Over the first decade or so of practice, I became increasingly aware that when a patient visits the doctor, it is a BIG DEAL. Even the simple visits. And, yes, it took about a decade for this realization to sink into my thick, seemingly uncaring brain.

If you have had an illness of any note, you will surely identify with my words.

...Keep in mind, most of my colleagues didn’t and still don’t embrace this challenge; thus, you will need to be equipped to best maneuver your next encounter.

Also, keep in mind that you have a very real problem, but its elusiveness makes it feel like it is in your head. It is not, I can assure you.

This newsletter is mostly a reprint of one of my favorite blogs from 14 years ago. I know you, or someone you care about, is out there suffering and afraid of the medical system because it did what it does best: ignore you.

First and foremost, I am declaring that I was the first to use this term: “The Rescue Patient.” I made my mark. My fifteen minutes of fame may be over.

“It is my ambition to say in ten sentences what others say in a whole book.” -Friedrich Nietzsche

All too common today is the misuse of the word “injury.”

When it comes to the majority of foot and ankle issues people experience, these ailments should not be called “injuries,” unless, of course, they really are an injury.

Anecdotal evidence of any kind is routinely denounced by the “purists”, the scientists. Let’s take a deeper look.

anecdotal (anikˈdōtl) adjective-(information) not necessarily true or reliable, because based on personal accounts rather than facts or research.

When I was practicing (retired), I would routinely see between 8 and 10 patients each week with a “new” foot or ankle problem who suffered from plantar fasciitis at some point in their past. It might have been 15 years prior, 5 for others, and even more recently for some.

Long ago, I began to suspect there was some sort of link between people with plantar fasciitis and other issues I was seeing.

For four decades now, I have been presenting, talking, discussing, even pleading, you name it, to my colleagues and anyone else who would listen, on the destructive effects of equinus and the power of simple calf stretching. Mostly to deaf ears.

Contrary to what you have read, heard, or have been told, plantar fasciitis doesn’t appear by magic. It does not just happen for no reason, and it definitely does not result from overuse or being overweight. Not knowing the reason, the root cause, will bring one no closer to solving the problem.

It’s time to talk a bit about plantar fasciitis, the most common foot and ankle badness. Chances are that over 50% of you reading this currently have or have suffered from plantar fasciitis in the past. I will focus mostly on

I would categorize this newsletter as more of a PSA, since a few of you may need to know about it.

About 40 years ago, I was a “runner”, sort of. At one point, I started having pain in my left buttocks radiating down into my lateral (outside of) lower leg. Being a hot off the press orthopaedic surgeon...

Hack: A highly efficient, clever, or unconventional solution to an everyday problem. It saves time or effort.

Okay, saving time or effort by utilizing calf stretching is debatable. Or is it?

First, let’s get one important order of “business” out of the way. It has come to my attention that a picture of me is floating around out there. Sadly, that is me, yikes. While this security leak is a potential problem, all I can say is, “What, me worry”?

A few years ago, my RN sister-in-law, let’s call her Sue, called me after seeing one of my orthopaedic colleagues, who recommended surgery for her acquired flatfoot deformity. At the time, he was the president of our foot and ankle society, the AOFAS, which means he was the leader of the foot and ankle herd of sheep. Much angriness.

Why do elective surgeries “fail” when seemingly they should almost always be successful, right?

• Well, surgeries can go bad and fail, duh. Head scratching, bad luck, or bad karma.

• Your surgeon does not do a stellar job. It happens.

• You don’t do your job, which is called noncompliance. It happens, A LOT.

• Expectations are not met. How about we talk about this one?

This newsletter is basically reverse psychology, so to speak, sort of. Stick with me here.

Last week, we covered the predilection phenomenon and why the poor gastrocnemius is picked on like a little brother. Actually, it is the foot and ankle that is bullied downstream from the gastrocnemius. As a simplified preamble, the incremental damage to the foot and ankle produced by a tight gastrocnemius (equinus) produces unacceptable tension and bending forces on the foot and ankle. You have to trust me on this one...

Now for my favorite and final building block regarding the origins of equinus, and it is a two-parter, yahoo. I’m afraid you will have to put on your thinking and engineering caps and be open-minded to this voodoo, but essential voodoo.

Evolution suggests...

Oopsies, I missed last week. Apologies all around because I know you stare at your device waiting for my terse enlightenment.

This week, I am going to take a break from our muscle tightness journey to address some nonsense I found and continue to find on Facebook. Unfortunately, this FB blather is not restricted to this particular FB group; it appears to be systemic.

I’ve labeled this equinus category “bone/muscle growth mismatch.” It is definitely pretty much unknown.

In this category, the gastrocnemius is “normal” length, genetically speaking, but the tibia has grown too long, creating a situational isolated gastrocnemius contracture or equinus.

There is no doubt that genetics plays, if nothing else, a subtle role in the progressive contracture of connective tissue. This would account for a possible familial proclivity to calf tightness or tightness of other muscle groups.

Genetics might also account for why an individual is more prone to muscle contractures that lead to tendon and joint problems in multiple areas of the body, or to recurrent issues in one location.

We all should know and understand that we tend to get stiffer as we age. Speaking of that, knowing I have to get out of this chair after all this typing is going to be irritating. So, why do we get stiffer as we age?

The disconnect between the foot or ankle problem you may be experiencing and why it arrived when it did could not be wider. These things don’t just happen without a reason. Yet, the singular reason the majority of non-traumatic acquired foot and ankle issues exist, equinus, is silent. You are totally unaware that you have equinus. To you, it does not exist, so it can’t possibly be a problem...

Can I be angry with me? No matter, I am, and it feels so good. I have had a few goofs so far with my first foray into the newsletter business, but none were significant until Monday. So consider this an erratum of sorts.

Highly active athletes also develop equinus, even though they're active and would seem less likely to. Their athleticism does not protect them from the same equinus-related foot and ankle problems that can affect less active people.

My esteemed colleagues, Runner’s World, and whoever else wants to have an opinion, would consider these running-related misfortunes to result from training errors; doing too much too fast, too hard, etc. Equinus is not even on the table, period.

In the last round, we looked at slow-developing, decreased activity-related changes that can shorten all muscles and tendons to varying degrees, but this is particularly seen in the calf. This is an intermittent process that ratchets the muscle-tendon unit (MTU) shorter, bit by bit. 3 steps forward, two steps back! Think of reduced activity-related changes as the tortoise.

Apologies for the delay. I am on the other side of the world, if you are in the US, that is.

So, why in the HE-double-hockey-sticks would we develop acquired equinus (hereby will be just equinus to save my typing digits)? Equinus does not happen by magic, voodoo, or bad luck; i.e., it is not a mystery, even though most of us do not have a clue as to its presence, let alone why it exists in the first place. Talkin’ bout making me angry. OK, maybe bad karma could be in play, but rarely-that’s your call.

Mrs. Angry, my bride, told me that my newsletters are too sciencey, her words, not mine. As a result, we are already off to an annoying start. To be honest, which I am ALWAYS, this stuff requires some science.

So, relax, I’m not about to drag you through a med school boot camp. Fortunately, this stuff is way easier than the white coats want you to believe, but there are a few critical takeaways.

Equinus comes in two flavors. First, you’ve got the ankle that’s locked in a permanent toe-pointing contest—fixed ankle plantarflexion. But the real troublemaker? That’s acquired equinus, the sneaky villain of this story.

Welcome to your weekly AngryOrthopod foot and ankle orthopaedic newsletter. Thanks so much for joining me.

My goal here is to have fun, cut through the BS, and help you guys understand the human foot and ankle in a different way, the right way. In turn, I want you to be equipped to solve many of your own foot and ankle issues, thus stopping the waste of time and money. It is all about getting your quality of life back.