Ortho Oracle - orthopaedic operative atlas
Home » Bones » Foot » Calcaneovalgus Foot

Calcaneovalgus Foot

- Discussion:
    - calcaneovalgus (congenital calcaneovalgus) refers to flexible flatfoot in infants and young children;
    - frequently seen infant foot disorder w/ forefoot abducted and the ankle severely dorsiflexed;
          - mild form may be seen in upto 30% of infants but a more severe form is present in 1/000 infants;
    - pathophysiology:
          - common disorder presummed to be a result of intra uterine positioning;
          - muscle imbalance:
                - occurs as a result of flaccid paralysis or weakness of the plantarflexors;
                - in myelomeningocele, there is unopposed action of the tibialis anterior and/or extensor tendons;

- Clinical Features:
    - infants allow dorsiflexion to the tibia and allows full plantar flexion and inversion;
    - forefoot is abducted and the ankle severly dorsiflexed;
    - look for abduction of the forefoot and heel valgus;
    - the plantar surface of the foot is flat, the hindfoot is in valgus position, and the forefoot is abducted;
           - superficially may resemble congential vertical talus;
    - when the foot and ankle are dorsiflexed, the dorsal aspect of the foot can be opposed to the anterior aspect of the tibia;
    - need to distinguish calcaneovalgus from planovalgus:
           - major distinguishing feature between calcaneovalgus and planovalgus is the age of onset;
    - fact that heel can be dorsiflexed helps to distinguish this deformity from congential vertical talus, in which foot is stiffer & heel is in 
    - anterior ankle structures may be contracted, the deformity typically is flexible & foot can passively be placed in the normal position;
    - untreated neurologic cancalneovalgus feet generally have forefoot equinus, large callused heel that is prone to skin break down, and 
           cock up toes;
    - fact that the heel can be dorsiflexed helps to distinguish this deformity from congenital vertical talus, in which the foot is stiffer and the 
           heel is in equinus;

- Non Operative Treatment:
    - in most cases the deformity resolves without treatment;
    - occasionally plantarflexion-inversion casting is used in infant if spontaneous resolution is not seen w/in first few months of life;
    - orthotics are of no proven benefit;
    - when there is muscle imbalance resulting from paralytic conditions, ankle-foot orthotics can control foot while child is small;
    - it is impossible to quantitate what constitutes flexible flat foot;
    - no device has been developed that predictably alters growth, development, or final adult configuration of a flexible flat foot;
    - it is difficult to determine how much pain or excessive shoe wear should be tolerated;

- Surgical Treatment:
    - results of surgery in the treatment of flexible flatfoot are extremely difficult to assess;
    - it has not been proven that the mere presence of a flexible flatfoot requires any form of treatment;
    - children may be candidates for tendon transfer (tibialis anterior to os calcis), &, or hindfoot stabilization by subtalar fusion is needed;
    - older children may need a calcaneal elongation osteotomy in addition to tendon transfer & plantar fascia release;
    - children over 10 years of age may require triple arthrodesis