title: Anatomical origin of forefoot varus malalignment.
abstract: BACKGROUND
  Forefoot varus malalignment is clinically defined as a nonweightbearing inversion of the metatarsal heads relative to a vertical bisection of the calcaneus in subtalar joint neutral. Although often targeted for treatment with foot orthoses, the etiology of forefoot varus malalignment has been debated and may involve an unalterable bony torsion of the talus.
  
  
  METHODS
  Forty-nine feet from 25 cadavers underwent bilateral measurement of forefoot alignment using adapted clinical methods, followed by dissection and measurement of bony talar torsion. The relationship between forefoot alignment and talar torsion was determined using the Pearson correlation coefficient.
  
  
  RESULTS
  Mean ± SD forefoot alignment was -0.9° ± 9.8° (valgus) and bony talar torsion was 32.8° ± 5.3° valgus. There was no association between forefoot alignment and talar torsion (r = 0.18; 95% confidence interval, -0.11 to 0.44; P = .22).
  
  
  CONCLUSIONS
  These findings may have implications for the treatment of forefoot varus since they suggest that the source of forefoot varus malalignment may be found in an alterable soft-tissue deformity rather than in an unalterable bony torsion of the talus.
authors.affiliation: Anatomy and Cellular Biology, Tufts University School of Medicine, Boston, MA, USA. rebecca.lufler@tufts.edu
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Lufler
authors.forename: T M
authors.initials: TM
authors.lastname: Hoagland
authors.forename: Jingbo
authors.initials: J
authors.lastname: Niu
authors.forename: K Douglas
authors.initials: KD
authors.lastname: Gross
mesh_terms: D000369:Aged, 80 and over; D060750:Bone Anteversion / Q000473:pathology*; D002102:Cadaver; D005260:Female; D005530:Foot Deformities / Q000473:pathology*; D005545:Forefoot, Human / Q000473:pathology*; D006801:Humans; D008297:Male; D013628:Talus / Q000002:abnormalities; D014102:Torsion Abnormality