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

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

• A. Rearfoot driven cavus; lateralizing calcaneal osteotomy
• B. Forefoot driven cavus; dorsiflexory osteotomy of 1st ray
• C. Forefoot driven cavus; calcaneal osteotomy
• D. Rearfoot open wedge osteotomy

Answer: (A)

Coleman block testing differentiates whether cavus is driven by the forefoot or the hindfoot by observing hindfoot alignment when the forefoot is allowed to plantarflex. If the calcaneus remains in varus with a block under the forefoot, the hindfoot is the source of the deformity—this is rearfoot-driven cavus. The appropriate plan is to correct the hindfoot alignment, which is most effectively done with a lateralizing calcaneal osteotomy. Shifting the calcaneal tuberosity laterally reduces varus and improves hindfoot and subtalar joint mechanics. In contrast, forefoot-driven cavus would show hindfoot correction when the forefoot is unloaded, pointing toward a first-ray dorsiflexion osteotomy, not a hindfoot lateralizing procedure.

Coleman block testing differentiates whether cavus is driven by the forefoot or the hindfoot by observing hindfoot alignment when the forefoot is allowed to plantarflex. If the calcaneus remains in varus with a block under the forefoot, the hindfoot is the source of the deformity—this is rearfoot-driven cavus. The appropriate plan is to correct the hindfoot alignment, which is most effectively done with a lateralizing calcaneal osteotomy. Shifting the calcaneal tuberosity laterally reduces varus and improves hindfoot and subtalar joint mechanics. In contrast, forefoot-driven cavus would show hindfoot correction when the forefoot is unloaded, pointing toward a first-ray dorsiflexion osteotomy, not a hindfoot lateralizing procedure.