Measuring the Forefoot-to-Rearfoot Relationship in the Sagittal Plane—A Novel Measurement for Evaluating Pseudoequinus in the Lower Extremity

Evaluation of the static angle of the forefoot-to-rearfoot relationship in the sagittal plane is essential in determining the degree of pseudoequinus in the lower extremity. The concept of an increased sagittal plane forefoot-to-rearfoot relationship is generally referred to as anterior equinus, which may result in a pseudoequinus syndrome. As its name implies, pseudoequinus is not a true lack of ankle joint dorsiflexion but rather a condition wherein the ankle joint functions as if it were restricted. Currently, the literature lacks specifications on how to obtain this measurement. Qualitative methods exist to identify an increased sagittal plane forefoot-to-rearfoot relationship whereby the clinician observes whether the patient has an anterior equinus or pseudoequinus present. However, no method has been reported that is suitable for structured evaluation determining the degree of pseudoequinus present. Evaluation of this measurement is important in understanding the overall magnitude of equinus influence present and its concomitant effects on the superstructure. This article describes a new method for measuring the static angle for the sagittal plane forefoot-to-rearfoot relationship using an orthopedic evaluation device. The results of this study indicated that this measurement yielded high interrater and intrarater reliabilities. In effect, this is a simple-to-perform analytics assessment that, as part of comprehensive biomechanical examination, will provide the astute clinician with additional insights into the cause and effect of pathomechanical foot and limb function.