Calcaneovalgus Foot

By admin Last updated Jan 7, 2024

Ovid: 5-Minute Orthopaedic Consult

Editors: Frassica, Frank J.; Sponseller, Paul D.; Wilckens, John H.

Title: 5-Minute Orthopaedic Consult, 2nd Edition

> Table of Contents > Calcaneovalgus Foot

Calcaneovalgus Foot

Paul D. Sponseller MD

Basics

Description

Calcaneovalgus foot is a congenital condition thought to result from intrauterine positioning (1).
The hindfoot is held in valgus and the
foot is markedly dorsiflexed, with the dorsum of the foot nearly
touching the anterior tibia.

Epidemiology

The condition occurs in neonates.
No gender predominance is noted.
It is one of the most common congenital foot disorders.

Prevalence

Present to varying degrees in 5% of all births

Pathophysiology

The Achilles tendon is stretched temporarily, but it recovers spontaneously after birth.
No bony abnormalities are present.

Associated Conditions

Infants with a calcaneovalgus foot should be checked for other positioning deformities, such as DDH or torticollis.
No evidence suggests that this condition may predispose the patient to the development of pes planus (flat feet).

Diagnosis

Signs and Symptoms

This condition, present at birth, has no symptoms.
The foot is markedly dorsiflexed, with the dorsum of the foot resting against the anterior tibia.
The hindfoot is held in valgus and, occasionally, a contracture of the anterior muscles (dorsiflexors) is present.
The deformity usually is supple, and the foot can be passively plantarflexed easily.

Physical Exam

The appearance of the foot usually is diagnostic.
The foot is easily plantarflexed and supinated, but it may not be passively correctable right away (Fig. 1-1).
Note the orientation of the calcaneus to rule out convex pes planus (vertical talus).
- In vertical talus, the hindfoot is in equinus.
- In calcaneovalgus foot, the hindfoot is dorsiflexed (heel is pointing down)
  
  Fig. 1. Calcaneovalgus foot in a newborn.

Tests

Imaging

If the physical examination alone is not diagnostic,
obtain routine AP and lateral foot and ankle radiographs to rule out
bony abnormalities.

Differential Diagnosis

Convex pes valgus (congenital vertical talus) (1):
- To differentiate the 2 conditions, note the position of the calcaneus.
  - In congenital vertical talus, the
    calcaneus is fixed in plantarflexion with contracture of the Achilles
    tendon and dislocation of the navicular on the dorsal neck of the talus
    (i.e., the heel points upward).
  - In calcaneovalgus foot, the calcaneus is dorsiflexed (i.e., the heel points downward) and is somewhat in valgus.
Posteromedial bow of the tibia:
- In this condition, the foot is in the
  same position as the calcaneovalgus foot (dorsiflexed and everted), but
  the cause is a bow in the tibia rather than in the joint.
- The bony abnormality can be palpated.
L5 paresis, as seen in spina bifida, can produce a fixed dorsiflexed foot because of muscle imbalance.

P.49

Treatment

General Measures

Reassure the patient’s parents that the condition self-corrects with time.
- Treatment often requires repeated counseling to convince the parents that this is not a fixed deformity.
To maintain the child’s foot in a corrected position, the parents may perform gentle stretching maneuvers several times per day.
- Parents who wish to be actively involved
  may be taught to plantarflex and supinate the patient’s feet passively;
  however, the deformity corrects on its own.
Occasionally, serial casting can be used to speed correction.

Activity

No activity restrictions are indicated because the malposition usually resolves quickly.

Surgery

Surgery is never needed for this condition.

Follow-up

Disposition

Issues for Referral

Newborns with substantial deformity or possible
congenital convex pes valgus should be referred to an orthopaedist for
monitoring.

Prognosis

This benign condition corrects over time.
Prognosis is excellent for development of normal shape, strength, and function.
No definite evidence suggests that the foot is prone to be flat in later life.

Complications

On rare occasions, subluxation of the peroneal tendons may occur with this condition.
This subluxation resolves with serial cast treatment.

References

1. Kasser
JR. The foot. In: Morrissy RT, Weinstein SL, eds. Lovell and Winter’s
Pediatric Orthopaedics, 6th ed. Philadelphia: Lippincott Williams &
Wilkins, 2006:1257–1328.

Miscellaneous

Codes

ICD9-CM

754.69 Calcaneovalgus foot

Patient Teaching

Inform the family about the benign natural history of the condition and the tendency for the foot to correct on its own.

FAQ

Q: Will the foot be flat as the baby grows older?

A: No evidence suggests that this outcome is more likely than in any other infant.

Q: Should the baby wear casts or special shoes?

A: Such measures are not necessary because the condition should improve on its own.