Abstract
Pediatric pes planovalgus deformity may be classified as flexible or rigid. The rigid
pes planovalgus is often a result of a tarsal coalition, which is typically characterized
as a painful unilateral or bilateral deformity, frequently associated with peroneal
spasm. However, many tarsal coalitions are asymptomatic and demonstrate no peroneal
spasm or pes planovalgus deformity. Likewise, the severe pes planovalgus foot type
can demonstrate some of the same clinical and radiographic features of a tarsal coalition,
especially in the obese adolescent patient. Also, peroneal spasm may occur in the
noncoalesced foot, making diagnosis and etiology more difficult to elucidate. The
authors believe that many patients with a pes planovalgus deformity lie in this “gray
zone”: somewhere between the frank osseous coalition and the flexible pes planovalgus.
The “step-forward Hubscher maneuver” is introduced as an effective means of evaluating
the flexibility of a pes planovalgus foot by negating the effects of a gastrocnemius
or gastrocnemius-soleus equinus. This article focuses on the clinical examination
and findings of specific imaging studies to assist in an accurate diagnosis of these
complicated patients. This will also help to reveal the various surgical options that
are appropriate for the individual patient. Emphasis is placed on computerized tomography
(CT) imaging and offers enhanced methods for ordering this test to specifically evaluate
middle facet coalitions of the subtalar joint. The authors also introduce “lateral
tarsal wedging,” an image finding associated with severe deformities, the implications
of this finding, as well as its impact on surgical planning.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: March 31, 2010
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
Identification
Copyright
© 2010 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
