Calcaneovalgus foot is also known as flexible flatfoot in infants and young children. In infants this foot disorder is seen with the foot abducted (turned) and the ankle severely dorsiflexied (twisted). Upon birth the foot looks like it is plastered against the front of the leg. A mild form of calcaneovalgus foot may be seen in 30% of infants, but the more severe form may be present in 1/1000 infants.
Calcaneovalgus foot is a common foot disorder which is a result of intra uterine positioning, and muscle imbalancing, which happens because of weakness of plantarflexors.
Calcaneus indicates that the heel is downward, and the ankle is flexed upward. Valgus refers to the heel turned outward. Calcaneovalgus feet are often called "packaging problems" because the structures were normally formed, but were deformed in the uterus because of crowding. It is commonly seen in first-born children and females.
Diagnosis is made by physical exam. The feet have a classic appearance with the feet bent upward, and the heel bone should be palpable to the heel pad in a twisted position. There should be good ankle motion, but may be limited by tight anterior structures. There should also be good flexibility in the hindfoot and forefoot. It is important to verify the flexibility of the foot and ankle.
Treatment can often be very simple. Gentle stretching and massage will help mobility and appearance. Within one to two months, the feet will have improved. In serious cases casting, followed by stretching exercises and an AFO splint for additional months may be necessary.
Most infants have a full recovery with recommended treatment. Rarely there is an external rotation alignment issue to the legs as the child begins to walk, but this typically corrects itself over time.
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