A cavus foot deformity is considered rearfoot-driven if the Coleman block test shows the calcaneus remains in varus. Which statement is true?

• A. Yes, this indicates rearfoot-driven cavus; lateralizing calcaneal osteotomy is often needed.
• B. This indicates forefoot-driven cavus; dorsiflexory osteotomy of 1st ray.
• C. This indicates flexible flatfoot.
• D. This indicates hindfoot valgus.

Answer: (A)

The test distinguishes whether the cavus deformity is driven by the hindfoot or the forefoot by seeing how the hindfoot position responds when the forefoot is unloaded. If the calcaneus stays in varus even when you block the first ray to allow the forefoot to drop, the hindfoot deformity is the primary issue—this is rearfoot-driven cavus. In that situation, treatment often targets the hindfoot alignment, and a lateralizing calcaneal osteotomy is a common option because it shifts the hindfoot into valgus and reduces varus, addressing the root driver of the deformity. If the hindfoot corrected to neutral or valgus with the block, the cavus would be forefoot-driven and addressed with procedures focused on the first ray, such as a dorsiflexory osteotomy of the first ray. The statements about flexible flatfoot or hindfoot valgus don’t fit this scenario, since persistent hindfoot varus on Coleman block points to a hindfoot-driven deformity.