Hindfoot valgus, sometimes also called prone foot or foot valgism, is a malformation that affects a high percentage of the world’s population

However, as it is a condition that often manifests itself in a mild form, it frequently goes unnoticed.

The disorder affects the bone structure of the foot, causing multiple biomechanical and postural alterations.

To be treated effectively, it is important to make a correct diagnosis at a young age and proceed with the right therapy.

Find out everything you need to know about rearfoot valgus in this article.

What does hindfoot valgus consist of?

First of all, let’s look in more detail at what is meant by the concept of hindfoot.

The term ‘hindfoot’ refers to two specific bones: the calcaneus and the talus.

While the former, in addition to the talus, is in direct contact with the ground and the bone segments of the midfoot, the latter rests on top of the calcaneus.

The hindfoot valgus is a pathological condition of the foot in which an abnormal inward inclination of the calcaneus, caused by a slippage of the talus downwards and towards the midline, can be observed from a posterior view.

The condition of valgus of the foot is not to be confused with varus.

One speaks of varus, in fact, when the feet tend to move away from the midline and the sole of the foot is thus inclined outwards.

A hindfoot valgus is often associated with a flat foot in that the incorrect positioning tends to abnormally lower the plantar arch, causing the sole to rest completely on the ground and to be flattened.

This condition can manifest itself with different degrees of severity depending on the degree of inclination and cause different symptoms depending on the case.

In fact, it is possible that the person suffering from valgus foot may not experience discomfort or pain of any kind.

However, the condition can affect the general well-being of the body and lead to secondary complications.

Among the possible consequences of rearfoot valgus are

• Lumbar lordosis, caused by internal rotation of the lower limb and anteversion of the pelvis.
• The development of knee valgus, resulting in overloading of the medial meniscus and excessive tension of the collateral ligament.

Causes of hindfoot valgus

The causes of hindfoot valgus can be divided into two categories. In a large number of cases, hindfoot valgus is a congenital condition, in which plantar crushing is already present at birth due to a malformation of the calcaneus or from what is commonly referred to as ‘fetal flatfoot’.

More frequently, however, valgus hindfoot has post-traumatic causes, i.e. related to an injury at the structural level of the calcaneus or a failure of the capsular ligament structures.

These injuries can be the result of:

• Fractures;
• Paralysis;
• Inflammatory processes;

Insufficiency of the activating muscles of the foot: this is the case of overloads or deficits of the ligamentous structures during normal adolescent development;

Neoplasms.

What are the main symptoms of hindfoot valgus?

As mentioned earlier, people suffering from hindfoot valgus may not present painful symptoms for a long time, although several manifestations of the disorder can serve as alarm bells, including:

• Tarsal tunnel or metatarsalgia, characterised by localised pain at the level of the metatarsals.
• Plantar fasciitis, also called heelonitis, characterised by pain at the level of the heel.
• Hallux valgus, caused by an altered thrust on the metatarsals, which tends to accentuate the thrust on the big toe.

Other symptoms that may arise due to a valgus foot are

• Pain, often more acute in the early hours of the morning due to prolonged rest, which causes the plantar fascia and ligamentous structures to stiffen or forces neighbouring areas such as the tibia, retro malleolar area and ankle to become rigid.
• Swelling, caused by inflammation of the area, subject to incorrect weight distribution.
• Inflammation of the tendons.

Often, especially in cases where the inclination is very pronounced, it is possible to make a diagnostic suspicion of the presence of a hindfoot valgus simply by observing the footwear.

It happens very frequently, in fact, particularly with shoes with soft soles, that the latter tend to wear down or even deform towards the inner side of the foot.

How is the diagnosis made?

As already emphasised above, it is very important to make an early diagnosis both when there is a congenital type of rearfoot valgus and in cases where the condition manifests itself after an injury. In this way, not only can treatment be more effective, but the condition can be prevented from worsening or giving rise to other serious pathological conditions.

It is therefore necessary to consult a specialised physician, in this case a podiatrist, to get a correct diagnosis and establish an effective treatment plan.

It should be pointed out, however, that in cases where the hindfoot is congenital, it cannot be diagnosed before the age of three, as it is only at that age that the plantar vault assumes a stable shape.

First of all, the podiatrist will look for the cause that led to the origin of the rearfoot valgus and then, at a later stage, will quantify the degree of pronation through certain manual tests and the baropodometric test.

Furthermore, it is not excluded that the doctor may request further instrumental tests, such as an X-ray of the hindfoot, to assess the deformity from a bony point of view.

What are the treatments to correct hindfoot valgus?

In the presence of painful symptoms the patient is advised to place ice packs on the painful area for ten minutes in the morning and evening.

In addition, it is very helpful to apply anti-inflammatory creams to the affected area with a circular massage.

In addition, it is strongly recommended to pay attention to the type of footwear worn, preferring those with a stiffer back than the front.

This type of footwear corrects gait defects and provides greater support for the entire foot.

These, however, are only temporary remedies that will have to be combined with corrective treatments that can give long-term results.

Let’s see what they are.

Physiotherapy to correct rearfoot valgus

The main aims of physiotherapy for hindfoot valgus are to reduce pain, strengthen the muscles and prevent recurrences.

Correcting the patient’s gait and poor posture, so as to prevent inflammation and other related problems, is the ultimate goal of physiotherapeutic treatment.

Antalgic therapy, which makes use of specific instruments, is particularly useful and promises effective results.

Technologies such as Tecaterapia, high-power laser and ultrasound are used.

In some cases, taping can be performed at specific points to reduce symptoms and promote rebalancing.

Manual massage, stretching exercises and trigger point treatments, which are very useful in the re-education process, are also part of the physiotherapeutic treatments for the correction of the hindfoot valgus.

The re-education work focuses on strengthening the calf muscles, the external rotators of the hip, the buttocks and the muscles of the plantar vault, with the aim of realigning the incorrect stance.

Among the most useful therapies in the case of foot valgism is postural re-education using the Mezieres method, also known as Morphological or Postural Rehabilitation.

In some more severe cases, however, physiotherapy is not sufficient to treat the deformity.

Surgery to solve rearfoot valgus

Surgery becomes a mandatory choice in cases where the rearfoot valgus is severe and creates too many problems that cannot be solved with other treatments.

The most frequently proposed surgery is correction by means of an astragalic screw.

This type of surgery intervenes directly on the atragalus, the bone that acts as a link between the foot and the leg and connects the tibia and fibula with the calcaneus.

Its function makes it fundamental in distributing the weight of the foot.

The surgical operation involves the installation of a screw that will allow the position and movements to be re-established and corrected to perfection, making the subject assume the correct posture.

After the operation, walking, thanks to a special type of footwear, will be immediately possible.

However, walking will have to be controlled and not excessive as it is essential to observe a rest period for a proper healing process.

It is not possible to give a precise time frame for the prognosis as the rehabilitation period varies depending on the age of the patient, the invasiveness of the operation and other unpredictable factors.

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