to push off — needs urgent foot and ankle surgical review.
Related content
Keep reading.
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Achilles tendinopathy
The other end of the calf–Achilles complex.
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Plantar fasciitis
The classic foot-pain condition driven by equinus.
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