Unilateral calcaneal valgus: what can it mean?

right calcaneal valgus

right calcaneal valgus

Take a good look at this picture and what do you see? Do you see the calcaneal valgus on the right side. What runs through your mind?

Possibilities for causing this condition, as well as the clinical implications are numerous.

The short list should include:

  • A shorter leg on the contralateral side: often times we will pronate more on the longer leg side to compensate for a short leg on the opposite

  • Increased rear foot and/or fore foot pronation on the valgus side. Laxity of the spring ligament or incompetency of the musculature which helps to maintain your arch (tibialis posterior, foot intrinsics, tibialis anterior to name a few) often causes more collapse on the effected side

  • A lack of available rearfoot eversion on the contralateral side. It may be that the increase calcaneovalgus is normal and the opposite side is more rigid.

  • If you were seeing this in the middle of the gait cycle it could be that that is their strategy to get around a loss of hip extension or ankle rocker

  • External tibial torsion on that side. Go ahead, stand up and spin your right foot into external rotation and keep your left foot with a normal progression angle. Can you see how your arch collapses to a greater degree on the side with the external torsion? Remember that pronation is dorsiflexion, eversion and abduction.

  • Internal tibial torsion on the contralateral side. Internal tibial torsion puts the foot into supination which makes it into more of a rigid lever rather than mobile adapter.

    And the list goes on…

    Next time you see a unilateral deformity like this, hopefully some of these things run through your mind and will help you to pinpoint where the problem actually is.

    Dr Ivo Waerlop, one of The Gait Guys

    #calcanealeversion #rearfootvalgus
    #lowerextremitydeformities

Do you know SQUAT? Have you seen SQUAT? Have patients/clients that LIKE to squat? Seen a foot that looks like this? Can you say REARFOOT VALGUS?

 "Significant changes in lower limb kinematics may be observed during bilateral squatting when rearfoot alignment is altered. Shoe pitch alone may significantly reduce peak pronation during squatting in this population, but additional reductions were not observed in the subtalar neutral position. Further research investigating the effects of footwear and the subtalar neutral position in populations with lower limb pathology is required."
 
So, what does this study tell us?

when rearfoot aliment changes, so do the kinematics (duh)
the surface (tilted into varus or inversion) or shoes (which are medially posted) can make or break the man (or women) when it comes to "peak" pronation (we knew that already; confirmation is always nice)
inverting the rearfoot can change ankle dorsiflexion (read "ankle rocker"); inverting the rearfoot seems to reduce it
inverting the rearfoot can change knee flexion; inverting the rearfoot seems to increase knee flexion
inverting the rearfoot can change hip abduction (and thus knee valgus); reducing it

Learn about the gait kinematics and clinical findings associated with this foot type, along with video clip examples and always entertaining discussion with us tomorrow night on onlinece.com: Biomechanics 308: Focus on the Rear Foot.  5PST, 6MST, 7 CST, 8EST


Power V, Clifford AM. The Effects of Rearfoot Position on Lower Limb Kinematics during Bilateral Squatting in Asymptomatic Individuals with a Pronated Foot Type. J Hum Kinet. 2012 Mar;31:5-15. doi: 10.2478/v10078-012-0001-0. Epub 2012 Apr 3.

#rearfootvalgus #squat #foottype

2012 Mar;31:5-15. doi: 10.2478/v10078-012-0001-0. Epub 2012 Apr 3.

The Effects of Rearfoot Position on Lower Limb Kinematics during Bilateral Squatting in Asymptomatic Individuals with a Pronated Foot Type.

Power V1, Clifford AM.

Author information

Abstract

Clinicians frequently assess movement performance during a bilateral squat to observe the biomechanical effects of foot orthotic prescription. However, the effects of rearfoot position on bilateral squat kinematics have not been established objectively to date. This study aims to investigate these effects in a population of healthy adults with a pronated foot type. Ten healthy participants with a pronated foot type bilaterally (defined as a navicular drop >9mm) performed three squats in each of three conditions: barefoot, standing on 10mm shoe pitch platforms and standing on the platforms with foam wedges supporting the rearfoot in subtalar neutral. Kinematic data was recorded using a 3D motion analysis system. Between-conditions changes in peak joint angles attained were analysed. Peak ankle dorsiflexion (p=0.0005) and hip abduction (p=0.024) were significantly reduced, while peak knee varus (p=0.028) and flexion (p=0.0005) were significantly increased during squatting in the subtalar neutral position compared to barefoot. Peak subtalar pronation decreased by 5.33° (SD 4.52°) when squatting on the platforms compared to barefoot (p=0.006), but no additional significant effects were noted in subtalar neutral. Significant changes in lower limb kinematics may be observed during bilateral squatting when rearfoot alignment is altered. Shoe pitch alone may significantly reduce peak pronation during squatting in this population, but additional reductions were not observed in the subtalar neutral position. Further research investigating the effects of footwear and the subtalar neutral position in populations with lower limb pathology is required.

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Whoa!  It is amazing what the human frame can withstand…

This 300 pound individual is retired from working with tow trucks from a towing company as well as a service station.   He believes working with the tow trucks, particularly jumping out of them contributed to the O.A. of the ankles.

He has osteoarthritic ankles, a rear foot varus of 15 degrees left side, 5 degrees right.  He is currently in the New Balance 1040 shoe.  He would like some new orthotics built. He Fowler tests positive on his current orthotic set up (with the foot on the ground, dorsiflex the foot at the 1st metatarsal phalangeal joint (ie big toe joint), simulating terminal stance; the orthotic should hug the arch through the range of motion; ie about 45-60 degress of great toe dorsiflexion, which he incredibly has). He is unable to one leg stand because of the O.A. on the ankles and pain.

He has bi-lat. internal tibial torsion, Left > Right and moderate tibial varum, L > R. He has very little internal rotation of the hips bi-lat. Ankle dorsiflexion is about 5 degrees bilaterally.

He is currently in an older New Balance motion control shoe. You can see how he has worn the shoes into varus. More neutral shoes hurt his feet; attempts to put his rear foot into valgus causes increased ankle pain. Exercise compliance is minimal.

WHAT WOULD YOU DO?

The Gait Guys. Teaching and educating with each post.