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 up to 30% of infants but a more severe form is present in 1/000 infants;

 

pathophysiology:

        common disorder presumed 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 fromcongential vertical talus, in which foot is stiffer & heel is in equinus;

        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 forefootequinus, 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 oscalcis), &, 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