You are in the right place. Dr. Tom Biernacki, DPM, FACFAS — board-certified foot & ankle surgeon with 3,000+ surgeries — explains exactly what equinus contracture / gastrocnemius recession means and what actually works. Call (810) 206-1402 for a same-day appointment at our Howell or Bloomfield Hills office.
Medically reviewed by Dr. Tom Biernacki, DPM · Board-Certified Podiatric Surgeon · Last reviewed: April 2026 · Editorial Policy
The most important clinical decision with Equinus Contracture Gastrocnemius Recession Percutaneous Lengthening isn’t which treatment to start with — it’s identifying the correct subtype. That changes everything. Call (810) 206-1402.
Quick Answer
Equinus Contracture: Gastrocnemius Recession vs. Percutaneou relates to foot pain — typically caused by overuse, footwear, or biomechanics. Most patients improve in 6-12 weeks with conservative care. Same-week appointments in Howell + Bloomfield Hills: (810) 206-1402.
Quick Answer
Achilles tendonitis causes pain and stiffness at the back of the heel along the Achilles tendon. Eccentric heel drops plus heel lifts resolve most cases within 6-12 weeks. See a podiatrist same-day for a sudden “pop” sound or inability to push off — that may be a rupture.
Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.
Watch: Dr. Tom Biernacki, DPM
Medically Reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.
Equinus contracture — reduced ankle dorsiflexion from tightness of the gastrocnemius (isolated contracture) or the gastrocnemius-soleus complex (combined contracture) — is one of the most clinically significant biomechanical abnormalities in foot and ankle medicine, acting as an underlying driver of plantar fasciitis, metatarsalgia, diabetic plantar forefoot ulcers, Charcot arthropathy progression, and adult-acquired flatfoot. Distinguishing isolated gastrocnemius contracture (Silfverskiöld test positive — dorsiflexion deficit resolves with knee flexion) from combined gastrosoleus contracture (deficit persists with knee flexion) is essential for selecting the appropriate surgical release procedure.
Anatomy, Assessment, and Pathomechanics
Ankle dorsiflexion requirements for normal gait: 10° of ankle dorsiflexion is required during mid-stance and terminal stance; 15–20° for normal stair climbing and squatting; equinus (dorsiflexion <5° with knee extended) compensates by subtalar pronation, midfoot break, and early heel rise — creating the ‘equinus cascade’ of foot deformities. Silfverskiöld test: ankle dorsiflexion measured with knee extended (gastrocnemius and soleus tight) and knee flexed (relaxes gastrocnemius, isolates soleus); dorsiflexion deficit with knee extended that resolves (improves ≥10°) with knee flexion = isolated gastrocnemius contracture — Silfverskiöld positive. Deficit persisting with knee flexed = combined contracture. Clinical significance of equinus: contributes to plantar fasciitis (restricted dorsiflexion loads the plantar fascia); metatarsalgia (equinus shifts load onto the metatarsal heads); diabetic plantar forefoot ulcers (elevated peak plantar pressure from equinus); Charcot progression (ongoing plantar loading with insensate neuropathic foot). Conservative management: serial casting for spastic equinus; gastrocnemius stretching program (knee-extended Achilles stretch — 3 × 30 seconds × 3×/day); night splinting; custom orthotics with heel lift to accommodate contracture temporarily.
Surgical Release Options
Proximal medial gastrocnemius recession (Strayer procedure): the most commonly performed procedure for isolated gastrocnemius contracture — transection of the medial (and lateral if needed) gastrocnemius aponeurosis at the musculotendinous junction just distal to the medial knee; approach: medial leg incision at the musculotendinous junction; releases the gastrocnemius fascial restriction without cutting the soleus; gains 10–15° additional dorsiflexion; preserves ankle plantarflexion strength (soleus intact); low complication rate (sural nerve injury 2–3%); appropriate for Silfverskiöld positive patients. Percutaneous (Hoke) Achilles tendon lengthening: indicated for combined gastrosoleus contracture when Silfverskiöld test is negative — three stab incisions along the Achilles tendon with a tenotome; Z-lengthening of the entire Achilles allows 10–15° additional dorsiflexion; risk of over-lengthening producing calcaneal gait (loss of push-off strength); appropriate for diabetic equinus correction when combined contracture is present. Dr. Biernacki at Balance Foot & Ankle assesses equinus contracture with the Silfverskiöld test and performs gastrocnemius recession and Achilles lengthening at our Bloomfield Hills and Howell offices. Call (810) 206-1402.
📧 Get Dr. Tom’s Free Lab Test Guide
Discover the 5 lab tests every person over 35 should ask their doctor about — explained in plain English by a board-certified physician.
📍 Located in Michigan?
Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.
More Podiatrist-Recommended Foot Health Essentials
Hoka Clifton 10
Max-cushion everyday shoe — podiatrist favorite for walking and running.
OOFOS Recovery Slide
Impact-absorbing recovery sandal — wear after long days on your feet.
As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. Product recommendations are based on clinical experience; prices and availability shown above update live from Amazon.
When to See a Podiatrist
If foot or ankle pain has been bothering you for more than a few weeks, home care alone may not be enough. Balance Foot & Ankle offers same-week appointments at our Howell and Bloomfield Hills clinics — no referral needed in most cases. Bring your current shoes and a short list of symptoms and we’ll build you a treatment plan in one visit.
Call Balance Foot & Ankle: (810) 206-1402 · Book online · Offices in Howell & Bloomfield Hills
Frequently Asked Questions
When should I see a podiatrist?
See a podiatrist for any foot or ankle pain that persists more than 2 weeks, doesn’t improve with rest, limits your daily activities, or is accompanied by swelling, numbness, or skin changes. People with diabetes or circulation problems should see a podiatrist regularly even without symptoms.
What does a podiatrist treat?
Podiatrists diagnose and treat all conditions of the foot, ankle, and lower leg including plantar fasciitis, bunions, hammertoes, toenail problems, heel pain, nerve pain, diabetic foot care, sports injuries, fractures, and foot deformities — both surgically and non-surgically.
What can I expect at my first podiatry visit?
Your first visit includes a full medical history, physical examination of your feet and gait, and in-office diagnostic imaging if needed (X-rays, ultrasound). We’ll discuss your diagnosis and create a plan tailored to your foot type. Most visits take 30–45 minutes.
Need Treatment at Balance Foot & Ankle?
Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients at our Howell and Bloomfield Township offices.
Book Online or call (810) 206-1402
Insurance Accepted
BCBS · Medicare · Aetna · Cigna · United Healthcare · HAP · Priority Health · Humana · View All →
Howell Office
4330 E Grand River Ave
Howell, MI 48843
Get Directions →
Bloomfield Hills Office
43494 Woodward Ave, #208
Bloomfield Hills, MI 48302
Get Directions →
Your Board-Certified Podiatrists
Ready to Get Back on Your Feet?
Same-week appointments available at both locations.
Book Your AppointmentDifferential Diagnosis: What Else Could It Be?
Several conditions share symptoms with Achilles Tendonitis and are commonly misdiagnosed in the first office visit. Considering these alternatives is part of every Balance Foot & Ankle exam:
- Haglund’s deformity. Bony bump at the back of the heel rubbing against the shoe counter.
- Insertional vs. mid-substance Achilles. Insertional pain at the heel bone responds differently than mid-tendon pain 4–6 cm above.
- Retrocalcaneal bursitis. Fluid-filled bursa anterior to the tendon — squeeze pain with side-to-side compression.
If your symptoms don’t fit the textbook pattern, ask your podiatrist which differentials they ruled out — that conversation often shortcuts months of trial-and-error treatment.
In Our Clinic
Most Achilles tendonitis patients we see at Balance Foot & Ankle are recreational runners in their 40s or 50s who ramped up mileage too quickly, plus a second cohort of middle-aged women who recently switched from heels to flat shoes. The first question we ask is whether the pain is at the insertion on the heel bone versus 2–6 cm up the mid-substance — the treatment ladder is genuinely different. Eccentric heel-drops, heel lifts, and a soft-strike gait retraining pass resolve ~80 % of cases. The ones who aren’t improving by week 8 usually have an unrecognized Haglund’s deformity or insertional calcific tendinosis that needs imaging.
Most Common Mistake We See
The most common mistake we see is: Stretching the Achilles into pain during rehab. Fix: eccentric heel drops performed pain-free, 3 sets of 15, twice daily, straight-knee and bent-knee.
Warning Signs That Need Same-Day Care
Seek immediate evaluation at Balance Foot & Ankle if you experience any of the following:
- Pop or snap with sudden inability to push off
- Loss of active plantarflexion
- Significant swelling within 24 hours
- Rest or night pain in the tendon
Call (810) 206-1402 — same-day and next-day appointments at our Howell and Bloomfield Hills offices.
Watch: Dr. Tom explains
Podiatrist-recommended products
As an Amazon Associate, Dr. Tom earns from qualifying purchases.
Related resources
Ready to solve this? Book today.
Same-week appointments · Howell & Bloomfield Hills · 4.9★ (1,123+ reviews)
☎ (810) 206-1402Book Online →Pros & Cons of Conservative Care for foot care
Advantages
- ✓ Conservative care first
- ✓ Same-week appointments
- ✓ Multiple insurance accepted
Considerations
- ✗ Self-treatment can mask issues
- ✗ See a podiatrist if pain >2 weeks
Dr. Tom’s Recommended Products for foot care
Affiliate disclosure: As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. We only recommend products we use with patients.
Footnanny Heel Cream Dr. Tom’s Pick
Best for: Daily moisturizer for cracked heels
Ready to Get Back on Your Feet?
Same-day appointments in Howell + Bloomfield Hills. Most insurance accepted. Dr. Tom Biernacki, DPM & team.
Book Today — Same-Day Appointments Available
Call Now: (810) 206-1402
About Your Care Team at Balance Foot & Ankle
Dr. Tom Biernacki, DPM · Board-Certified Foot & Ankle Surgeon. Specializes in conservative-first care, minimally invasive bunion surgery, and complex reconstruction.
Dr. Carl Jay, DPM · Accepting new patients. Specializes in sports medicine, athletic injuries, and routine podiatric care.
Dr. Daria Gutkin, DPM, AACFAS · Accepting new patients. Specializes in surgical reconstruction and pediatric podiatry.
Locations: 4330 E Grand River Ave, Howell, MI 48843 · 43494 Woodward Ave Suite 208, Bloomfield Hills, MI 48302
Hours: Mon–Fri 8:00 AM – 5:00 PM · (810) 206-1402
Visit Balance Foot & Ankle — Same-Day Appointments Available
Our podiatry team serves patients throughout Michigan including Howell, Brighton, and Bloomfield Hills. If you’re dealing with heel pain, ingrown toenails, or a foot injury, we have same-day appointment availability.
Same-day appointments available. (810) 206-1402
Frequently Asked Questions
When should I see a podiatrist?
If symptoms persist past 2 weeks, affect your normal activity, or are accompanied by red-flag symptoms (warmth, redness, swelling, inability to bear weight).
What does treatment cost?
Most diagnostic visits and conservative treatments are covered by Medicare and major insurers. Out-of-pocket costs vary by your specific plan.
How quickly can I get an appointment?
Most non-urgent cases see us within 5 business days. Urgent cases (sudden pain, possible fracture) typically same or next business day.
Ready to fix this for good?
Reading goes only so far. The fastest path to relief is a 30-minute office visit with Dr. Biernacki — same-day Howell or Bloomfield Hills. Call (810) 206-1402 or use our online booking.
Ready for Expert Care?
Same-day appointments in Howell & Bloomfield Hills, MI.
4.9★ | 1,123 Reviews | 3,000+ Surgeries
Or call: (810) 206-1402
Dr. Tom Biernacki, DPM is a board-certified foot & ankle surgeon (ABFAS & ABPM) at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views and almost 1 million subscribers on youtube.