Talipes Calcaneovalgus

Question 1

What is the most common congenital foo malformation

Answer 1

Talipes calcaneovalgus

Question 2

Describe talipes calcenovalgus

Answer 2

Postural deformity
Present at birth
Characterized by marked dorsiflexion and valgus position of the foot in relation to the left

Question 3

What is the clinical description of talipes calceneovalgus

Answer 3

Dorsal surface of the foot is resting or in close proximity with the anterolateral surface of the leg - foot is “up and out”
- limitation of both plantarflexion and inversion
- difficult to bring the foot into a neutral position
- concavity over the sinus tarsi
- redundant skin folds laterally that blanch upon inversion
- medial ankle skin will appear stretched and taut

Question 4

What are the extrinsic etiology of TCV

Answer 4

Fetal position - usually breech birth
Tight uterus
Sleeping habits
Sitting position - reverse “W”
Early walking or crawling

Question 5

What are the intrinsic etiologies of TCV

Answer 5

Neuromuscular
Ligamentous laxity syndromes

Question 6

What are the DP view findings of TCV

Answer 6

• midtarsal join generally demonstrates altered alignment due to the valgus position on the foot
• increase in the talocalcaneal angle
• decreased Talonavicular congruity
• medial angulation of the talar head and neck

Question 7

What are the lateral view findings for TCV

Answer 7

• plantarflexion of the talus - not true plantarflexion but rather manifestation of the remaining portion of the foot being in a dorsiflexed attitude with respect to the talus
• talar bisection will fall inferior to the plantar aspect of the cuboid
• significant dorsiflexion of the calcaneus
• superimposition of the metatarsal bones

Question 8

What are some differential diagnoses for TCV

Answer 8

Congenital vertical talus
Congenital medial posterior bowing of the tibia
Spinal dysraphism

Question 9

Differentiate Vertical talus findings versus TCV findings with regards to foot dorsiflexion on leg

Answer 9

VT - foot is at 90 degrees with respect to the leg or in a poison of equinus
TCV findings - foot in a marked dorsiflexion and contact with leg

Question 10

Differentiate Vertical talus findings versus TCV findings with regards to calcaneal position

Answer 10

VT - calcaneus is in a position of equinus
TCV - calcaneus is dorsiflexed

Question 11

Differentiate Vertical talus findings versus TCV findings with regards to alignment

Answer 11

VT - often cannot reduce to neutral position
TCV - valgus alignment of the heel

Question 12

Which structures of the foot are targeted in conservative stretching of TCV

Answer 12

Anterolateral and dorsolateral structures

Question 13

Why should you never correct TCV deformity on the first visit

Answer 13

Danger of skin necrosis to the dorsum of the foot due to extreme contracture of the skin

Question 14

When is surgical treatment done for TCV?

Answer 14

Only for residual deformity

Question 15

Describe the surgical treatment for TCV

Answer 15

• Evans - advocated calcaneal osteotomy with insertion of a bone graft
• Lateral column lengthening - transverse osteotomy in the calcaneus 1.5cm proximal and parallel to the calcaneocuboid joint
• Soft tissue tendon lengthening and releases are also recommended