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Introduction
  • A soft tissue contracture foot deformity characterized by excessively dorsiflexed hindfoot
    • hindfoot valgus
    • no dislocation or bony deformity
  • Etiology
    • usually a positional deformity caused by intrauterine "packaging"
  • Epidemiology
    • more common in females and first born children
  • Similar or related conditions
    •  posteromedial tibial bowing
      • calcaneovalgus foot is USUALLY accompanied by posteromedial bowing of the tibia
    •  vertical talus
      • clinically it looks similar to vertical talus but you can differentiate on physical exam and with plantar flexion radiographs. in vertical talus the heel is in equinus, which is the opposite of calcanealvalgus.
    •  paralytic foot deformity
      • deformity is caused by 
        • spasticity of 
          • foot dorsiflexors (L4 and L5)/evertors (S1)
        • weakness of 
          • plantar flexors  (S1 and S2) /inverters (L5)
        • this muscle imbalance can be caused by an L5 spinal bifida, which is a one cause of this deformity
Presentation
  • Physical exam
    • excessively dorsiflexed hindfoot that is passively somewhat correctable 
    • dorsal surface of foot rests on anterior tibia
    • looks similar to vertical talus
      • differs on exam in that vertical talus has a rigid hindfoot equinus/valgus and rigid dorsiflexion through midfoot .  and vertical talus has mid-foot valgus, with a medial prominant talar head.
Imaging
  • Radiographs
    • AP and lateral tibia
      • used to determine presence of posteromedial bowing
    • plantar flexion radiographs
      • useful to differentiate from vertical talus
      • before ossification of navicular at age 3, the first metatarsal is used as a proxy for the navicular on radiographic evaluation        
        • calcaneovalgus foot
          • first metatarsal will line up with talus with calcaneovalgus foot
        • vertical talus
          • the axis of the talus is plantar to the 1st metatarsal (and navicular if visible yet) on both standard lateral and plantar flexion lateral radiographs 
Treatment
  • Nonoperative
    • observation & passive stretching exercises
      • typically resolves spontaneously
      • resolution may be expedited by stretching performed by parents 
Complications
  • Leg Length Discrepancy
    • LLD a possible complication when associated with posteromedial bowing of the tibia
    • the most common surgery needed for posterior medial bowing is to address the LLD

 

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