Calcaneovalgus Foot

This 4-month-old infant has calcaneovalgus foot- a relatively common finding in newborns. The foot has excessive dorsiflexion that allows its dorsum to come into contact with the anterior aspect of the lower leg. The forefoot has an abducted appearance.

Physical examination. Calcaneovalgus foot occurs secondary to a normal variation in the in utero position.¹ The plantar surface of the foot is against the wall of the uterus, which forces it into a hyperdorsiflexed and everted position. This fetal position also produces external tibial torsion (in fact, external tibial torsion of 30 to 50 degrees is a finding commonly associated with calcaneovalgus foot. Plantar flexion usually remains normal or almost normal. Calcaneovalgus foot is typically a unilateral deformity, but may occasionally be bilateral.

It is important to rule out 3 other conditions with a similar appearance:

• Congenital vertical talus.
• Posteromedial bow of the tibia.
• A neuromuscular disorder, such as paralysis of the gastrocnemius muscle.

Radiographic evaluation. AP and lateral simulated weight-bearing radiographs of the foot may be necessary to differentiate between calcaneovalgus foot and congenital vertical talus. In a calcaneovalgus foot, the radiographs either appear normal or reveal a mild increase in forefoot abduction and hindfoot valgus. In congenital vertical talus, the lateral view demonstrates a vertical orientation at the talus and dorsal subluxation at the midfoot. AP and lateral radiographs of the tibia and fibula are necessary if there is bowing of the lower leg.

Management. No treatment is necessary for the typical calcaneovalgus foot. The problem usually resolves by the time the child begins to st and walk independently. The external tibial torsion may persist, however, and follows the same natural history as internal tibial torsion. This usually resolves by 2 years of age.

References:

REFERENCE:1. Thompson GH. Gait disturbances. In: Kliegman RM, ed. Practical Strategies in Pediatric Diagnosis and Therapy. Philadelphia: WB Saunders Company; 1996:757-778.