Abnormal Foot Alignment

Abnormal Foot Alignment

Pronated foot (general):
Lateral view:
Anterior break in cyma line
Sinus tarsi is obliterated
Talus declination angle is increased
Decrease in calcaneal inclination angle
Sustentaculum tali is less dense
Cuboid is lower
AP view:
Break in cyma line
Medial rotation of head of talus

Forefoot varus:
1) Compensated:
evidence of subtalar joint pronation and subluxation  Cyma line severely disrupted
on lateral view there should be a large amount of superimposition of navicular and cuboid
‘wedging’ of navicular
2) Uncompensated:
greater superimposition of tarsal and metatarsal bones
no evidence of subtalar joint pronation or subluxation

Rigid Forefoot valgus/plantarflexed first ray:
higher arched appearance (see supinated foot below)
accentuated sinus tarsi
dorsiflexed position of first ray on lateral view

Rearfoot varus:
1) Compensated:
despite maximum subtalar joint pronation  no subluxations of joints
2) Uncompensated:
Inverted position of forefoot  greater superimposition of tarsal bones
No subtalar joint pronation evident

Pronated foot due transverse plane abnormality:
tend to have greater talocalcaneal angle on AP view
Cyma line tends to be more severely displaced.

Compensated equinus:
‘Rocker bottom’ appearance to foot – the ‘Nutcracker syndrome’
features of pronated/subluxed foot – especially severe anterior cyma line displacement; wedging of navicular; subluxation of subtalar joint
flattening of trochlea surface of talus

Supinated foot/high arched foot (general):
higher arch morphology
increased calcaneal inclination angle; increased metatarsal declination angle
accentuation of sinus tarsi – the ‘bullet hole’ sign
may have posterior break in cyma line
clawed toes

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