Which correction is best for a flexible hindfoot varus?

A lateral heel wedge is the best correction for a flexible hindfoot varus because it provides the necessary support to realign the heel and improve overall foot posture. In cases of hindfoot varus, the calcaneus (heel bone) tilts inward, which can lead to difficulties in weight distribution during ambulation. By using a lateral heel wedge, the force is redirected to encourage a more neutral alignment of the hindfoot, allowing it to function properly during the gait cycle.

This approach not only helps in addressing the deformity but also minimizes the risk of associated complications, such as calluses or joint pain, by promoting a more stable footing during movement. The lateral wedge effectively increases the ground reaction force on the lateral aspect of the foot, helping to correct the varus position dynamically as the individual bears weight.

Other options like the metatarsal bar, Thomas heel, or medial heel wedge may not specifically target the misalignment associated with flexible hindfoot varus. The metatarsal bar primarily impacts the metatarsal head region, which doesn't directly correct the heel's position. The Thomas heel provides added support to the arch but is more useful in managing different types of foot issues (such as rigid pes planus). A medial