everted forefoot
everted forefoot
; forefoot valgus congenital rigid or flexible foot deformity with forefoot eversion relative to plantar plane of the rearfoot (when the subtalar joint is in neutral and the midtarsal join is maximally pronated about both axes); presenting as total forefoot valgus (i.e. entire plantar plane of forefoot is everted relative to rearfoot), or as partial forefoot valgus (i.e. first ray is plantarflexed relative to remainder of forefoot); Table 1; Figure 1| Presentation | Characteristics |
| Rigid forefoot valgus | Rearfoot relationship to lower leg normal Non-adaptation of foot during loading, in relation to imposed ground reaction forces under forefoot Forefoot loads from medial to lateral, i.e. 1 MTPJ to 5 MTPJ (not 5 MTPJ to 1 MTPJ, as in the normal foot) Little or no available MTJ supination Excessive supination at the STJ Reduced contact period pronation External rotation of the leg with resultant lateral instability of the knee, ankle and STJ |
| Signs and symptoms | Increased height of the medial longitudinal arch Calcaneal inversion Lateral ‘rock’ during gait due to early stance-phase STJ supination (supinatory rock) Loss of shock absorption mechanisms in lower limb with induced lower-back, hip, knee and shin pathologies Reduced MTJ mobility Retraction or clawing of the lesser toes and triggering of the hallux, with local shoe trauma Hyperkeratoses of the plantar skin overlying the 1 and 5 MTPJs Posterolateral calcaneal irritation Difficulties in obtaining shoes that accommodate the foot deformity Excess wear on lateral side of sole of shoe |
| Mobile forefoot valgus | Rearfoot relationship to lower leg normal Forefoot loads from medial to lateral, i.e. 1 MTPJ to 5 MTPJ (not 5 MTPJ to 1 MTPJ, as in the normal foot) The foot is mobile and distorts (pronates excessively) under load, so that the first ray dorsiflexes and the MTJ supinates The MTPJ unlocks when supinated, with resultant forefoot hypermobility |
| Signs and symptoms | Hallux abductovalgus and/or hyperextension of hallux at interphalangeal joint Lesser-toe deformities, including hammered second toe Hyperkeratoses of the plantar skin overlying the 2, 3 and 4 MTPJs Adductovarus of the fifth toe with dorsal and lateral hyperkeratosis Tailor's bunion Plantar digital neuritis Plantar fasciitis and foot strain Medial sesamoiditis First metatarsal – medial cuneiform osteoarthritis Compensatory calcaneal (STJ) pronation leading to Haglund's deformity, medial knee, shin and lower-back pain |
MTJ, midtarsal joint; MTPJ, metatarsophalangeal joint; STJ, subtalar joint. | |
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Figure 1: Rearfoot varus. A, uncompensated rearfoot varus. B, compensated rearfoot varus. C, pattern of hyperkeratotic lesions in the compensated foot. D and E, orthotic and shoe modification to control compensation. This article was published in Neale's Disorders of the Foot, Lorimer, French, O'Donnell, Burrow, Wall, Copyright Elsevier, (2006).