Brief overview
- What is a bunted foot? This foot deformity is usually congenital, but can also be caused by illness or accidents. The foot is strongly bent upwards, in extreme cases the toes rest against the shin.
- Treatment: In newborns, usually spontaneous healing, physiotherapy, plaster and splints, surgery, special shoes
- Causes: Constricted position of the baby in the womb, viral infections, genetic causes, neurological disorders, accidents
- Diagnosis: Assessment of visible symptoms, imaging procedures, gait analysis
- Prevention: Not possible with the common primary form, careful treatment of pre-existing conditions and injuries
What is a heel foot?
A heel foot (pes calcaneus) is a special deformity of the foot. It is either congenital or acquired in the course of life. This secondary heel foot is the result of another condition. In the majority of cases, babies are born with a bunions foot. Less common is a combination of a hooked foot and a bent foot, which is referred to as a hooked-bent foot or bent-hooked foot (pes valgocalcaneus).
Symptoms: This is what a heel foot looks like
A pronounced heel foot is noticeable. The entire foot is stretched upwards towards the shin. Doctors refer to this symptom as dorsiflexion. This hyperextension means that it is not possible to bend the foot downwards normally (plantar flexion). In extreme cases, the toes rest against the shinbone so that the sole of the foot points outwards. The foot looks as if it has been folded. It is therefore visually the opposite of the pointed foot, in which the toes point downwards.
As a rule, the deformities only affect the soft tissue, the bones are not affected. This is why this deformity can usually be treated well. Congenital bunions with deformed bones, on the other hand, are very rare.
In the case of bowed heel foot, the sole of the foot is also overstretched upwards towards the shin. In addition, the ankle is slightly bent inwards, which causes the sole to turn slightly outwards.
Possible complaints due to consequential damage
It is not possible to walk normally if you have a pronounced heel foot. Even if the deformity is less pronounced, it should definitely be treated – if it does not disappear on its own. This is important to avoid consequential damage. After all, even a slight heel foot affects the entire musculoskeletal system.
How is a heel foot treated?
The treatment of heel foot depends primarily on the cause. A baby’s bunions usually heal without treatment.
Spontaneous healing
Hackfeet in babies is a common foot deformity. However, doctors do not automatically have to treat it because in many cases it heals itself. This sometimes happens within a few days after birth.
Massage and physiotherapy
If the foot malposition does not return to normal shortly after birth, doctors treat the baby’s bunions. The first step is manual mobilization: muscles and ligaments are massaged and stretched until the sole of the foot has returned to its normal position.
It is recommended that parents support this process by asking the physiotherapist to show them exercises that they can do with their child at home. If necessary, the children can perform the exercises themselves under supervision as they get older. However, this is rarely necessary.
Treatment with plaster casts or splints
Treatment for a baby’s heel foot is usually supplemented by a treatment called redression. In simple terms, this involves forcing the foot into the correct position and holding it there until the structures have adapted and the foot remains in this position. This is done in two phases.
Surgery
Surgery is very rarely necessary for a baby with congenital bunions. Doctors use it more frequently for the secondary form. If the deformity cannot be corrected by conservative measures, there are various options for surgical treatment. Surgeons have various methods at their disposal for this. These are the most important:
- The Achilles tendon connects the calf muscle to the heel bone. It is permanently overstretched in the case of a heel foot. It is therefore advisable to shorten it or change its position in order to exert traction on the sole of the foot.
- Surgeons have a similar effect when they insert additional muscle tendons in the area of the Achilles tendon to strengthen it and thus increase muscle traction.
- Surgeons sometimes remove a piece of bone from the heel bone (hindfoot osteotomy) to help the foot return to its normal position.
- Another option is to force the foot into the correct position and fix it there permanently. Doctors stiffen the ankle joint with a screw (arthrorisis), for example. However, this option restricts the patient’s mobility in the long term. This is noticeable when walking fast or running, for example.
Insoles and special shoes
How does a heel foot develop?
Among the possible causes of pes calcaneus, it is important to distinguish between congenital and acquired variants.
Congenital heel foot
Congenital heel foot in babies is either an independent condition or occurs as a result of another condition. Accordingly, there are various causes.
The common primary bunions, which heal without problems in most cases, are probably caused by the position of the child in the womb. If pressure is exerted on the baby’s feet due to a lack of space, they initially remain in the wrong position. Spontaneous regression within a few days is likely.
There are also genetic causes. In some children, there is an imbalance in the muscles between the lower legs and feet. The calf muscles are then proportionally too weak, which is why the muscles in the area of the shin and the back of the foot pull the foot upwards.
Acquired heel foot
In principle, secondary heel foot occurs at any age. Possible causes are inflammations such as those triggered by the viral disease poliomyelitis (polio). In many cases, they lead to paralysis and thus also to a heel foot. However, polio is considered to have been eradicated in Germany thanks to extensive vaccinations. The autoimmune disease myasthenia gravis, for example, has a similar effect.
A heel foot may also occur if the Achilles tendon is injured or possibly severed. It helps to keep the foot in position. The calf muscles also play an important role. If they are injured or no longer properly supplied because the corresponding nerve is damaged in an accident, for example, this often leads to an imbalance in the muscles and, as a result, to misalignment of the foot.
Surgery is also a possible cause of bunions. This is particularly the case if doctors want to correct another foot deformity and the correction is too intensive, for example by lengthening the Achilles tendon too much. A foot that is permanently positioned incorrectly can also lead to malpositions.
How is a heel foot diagnosed?
In a newborn, a comprehensive diagnosis is particularly relevant if the heel foot has not regressed after a few days. Some of the examinations are also important in order to identify or rule out other diseases as the cause.
In a discussion with the parents or the adult affected, the doctor clarifies any relevant previous illnesses (anamnesis). A neurological examination checks the function of the nerves and looks for disorders or deficits such as signs of paralysis.
Imaging procedures such as X-rays, ultrasound, magnetic resonance imaging (MRI) and computer tomography (CT) help to precisely determine the extent of the heel foot. A gait analysis is useful for older patients.
If the disease is advanced, further examinations may be necessary. The doctor assesses the extent to which consequential damage to the musculoskeletal system has already occurred. The focus here is on the knees, pelvis and spine.
Prevention
It is not possible to prevent primary bunions in babies. If conditions are diagnosed during pregnancy that may lead to secondary bunions, such as an open back, these are treated comprehensively.
After injuries, it is important to fix the foot in the correct position for the healing process in order to prevent bunions.
