| 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
- Pathoanatomy
- deformity is caused by
- spasticity of
- foot dorsiflexors/evertors (L4 and L5)
- weakness of
- plantar flexors /inverters (S1 and S2)
- this muscle imbalance can be caused by an L5 spinal bifida, which is a one cause of this deformity
- Associated conditions
 posteromedial tibia bowing
- calcaneovalgus foot is often confused with posteromedial bowing, another condition caused by intrauterine positioning
- the two conditions may occur together or independently of each other
- vertical talus
- clinically it looks similar to vertical talus but you can differentiate on physical exam and with plantar flexion radiographs
- paralytic foot deformity
- may be caused by L5 spinal bifida
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| Presentation |
- Physical exam
- excessively dorsiflexed hindfoot that is passively correctable to neutral
- 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
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| 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
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| Treatment |
- Nonoperative
- observation & passive stretching exercises
- typically resolves spontaneously
- resolution may be expedited by stretching performed by parents
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| Complications |
- Leg Length Discrepancy
- LLD a possible complication when associated with posteromedial bowing of the tibia
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