Anatomical Foot Deformities

The feet are extremely powerful when it comes to movement being successful or not.  This is most likely for a few reasons, firstly, because it is the feet that hit the floor, they are the first link in the chain of a vast majority of our movements.  If at this point they go through motions that help the rest of the chain, that’s good.  If on the other hand they do not go through the required motions that can cause a big knock on effect further up the chain.

Another reason they are so powerful is because they are extremely stubborn!!  They are ‘built’ to withstand large forces and to withstand those forces repeatedly without complaining.  So when things aren’t as they should be that stubbornness can play against us.

Today I wanted to go through a few of the anatomical foot deformities that we all see day to day to varying degrees and I think in subsequent posts we will have a look at the effects of those deformities locally and globally before we have a look at how to deal with them when you see them.

Rear Foot Varus

I thought we’d start with the rear foot varus because it is really common and we see them to varying degrees each day in the clinic.  A varus is when the foot is in a relatively inverted position, even when in sub talar neutral.  It’s normal for the calcaneus to be in about 2 degrees of varus, so there’s no need to worry about that.  However, if there is more than that it could be that the body is having to compensate for those differences.  This could cause many varying types of compensation in the range of motion, the speed of motion or the timing of motion locally at the foot, with knock on consequences further up the chain.

A rear foot varus is when the calcaneus is excessively inverted relative to the tibia.  So to assess a rear foot varus I will have the patient prone with their feet freely dangling off the end of the treatment table.  It’s then important to find sub talar neutral for the tab individual and then you can assess the relative position of the calcaneus to the tibia.  Personally, I eyeball the result and make my clinical decision based on that.  However, there are ways of measuring it, which are to detailed to go into on here.  If the calcaneus is excessively inverted relative to the tibia I will consider them positive for a rear foot varus.

Forefoot Varus

I think from memory this is statistically the most common foot deformity.  However, whereas the rear foot varus is the relationship between the calcaneus and tibia, a forefoot varus is the relationship between the rear foot and the forefoot.  Again, because this is a varus, the deformity will be if the forefoot is excessively inverted relative to the rear foot.

I assess in the same position, prone with feet off the end of the bed.  There’s no need for sub talar neutral as you are simply looking at the relationship between the rear foot and the forefoot.  Position yourself over the foot so you are looking down on the calcaneus and can see along the sole of the foot.  To assess I imagine a plane under the calcaneus that is where the floor would be, which give me the plane of the rear foot.  Then I compare that to the imaginary plane under the metatarsal heads, which gives me the plane of the forefoot.  If the two planes line up you can begin to think there is no forefoot varus. If the plane of the forefoot is showing a position of an inverted forefoot, then you can begin to think there is a forefoot varus.

Forefoot Valgus

Though this is less common you will see them.  The assessment is exactly the same as for the forefoot varus, however the plane of the forefoot will show it to be everted relative to the rear foot.  If this is the case you can begin to think you are dealing with a forefoot valgus.

Plantarflexed First Ray

This is when the first ray of the foot is lower/plantarflexed relative to the plane of the other metatarsals.  I assess again in prone with the patients feet off the end of the table.  You need to look at the alignment of the metatarsal heads.  If they are all in line, then there maybe no problem, however, if you see the first ray is lower/plantarflexed relative to the others then you may be dealing with a  plantarflexed first ray.

These often occur in conjunction with other deformities.  You particularly have to be careful with a forefoot varus that also has a plantarflexed first ray as in combination they can look like a normal foot.  So keep an eye out for that one!!

Equinus

An equinus is when the forefoot is plantarflexed relative to the rear foot.  So again looking down on the calcaneus along the sole of the foot or looking from the side of an off weight bearing foot you will see that the forefoot is plantarflexed relative to the rear foot.  This is a really stubborn one and the patient will have very little functional dorsiflexion as they are using all the range they have to compensate for the deformity…however, we’ll get into that more when I post about that specifically.

Summary

These are just some of the more common things you will see when assessing the structure of a foot.  I always say that even if you are assessing and see an apparent deformity that you ‘may’ be looking at that type of deformity.  This is because I use a battery of tests to assess a foot.  The off weight bearing assessment is key, but is only part of it.  I always want to know their function on weight bearing too.  Only then can I make a clinical decision as to what will best help that patient.

The follow up posts to this will deal with the functional side to the assessment, the kinetic chain compensations you see with the different deformities and how I go about treating them.  I think I’ll do 1 post a week on this so not to overload on the foot (again!!!)

Physioblogger

Related Posts

Anatomical Foot Deformities: Rear Foot Varus

Anatomical Foot Deformities: The Rear Foot

Anatomical Foot Deformities: The Forefoot Valgus

Anatomical Foot Deformities: The Forefoot Equinus

Anatomical Foot Deformities: The Plantar Flexed First Ray

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11 Responses to Anatomical Foot Deformities

  1. kevin hubble February 7, 2012 at 2:02 pm #

    Great read thank you Neil.

  2. Dawna February 7, 2012 at 5:52 pm #

    Awesome – I’ve encountered several of these – great introduction! Looking forward to subsequent posts on this topic!

    • physioblogger February 9, 2012 at 11:19 am #

      Thanks guys…obviously my obsession with the foot finally caught up with me…I’ll try to keep it to one a week 🙂

  3. Kedar March 19, 2012 at 3:23 pm #

    Amazing articles. Thank you.

  4. Tony November 6, 2012 at 8:17 pm #

    Hi Neil Its interesting to read how much research you had to do to get your knowledge on orthotics!! Unfortunately I’m not going to be lucky enough to go over to the states & study any time soon!! Altougth I have just signed up to do the EFT course with Faster. It was mentioned that you will be teaching part of the course – will you be teaching anything on foot diformities & temporary orthotic making?? I am seriously looking forward to the course:) & was just wondering what you will be teaching?

    All the the best – Tony

    • physioblogger November 7, 2012 at 6:54 am #

      Hi Tony,
      Though I do work with FASTER, I’m not currently teaching for them due to other work commitments. However, I’m sure you will enjoy the course and I’m sure you can steer the conversation onto foot deformities at some point 🙂

      Thanks,

      Neil

  5. David January 29, 2014 at 2:53 am #

    Great article. However, it does matter whether the STJ is in neutral when assessing forefoot alignment, as the MTJ is influenced by whether the STJ is pronated or supinated. Ie the locking/unlocking mechanism of the MTJ. Not doing this is one of the more common reasons for a misreading, as assessing the forefoot alignment with STJ pronated often results in a false FF varus interpretation;STJ supinated results in a false FF valgus interpretation.

    Thanks for the great material.

    • physioblogger January 29, 2014 at 9:47 pm #

      Hi David,

      Thanks for your comment. I’m not sure if we are talking at crossed purposes…I think I was talking there about an off weight bearing assessment, therefore the STJ will not influence the MTJ. The assessment should be between the relationship of the forefoot relative to the rear foot, so I believe the STJ is not influencing this assessment.

      If I’m answering the wrong question, please let me know,

      Thanks,

      Neil

  6. Roman February 4, 2014 at 1:50 pm #

    Great. Thank you. Roman.

Trackbacks/Pingbacks

  1. Anatomical Foot Deformities: Forefoot Equinus | Sports Therapy Academy - August 19, 2012

    […] Anatomical Foot Deformities […]

  2. What Happens when the Foot is Dysfunctional? - Physioblogger - April 10, 2013

    […] The obvious place to start is with the anatomical structure of the foot.  This gives us massive clues as to what is going on and how the foot will react in function.  Having said that I hold far less stock in that idea than I have previously.  It’s too much to go into in one post, but we can cover the principles.  If you want more detail take a look at the series on anatomical foot deformities. […]

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