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.