Positional Abnormalities/Child: Positional Deformities

CONGENITAL FOOT DEFORMITIES

Flatfoot (aka Pes Planus, Flexible Flatfoot, Pronated Foot, and Pes Planovalgus and Calcaneovalgus if more severe)

Pes Planus DP view: Observe the hindfoot valgus (calcaneal axis is directed more laterally relative to the talus and a "V"-like gap is seen between the anterior aspects of both bones). Also observe the forefoot valgus (second metatarsal is directed parallel or lateral relative to the calcaneal axis).

Lateral view: Observe the hindfoot valgus (the talar axis is oriented more vertically than normal).

Pes Planovalgus DP view: Again, observe the hindfoot valgus (calcaneal axis is directed more laterally relative to the talus and a "V"-like gap is seen between the anterior aspects of both bones). When the navicular ossification center is visible as it is in this patient, it will be positioned laterally relative to the talar head in hindfoot valgus. Forefoot valgus is not seen (i.e., the second metatarsal axis is mildly adducted relative to the calcaneal axis, the normal expected finding).

Lateral view: Observe the mild forefoot varus (ladder-like arrangement of metatarsals; this is probably due to some supination of the foot during positioning of it for this view).

Congenital Vertical Talus (aka Convex Pes Valgus, Rigid Flatfoot)

DP view: Note the severe hindfoot valgus and forefoot valgus (refer back to film #PA1 if you don't).

Lateral view: The talar axis is vertical and parallel (colinear) with the tibial axis. Also note the calcaneus position of the calcaneus (the bone is plantarflexed relative to the plane of support). Forefoot valgus is also present: the metatarsal bones are nearly all superimposed upon one another.

Forced plantarflexion lateral view: an attempt is made to reposition the navicular such that it articulates with the anterior aspect of the talar head. If it does not, it is a true vertical talus. If it does, the condition is referred to as an oblique talus. Obviously, if the navicular is not yet visible, as in this infant, the above criteria cannot be utilized. Since the navicular articulates with the cuneiforms, one could compare the talar head with the lateral cuneiform (L), which is visible.

Lateral view: As in the film above, the talar axis is vertical (parallel/colinear with the tibial axis) and the calcaneus is plantarflexed relative to the plane of support. Now that the navicular ossification center is visible, the navicular's articulation with the superior surface of the head and neck of talus as well as with the talar dome is easily seen.

Metatarsus Adductus (aka, when more severe, Met Adductovarus, Skewfoot, Serpentine Foot)
Common metatarsus adductus:

DP view: The 2nd metatarsal axis is greatly adducted relative to the calcaneal axis. The talar and 1st metatarsal axes are nearly parallel. The calcaneal axis runs through the lateral one-third of the cuboid.

Lateral view: Most axial relationships appear nearly normal.

Metatarsus adductovarus:

DP view: Again, the 2nd metatarsal axis is greatly adducted relative to the calcaneal axis. The 1st metatarsal axis deviates medially relative to the talar axis. The calcaneal axis runs through the center to medial one-third of the cuboid. The talocalcaneal angle is decreased (hindfoot varus).

Lateral view: Observe the forefoot varus (ladder-like arrangement of the metatarsals). The first metatarsal axis is parallel to both the talar axis and the plane of support. The talar axis is nearly perpendicular to the tibia, and the talocalcaneal angle is decreased (hindfoot varus).

Clubfoot (aka Talipes Equinovarus or TEV)

DP view: The 2nd metatarsal axis is severely adducted relative to the calcaneal axis. The 1st metatarsal axis deviates severely medially relative to the talar axis. The calcaneal axis runs outside the cuboid laterally. The talocalcaneal angle is significantly decreased, indicative of severe hindfoot varus (note how the talar and calcaneal axes are fully superimposed upon one another).

Lateral view: Observe the forefoot varus (ladder-like arrangement of the metatarsals); however, also note that the first metatarsal axis is greatly declinated (nearly vertical) relative to the talar axis. The heel does not touch the plane of support. The talar axis is nearly perpendicular to the tibia, and the talocalcaneal angle is significantly decreased (severe hindfoot varus).

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This page was updated May 5, 1998.

	Pes Planus DP view: Observe the hindfoot valgus (calcaneal axis is directed more laterally relative to the talus and a "V"-like gap is seen between the anterior aspects of both bones). Also observe the forefoot valgus (second metatarsal is directed parallel or lateral relative to the calcaneal axis).
	Lateral view: Observe the hindfoot valgus (the talar axis is oriented more vertically than normal).

	DP view: Note the severe hindfoot valgus and forefoot valgus (refer back to film #PA1 if you don't).
	Lateral view: The talar axis is vertical and parallel (colinear) with the tibial axis. Also note the calcaneus position of the calcaneus (the bone is plantarflexed relative to the plane of support). Forefoot valgus is also present: the metatarsal bones are nearly all superimposed upon one another.
	Forced plantarflexion lateral view: an attempt is made to reposition the navicular such that it articulates with the anterior aspect of the talar head. If it does not, it is a true vertical talus. If it does, the condition is referred to as an oblique talus. Obviously, if the navicular is not yet visible, as in this infant, the above criteria cannot be utilized. Since the navicular articulates with the cuneiforms, one could compare the talar head with the lateral cuneiform (L), which is visible.

	DP view: The 2nd metatarsal axis is greatly adducted relative to the calcaneal axis. The talar and 1st metatarsal axes are nearly parallel. The calcaneal axis runs through the lateral one-third of the cuboid.
	Lateral view: Most axial relationships appear nearly normal.

	DP view: Again, the 2nd metatarsal axis is greatly adducted relative to the calcaneal axis. The 1st metatarsal axis deviates medially relative to the talar axis. The calcaneal axis runs through the center to medial one-third of the cuboid. The talocalcaneal angle is decreased (hindfoot varus).
	Lateral view: Observe the forefoot varus (ladder-like arrangement of the metatarsals). The first metatarsal axis is parallel to both the talar axis and the plane of support. The talar axis is nearly perpendicular to the tibia, and the talocalcaneal angle is decreased (hindfoot varus).