Hacked foot (pes calcaneus) is a relatively common deformity in which the foot is bent upward so much that the toes can touch the shin with light pressure and the heel is the lowest point. There are two forms of hack toe, congenital or acquired.
What is a heel foot?
With a heel foot, the foot is straight up, it is not possible to stand on the sole of the foot. With a heel foot, you can only stand on the heel. The sole of the foot is turned slightly outward. Excessive upward flexion, especially in infants with the congenital shape of the heel foot, allows the dorsum of the foot to move up to the shin. The Achilles tendon is very overstretched and worn out due to this poor posture. The tendons and the skin on the back of the foot, on the other hand, are shortened. This form of malalignment is the opposite of the pointed foot, in which the foot is severely hyperextended and the toes point downward rather than the heel.
Causes
Hack toe can have different causes, depending on whether it is congenital or acquired. The congenital form can be caused by a genetic muscle imbalance. Hack foot also occurs in certain spinal cord disorders, such as spina bifida, or in damage to the brain, such as that caused by hypoxia (lack of oxygen). Another possible cause of hackfoot is an unfavorable position of the embryo in the uterus. If the foot does not have enough space and is forced to bend strongly upwards, a hackfoot is formed. However, this form regresses well in the first weeks of life. Acquired heel foot occurs when the muscles of the calf are disturbed in their function. This can be caused by injuries of the tibial nerve or the Achilles tendon. A hack toe can also result from an incorrectly applied cast.
Symptoms, complaints, and signs
In a heel foot, the heel is bent upwards, so that affected persons have to walk almost exclusively on the heel, which puts extreme strain on it and leads to pressure points. Due to the malposition, the foot is overstretched as a whole and it is hardly possible to place it on the ground when walking. It can only be stretched to a very limited extent and standing on the toes is almost impossible. The deformity can sometimes be so severe that the back of the foot can touch the lower leg. Children born with a heel foot have difficulty learning to walk and learn late due to the foot deformity. Because the foot cannot be placed properly, there is a permanent misalignment in walking, with the knee and hip joints bent and the pelvis severely tilted. Due to this faulty way of walking, the heel foot increasingly stresses the statics of the entire skeleton. Pain occurs in the heel because it is chronically overloaded during walking and standing. The permanent pressure on the heel tissue can lead to pressure necrosis because the oxygen supply to the tissue is impaired by the constant pressure.
Diagnosis and progression
Hacked heel can be clearly diagnosed by its appearance. The severely upward flexion of the foot and the outward rotation of the sole of the foot give the typical appearance. With an x-ray, the physician can visualize the foot’s malposition and determine any effects on the rest of the skeleton. In newborns, the heel-toe, if caused by a forced position in the uterus, regresses on its own within a few days. If this malposition exists in adults, for example due to an injury to the tibial nerve, it is no longer possible for them to bring their toes to the ground. Walking takes place on the heels, which leads to an overload of the heel tissue. In the long run, pain develops, walking is difficult or impossible, depending on the severity of the deformity. The posture of the body changes due to the heel foot, as the affected person can no longer perform the normal movement sequences when walking. This can lead to a tilting of the pelvis, accompanied by an increasingly pronounced hollow back. At the heels, the tissues can become inflamed due to the constant pressure and die over time (pressure necrosis).
Complications
The heel-to-toe foot causes a very severe deformity of the foot. This deformity leads to various discomforts when walking and standing, and usually also leads to relatively severe pain.Due to the malposition, Zeus also causes other complaints, such as the so-called hollow back. Due to the movement restrictions and the permanent pain, many patients also suffer from psychological complaints or depression. Likewise, there may be a slight irritability. Children may also be teased or bullied due to the disease. Treatment of the disease is symptomatic and causal. Pain can be limited with the help of painkillers, and complications do not occur. However, long-term use of painkillers can also cause damage to the stomach. Furthermore, hackleg can also be corrected relatively easily. However, in most cases, various therapies continue to be necessary to completely limit the symptoms. No further complications or discomfort occur during treatment. As a rule, the symptoms of heel foot no longer occur in adulthood. The disease also does not reduce the patient’s life expectancy.
When should you see a doctor?
In most cases, hackleg is congenital and is detected in infants right after birth. It may be caused by an awkward position in the womb during pregnancy or it may be genetically predisposed. It is often a temporary deformity that corrects itself after a few days. However, a heel-toe can also be caused later by an injury, such as a rupture of the Achilles tendon. In case of a more severe deformity, which causes pain and pressure points and makes walking difficult, a doctor should definitely be consulted. He can usually already identify the reason by the type of malposition and the discomfort caused by it. In addition, an X-ray can provide even more detailed information about the cause. If the foot does not return to the correct position on its own, the doctor can prescribe physiotherapeutic measures; in rarer cases, surgery must be performed to correct the deformity. Since a heel foot can result in further complaints of the musculoskeletal system due to the incorrect posture, affected persons should consult a doctor as early as possible so that corrective measures can be initiated in good time.
Treatment and therapy
Therapy is based on the cause. Hack foot, which is caused in the newborn by too tight a position in the uterus, can be easily treated. It usually regresses almost by itself. The treatment to be given here merely has a supporting effect on the foot by repeatedly bringing it into the correct position with gentle pressure massages, holding it for a few seconds and then releasing it again. If the heel is more severely developed, it may be necessary to hold it in the correct position during the night with splints. Physiotherapeutic measures can be used to support regression. If the heel foot is acquired, surgery may be necessary. In this case, a wedge is cut out of the heel bone and thus the malposition is corrected. Another possible surgical therapy is shortening the Achilles tendon or stiffening the ankle joint.
Outlook and prognosis
A heel foot is a malposition of the foot, whereby the foot is constantly bent upwards. In this case, the entire heel bone stands steeply in a kind of extension of the lower leg. In addition, there is often a bend in the heel, which points outward. It is very difficult to give a specific prognosis in the case of a heel foot, since this clinical picture can occur in different degrees of severity. In general, a positive prognosis can be given for a heel foot, since an improvement can be brought about by physiotherapy or by a surgical intervention. In newborns, such a hackfoot occurs very frequently. However, this is not called an explicit clinical picture. This phenomenon usually disappears within a few days, so that no appropriate treatment needs to be initiated. Those who decide against treatment must reckon with considerable complications. In the course of age, permanent consequential damage to the joints may occur under certain circumstances.
Prevention
Congenital hackleg cannot be prevented because it is genetic or caused by a the amount of space in the uterus.In order to prevent the acquired heel foot, attention should be paid to the correct position of the foot after accidents, when the leg must be immobilized by a bandage or a cast. If the heel foot has formed, it should be treated as soon as possible to prevent further damage.
Aftercare
Affected persons have in most cases no special or direct measures and possibilities of an aftercare available for a heel foot. In this disease, the first priority is to detect and diagnose the disease at an early stage to prevent further discomfort or further complications. The earlier the disease is detected, the better the further course of the disease usually is. The treatment of the disease is usually done by wearing a splint or by wearing insoles. The affected person should make sure to use these aids permanently so that the heel foot disappears completely. Measures of a physiotherapy or a physiotherapy can also be very helpful with a heel foot and relieve the complaints permanently. Often, the exercises from physiotherapy can also be performed in the patient’s own home to speed up the healing process. If the heel is corrected by surgery, the patient should take care of the foot after the procedure and not exert himself. Physical and stressful activities should also be avoided. As a rule, heelfoot does not reduce the life expectancy of the affected person. Further measures of aftercare are not necessary.
What you can do yourself
Congenital heelfoot usually regresses on its own within a few days. In all other cases, the foot malposition must be treated therapeutically. The treatment can be effectively supported by some measures. Accompanying physiotherapeutic treatment, targeted foot training is recommended to strengthen the foot and toe flexors. Gentle pressure massages are also effective and are particularly helpful in the case of mild heel-toe foot. Severe deformities may need to be corrected with the help of splints or casts – sometimes only at night. If it is not possible to correct the heel sufficiently, wearing orthopedic shoes with insoles is indicated. In adolescents and adults – especially in the case of accidental heelfoot – surgical treatment is necessary. After the surgical intervention, the affected person must be on strict bed rest. The affected foot must be slowly prepared for everyday stress with the help of physiotherapy or light sport. In the first days to weeks after the operation, it is advisable to wear orthopedic insoles. Which measures the affected persons can take themselves apart from this, must be decided in each case by the responsible physician.