When A Patient Presents With Collapsing Pes Planovalgus

Ryan H. Fitzgerald, DPM, AACFAS

Management of these deformities can be quite challenging. Accordingly, the author provides an illuminating case study.

The patient is a 58-year-old male who presents complaining of significant pain along the medial ankle and medial arch of his left foot. The patient states that he has noticed his arch collapsing “over the last couple of years” but that it has only become painful over the last four to six months.

   The patient says he feels better with shoes that have high arches in them and relates that another podiatrist previously saw him and fitted him for orthotics. The patient believes the orthotics help somewhat although he still relates pain and loss of function. The patient denies any recent hospitalizations or changes to his medical history. He also denies nausea, vomiting, chest pain, shortness of breath, calf pain or any other symptoms.

   His past medical history reveals hypertension and hypercholesterolemia. His past surgical history consists of a cholecystectomy and previous open reduction internal fixation for his left wrist. He denies using tobacco, relates occasional alcohol use and drinks caffeine daily. He has no known drug allergies. He is currently taking atorvastatin calcium (Lipitor, Pfizer), hydrocholorothiazide and lisinopril.

What The Physical Exam Reveals

Upon the physical exam, the patient demonstrates a significant collapsing pes planovalgus foot type (left > right). (See photo 1.) Pedal pulses are palpable and graded +2/4 bilaterally with capillary fill time


Addressing the actual problems for the patient's benefit is always excellent practice. Strongly agree that calcaneal osteotomy be used rather than destruction of healthy bone, tissue, and function methods such as subtalar and metatarsal fusions.

Pre-planning is also essential. For example, why put a fusion rod in the subtalar ever, and especially when a later ankle arthroplasty is probable?

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