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Chirurgia del Piede 2010 April;34(1):7-17

Copyright © 2010 EDIZIONI MINERVA MEDICA

language: Italian

Dysmorphisms of coxa pedis (talipes cavus-valgus) and rotatory (femoropatellar disease) and torsional derangements (hip anteversion) of the lower extremities

Pisani G.

Centro di Chirurgia del Piede “Prof. G. Pisani”, Clinica Fornaca di Sessant, Torino, Italia

Starting from the concepts of coxa pedis, torsion and rotation, astragalus bone of foot, and astragalus bone of leg, a clinical picture of talipes cavus-valgus is described. Apparently flat when the medial side is resting on the ground, talipes cavus-valgus can be distinguished from true pes cavus by its external concave profile, the podoscopic imprint of pes cavus, and limb intrarotation. Unlike pes planus, in which the arch collapses on the sagittal plane thereby losing its vault-like structure, in talipes cavus-valgus the arch topples over but maintains its vault-like structure. Because the astragalus bone of leg is weight-bearing (closed kinetic chain), its abduction, as it everts, translates on the horizontal plane to intrarotation which transfers firmly to the lower limb. A manifestation of this is convergent strabismus of the patella with derangement of femoropatellar function. If the condition persists during growth, it may lead to apparently primary dysmorphisms of the tibial tuberosity owing to its progressive migration and of the trochleae. Similarly, intrarotation of the limb secondary to talipes cavus-valgus is reduced, functionally compensating physiological hip anteversion, the mechanical component of the iliacopsoas in the correction of physiological anteversion.