Calcaneal Foot Deformity – Causes and Treatment
Calcaneal foot deformity (Pes calcaneus) is a foot condition where the foot is permanently dorsiflexed, causing the person to walk primarily on the heel.
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Calcaneal foot deformity (Pes calcaneus) is a foot condition where the foot is permanently dorsiflexed, causing the person to walk primarily on the heel.
What is Calcaneal Foot Deformity?
Calcaneal foot deformity, known medically as Pes calcaneus, is a structural foot condition in which the foot is fixed in a dorsiflexed position -- meaning the front of the foot is permanently pulled upward and the heel becomes the primary point of ground contact during walking. The foot cannot be fully plantarflexed (pointing downward), which significantly affects the normal gait pattern. The condition may affect one or both feet and can be present from birth or develop later in life.
Causes
Calcaneal foot deformity can arise from several different causes:
- Congenital malposition: An abnormal position of the baby in the womb (e.g., breech presentation) can mechanically push the foot into an overextended position before birth.
- Muscle weakness or paralysis: Weakness or paralysis of the calf muscles -- as seen in conditions such as spina bifida, myelomeningocele, or cerebral palsy -- leads to an imbalance in which the muscles that lift the foot overpower those that lower it.
- Nerve damage: Injury to the peroneal nerve or other motor nerves can impair foot muscle function and contribute to a calcaneal foot posture.
- Over-correction of clubfoot: Surgical or conservative overcorrection of a clubfoot (Pes equinovarus) can occasionally result in a calcaneal foot deformity.
- Trauma: Injuries to the Achilles tendon or calf musculature may also predispose to a calcaneal foot position.
Symptoms
Common signs and symptoms of calcaneal foot deformity include:
- Visible permanent dorsiflexion of the foot -- the top of the foot points clearly upward
- Absent or severely reduced ability to point the foot downward (plantarflexion)
- Walking predominantly on the heel (calcaneal gait)
- Pressure sores and calluses on the heel
- Pain in the heel area, particularly when walking
- Reduced push-off strength during walking
- In advanced cases: shortening of the anterior leg muscles and restricted joint mobility
Diagnosis
Diagnosis is typically made through a clinical examination in which the physician assesses the shape of the foot, the range of motion of the ankle joint, and the gait pattern. Additional investigations may include:
- X-rays: To evaluate the bony structures and the angle of the calcaneus
- Electromyography (EMG): To assess muscle function and nerve conduction
- Gait analysis: For a detailed evaluation of movement patterns
- MRI or ultrasound: If accompanying soft tissue changes or tendon damage are suspected
Treatment
Treatment depends on the severity of the deformity and its underlying cause.
Conservative Treatment
- Physiotherapy: Strengthening of the calf muscles, stretching of shortened structures, and gait training
- Orthoses and splints: Custom insoles or lower leg orthoses help stabilize the foot and correct the abnormal position
- Serial casting: Particularly in newborns, progressive plaster casts can gradually correct the foot alignment
Surgical Treatment
In severe or treatment-resistant cases, surgical intervention may be required. Possible procedures include:
- Tendon lengthening or tendon transfer to restore muscle balance
- Bone-corrective procedures (osteotomies) of the calcaneus
- Arthrodesis (surgical fusion) of the ankle joint in severe cases
Prognosis
The prognosis of calcaneal foot deformity depends strongly on the underlying cause and the timing of treatment. In congenital cases without an underlying neurological condition, the outlook is generally good with early intervention. When the deformity is neurogenic in origin, long-term management by a multidisciplinary team including orthopedics, neurology, and physiotherapy is essential.
References
- Niethard, F. U., Pfeil, J., Biberthaler, P.: Duale Reihe Orthopaedie und Unfallchirurgie. Thieme Verlag, Stuttgart, 8th edition, 2017.
- Staheli, L. T.: Fundamentals of Pediatric Orthopedics. Lippincott Williams and Wilkins, Philadelphia, 4th edition, 2008.
- World Health Organization (WHO): International Classification of Functioning, Disability and Health (ICF). Geneva, 2001. Available at: https://www.who.int/classifications/icf/en/
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