During a Coleman block test, if the calcaneus everts, what cavus type and procedure are indicated?

During a Coleman block test, if the calcaneus everts, what cavus type and procedure are indicated?

• A. Forefoot driven cavus; dorsiflexory osteotomy of 1st ray
• B. Rearfoot driven cavus; lateralizing calcaneal osteotomy
• C. Forefoot driven cavus; metatarsal osteotomy
• D. Rearfoot driven cavus; first metatarsal fusion

Answer: (A)

The Coleman block test distinguishes whether cavus is driven by the forefoot or the hindfoot by seeing how the hindfoot behaves when the hindfoot is allowed to move on a block. If the calcaneus everts on the block, it shows that the hindfoot is flexible and the deformity is forefoot-driven, meaning the forefoot (typically a plantarflexed first ray) is pushing the arch upward. In this situation the corrective approach focuses on the forefoot: a dorsiflexion osteotomy of the first ray, which plantarflexes the first ray to reduce the cavus and bring the forefoot into a more normal position. If the hindfoot did not evert, the cavus would be rearfoot-driven, leading to a different plan such as a hindfoot procedure like a lateralizing calcaneal osteotomy.

The Coleman block test distinguishes whether cavus is driven by the forefoot or the hindfoot by seeing how the hindfoot behaves when the hindfoot is allowed to move on a block. If the calcaneus everts on the block, it shows that the hindfoot is flexible and the deformity is forefoot-driven, meaning the forefoot (typically a plantarflexed first ray) is pushing the arch upward. In this situation the corrective approach focuses on the forefoot: a dorsiflexion osteotomy of the first ray, which plantarflexes the first ray to reduce the cavus and bring the forefoot into a more normal position. If the hindfoot did not evert, the cavus would be rearfoot-driven, leading to a different plan such as a hindfoot procedure like a lateralizing calcaneal osteotomy.