What procedure is indicated for forefoot-driven cavus after Coleman block testing?

What procedure is indicated for forefoot-driven cavus after Coleman block testing?

• A. Dorsiflexion osteotomy of 1st ray
• B. Lateralizing calcaneal osteotomy
• C. Midfoot fusion
• D. Tendon transfer

Answer: (A)

Coleman block testing distinguishes whether cavus is driven by the forefoot or the hindfoot. If blocking the hindfoot allows the hindfoot to realign and the arch to flatten, the deformity is forefoot-driven, meaning the plantarflexed first ray is the main culprit. In that scenario, the procedure of choice is a dorsiflexion osteotomy of the first ray—the goal is to raise the first metatarsal/first ray so the forefoot aligns with the hindfoot and the cavus is corrected. This directly addresses the fixed plantarflexion of the first ray and improves overall foot mechanics. Lateralizing calcaneal osteotomy targets hindfoot mechanics and is used when the cavus is hindfoot-driven; midfoot fusion is for rigid midfoot deformities, and tendon transfers address dynamic soft-tissue imbalance rather than a fixed forefoot deformity.

Coleman block testing distinguishes whether cavus is driven by the forefoot or the hindfoot. If blocking the hindfoot allows the hindfoot to realign and the arch to flatten, the deformity is forefoot-driven, meaning the plantarflexed first ray is the main culprit. In that scenario, the procedure of choice is a dorsiflexion osteotomy of the first ray—the goal is to raise the first metatarsal/first ray so the forefoot aligns with the hindfoot and the cavus is corrected. This directly addresses the fixed plantarflexion of the first ray and improves overall foot mechanics. Lateralizing calcaneal osteotomy targets hindfoot mechanics and is used when the cavus is hindfoot-driven; midfoot fusion is for rigid midfoot deformities, and tendon transfers address dynamic soft-tissue imbalance rather than a fixed forefoot deformity.