Abstract
We are currently in the process of discovering that many, if not the majority, of the non-traumatic acquired adult foot and ankle problems are caused by a singular etiology: non-neuromuscular equinus or the isolated gastrocnemius contracture. There is no question that this biomechanical association exists and in time much more will be uncovered. There are three basic questions that must be answered: why would our calves tighten as we normally age, how does a tight calf, or equinus, actually cause problems remotely in the foot and ankle, and how do the forces produced by equinus cause so many seemingly unrelated pathologies in the foot and ankle? The purpose of this paper is to address the second question: how does a tight calf mechanically cause problems remotely in the foot and ankle? There has been little evidence in the literature addressing the biomechanical mechanisms by which equinus creates damaging forces upon the foot and ankle, and as a result, a precise, convincing mechanism is still lacking. Thus, the mere concept that equinus has anything to do with foot pathology is generally unknown or disregarded. The split second effect, described here, defines exactly how the silent equinus contracture creates incremental and significant damage and injury to the human foot and ankle resulting in a wide variety of pathological conditions. The split second effect is a dissenting theory based on 30 years of clinical and academic orthopedic foot and ankle experience, keen clinical observation along the way, and review of the developing literature, culminating in examination of many hours of slow motion video of normal and abnormal human gait. To my knowledge, no one has ever described the mechanism in detail this precise.
Highlights
Foot and ankle problems account for significant percentage of visits to physicians every year, primary care physicians, orthopedic surgeons, and podiatrists
The Split Second Effect little if any evidence concentrating on a mechanism of how the tight calf might produce problems in the foot and ankle [3, 4, 11, 15, 18, 31, 32, 44, 54,55,56]
The purpose of this paper is to describe the exact mechanism, the split second effect, by which a seemingly innocuous, subtle equinus contracture causes so much cumulative damage and deformity in the human foot and ankle over time as we age
Summary
Foot and ankle problems account for significant percentage of visits to physicians every year, primary care physicians, orthopedic surgeons, and podiatrists. There has been an increasing amount of literature in the last several decades suggesting a link between equinus and many foot and ankle conditions [1, 3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53]. The Split Second Effect little if any evidence concentrating on a mechanism of how the tight calf might produce problems in the foot and ankle [3, 4, 11, 15, 18, 31, 32, 44, 54,55,56]
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