Calcaneovalgus Feet

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

Further Reading