Forefoot Varus
Forefoot varus is considered a relatively rare condition. In simplistic terms, this abnormality is characterized by a fixed, inverted position of the forefoot relative to the rearfoot when the foot is placed in a neutral position. Forefoot varus can be broadly classified as compensated and uncompensated. In a compensated forefoot varus, the subtalar joint is forced into maximum pronation during midstance to enable the forefoot to contact the ground. This process has the effect of destabilizing the foot by encouraging hypermobility. Compensated forefoot varus is characterized clinically by excessive weight bearing on the medial border of the foot. Other clinical signs can include forefoot deformity due to the enhanced hypermobility. Deformities may include: hallux abducto valgus (bunions), lesser toe deformities and plantar metatarsal head callus (Fig. 8).
Figure 8 illustrates the common sites for callus associated with compensated forefoot varus which concentrates under the second metatarsal head. The management of forefoot varus should focus on reducing the development of callus by controlling abnormal pronation of the subtalar joint and reducing hypermobility of the forefoot. 'Ihis can be achieved by supporting the forefoot with a medial wedge. In simplistic terms, an uncompensated forefoot varus occurs when the forefoot is inverted relative to the rearfoot and relative to the ground, when the foot is placed in neutral position. This deformity is characterized by a foot which maintains an inverted, laterally-loaded position throughout the gait cycle due to a lack of available subtalar joint pronation. Uncompensated forefoot varus presents clinically as a rigid, immobile foot with minimal shock absorption.
Unlike compensated forefoot varus, forefoot deformity is an uncommon complication of this positional abnormality. Plantar callus distribution occurs beneath the fifth metatarsal head and the plantar aspect of the interphalangeal joint of the hallux (first toe). A common distribution of callus in the uncompensated forefoot varus is shown in Figure 9. Uncompensated forefoot varus should be managed using accommodative orthotics and footwear which redistribute pressure rather than control function. A lateral flare to the shoe can reduce the abnormal load placed on the lateral border of the foot and improve stability.
Forefoot varus is considered a relatively rare condition. In simplistic terms, this abnormality is characterized by a fixed, inverted position of the forefoot relative to the rearfoot when the foot is placed in a neutral position. Forefoot varus can be broadly classified as compensated and uncompensated. In a compensated forefoot varus, the subtalar joint is forced into maximum pronation during midstance to enable the forefoot to contact the ground. This process has the effect of destabilizing the foot by encouraging hypermobility. Compensated forefoot varus is characterized clinically by excessive weight bearing on the medial border of the foot. Other clinical signs can include forefoot deformity due to the enhanced hypermobility. Deformities may include: hallux abducto valgus (bunions), lesser toe deformities and plantar metatarsal head callus (Fig. 8).
Figure 8 illustrates the common sites for callus associated with compensated forefoot varus which concentrates under the second metatarsal head. The management of forefoot varus should focus on reducing the development of callus by controlling abnormal pronation of the subtalar joint and reducing hypermobility of the forefoot. 'Ihis can be achieved by supporting the forefoot with a medial wedge. In simplistic terms, an uncompensated forefoot varus occurs when the forefoot is inverted relative to the rearfoot and relative to the ground, when the foot is placed in neutral position. This deformity is characterized by a foot which maintains an inverted, laterally-loaded position throughout the gait cycle due to a lack of available subtalar joint pronation. Uncompensated forefoot varus presents clinically as a rigid, immobile foot with minimal shock absorption.
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