Calcaneovalgus Feet

Calcaneovalgus foot is a common positional deformity of the newborn foot characterized by excessive dorsiflexion and eversion of the hindfoot, resulting in the dorsum of the foot potentially touching the anterior tibia.

Key Characteristics:

• Excessive dorsiflexion at ankle
• Hindfoot valgus
• Flexible deformity
• Forefoot abduction
• Normal foot development

Epidemiology

• Affects approximately 5% of newborns
• More common in first-born children
• Female predominance
• Often bilateral (60% cases)
• Associated with intrauterine positioning

Etiology

• Primary Causes:
  • Intrauterine positioning
  • Breech presentation
  • Oligohydramnios
  • Primiparity
• Contributing Factors:
  • Ligamentous laxity
  • Maternal hormone influence
  • Limited intrauterine space
  • Family history of foot problems

Clinical Presentation

• Physical Examination:
  • Dorsum of foot may touch anterior shin
  • Prominent calcaneus
  • Soft, stretchy heel cords
  • Normal foot architecture
  • Flexible deformity
• Key Signs:
  • Excessive ankle dorsiflexion
  • Heel in valgus position
  • Forefoot abduction
  • Normal foot length
  • Normal arch development

Classification

• Mild:
  • Dorsiflexion to 20-30°
  • Easily correctable
  • Minimal valgus
• Moderate:
  • Dorsiflexion to 30-45°
  • Moderate heel valgus
  • Some resistance to plantar flexion
• Severe:
  • Dorsiflexion >45°
  • Marked heel valgus
  • Foot touches anterior tibia

Diagnostic Approach

• Physical Examination:
  • Range of motion assessment
  • Flexibility testing
  • Heel position evaluation
  • Assessment of foot architecture
  • Neurological examination
• Special Tests:
  • Passive plantar flexion
  • Heel squeeze test
  • Forefoot alignment check
  • Ankle dorsiflexion measurement

Imaging Studies

• Generally Not Required:
  • Clinical diagnosis usually sufficient
  • Radiographs rarely needed
  • Reserved for atypical cases
• If Imaging Needed:
  • Lateral stress views
  • Standing AP views
  • Ankle alignment assessment

Differential Diagnosis

• Congenital vertical talus
• Tibial torsion
• Hypermobile pes planus
• Neurological disorders
• Ehlers-Danlos syndrome

Treatment Approach

• Observation:
  • Primary treatment for most cases
  • Regular monitoring
  • Parental reassurance
  • Documentation of progress
• Conservative Management:
  • Passive Stretching:
    • Gentle plantar flexion exercises
    • Parent education
    • Regular monitoring
  • Manipulation:
    • Gentle heel varus positioning
    • Ankle plantar flexion
    • Forefoot alignment

Specific Management Protocols

• Mild Cases:
  • Observation
  • Parent education
  • Regular follow-up
• Moderate Cases:
  • Stretching exercises
  • Temporary splinting if needed
  • More frequent monitoring
• Severe Cases:
  • Serial manipulation
  • Consider short-term casting
  • Physical therapy referral

Long-term Follow-up

• Monitoring Schedule:
  • Initial visit at 2-4 weeks
  • Monthly follow-up until resolved
  • Assessment at walking age
• Expected Outcomes:
  • Excellent prognosis
  • 90-95% spontaneous resolution
  • Normal foot function
  • Rare need for intervention