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
is normally caused by spasticity of the tibialis posterior whilst mid-foot varus is normally caused by tibialis anterior spasticity.
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.
Their study noted a 100% union rate with return to prior activity level and no recurrence of fractures, when operative Jones fractures with hindfoot varus were supplemented with an orthotic to offload the varus.
On physical examination, the lower extremity is inspected and palpated while noting any existing hindfoot varus.
Patients with ankle instability and hindfoot varus deformity should be treated with a concurrent calcaneal osteotomy with lateral ankle ligament reconstruction.