Talipes equinovarus is a congenital deformity consisting of ankle equinus, hindfoot varus
, forefoot adduction and clubfoot is probably the most common congenital orthopaedic condition requiring intensive treatment.
Podoscopic examination showed a hindfoot varus
and defective medial support.
(19) The Dimeglio/Bensahel system consists of giving a score of 0 to 4 for equinus, hindfoot varus
, midfoot rotation, and forefoot adduction, and a score of 1 or 0 (present or absent, respectively) for posterior crease, medial crease, cavus, and abnormal underlying musculature.
The eventual plantar-flexed first ray thereafter drives both cavus, resulting in hindfoot varus
Dwyer's osteotomy of calcaneum will correct hindfoot varus
; medial rotational osteotomy of tibia will correct lateral rotational mal-alignment of the tibia and fibula.
(24) Clinically and radiographically, Raikin noted that 18 of 21 Jones fractures treated in his series had evidence of hindfoot varus, and he concluded that fractures of the fifth metatarsal may have a predisposing chronic etiology.
Additionally, the use of a supplemental lateral hindfoot wedge orthotic has been advocated in the setting of hindfoot varus. In one report, 18 of 21 operative Jones fractures were noted to have some degree of hindfoot varus, versus a previous estimate of approximately 25% of the general population having hindfoot varus.
On physical examination, the lower extremity is inspected and palpated while noting any existing hindfoot varus. The hindfoot motion should be recorded and peroneal muscle strength should be tested.
Patients with ankle instability and hindfoot varus deformity should be treated with a concurrent calcaneal osteotomy with lateral ankle ligament reconstruction.