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Calcaneovalgus Foot

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Topic updated on 05/16/14 10:08pm
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
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 
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


 

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