Helbing’s sign is an observation of the bending of the Achilles tendon in the frontal plane associated with a everted calcaneus (heel bone). This bending is seen when the person stands with their feet relaxed in their resting calcaneal stance position.
In the Veteran’s treatment records, a 1973 examination found ptosis with talar head bulge and lateral bowing, feet dorsiflexed, abducted, and everted upon weight-bearing. Helbing’s sign was positive.
What is Helbing’s Sign?
Helbing’s sign, also known as Helbing’s valgus, is the curving inward of the Achilles tendon that attaches to the large heel bone called the calcaneus. The condition is typically seen when the foot is in a relaxed stance position where the arch drops down which can be referred to as flat feet. Helbing’s sign can only be seen from the front of the foot which limits its usefulness but it has been used to indicate a pronated foot. More recently, clinicians have been examining the neutral subtalar joint position and not the relaxed stance position which has led to the introduction of new terms like forefoot supinatus and everted calcaneal stance position. Helbing’s sign is now more often referred to as this new terminology.
A Veteran presented for service treatment in 1973 and examination revealed ptosis with talar head bulge and lateral bowing of the feet which were dorsiflexed, abducted, and everted upon weight-bearing with positive Helbing’s sign.
Why is Helbing’s Sign Important?
Helbing’s sign is an important observation of the alignment of the Achilles tendon from behind when weight bearing. It is characterized by the amount of medial bowing of the Achilles tendon associated with an everted calcaneus (heel bone). It has traditionally been used as an observation of excessive pronation of the foot, but it is also often present in people who have normal or even flat feet.
Helbing’s sign is only an observation of static foot posture in the frontal plane and does not correlate well with sagittal or transverse plane observations or measurements. However, it is an important observation that can be used in conjunction with other observation of foot mechanics to determine treatment. In this case, the Veteran had moderate symptoms characterized by pain with use of orthotic inserts and examination findings including ptosis with talar head bulge, lateral bowing, dorsiflexion, abduction, and eversion of the feet on weight-bearing and a positive Helbing’s sign.
How Do I Know if I Have Helbing’s Sign?
A person who has Helbing’s sign will have a C-shaped curvature of the Achilles tendon. This curve occurs when a person is standing and is most noticeable when the person is barefoot. Helbing’s sign is often present in people who have flat feet. The condition is also known as pes planus.
To diagnose Helbing’s sign, a doctor will check a patient’s foot posture and alignment. They will look at the frontal plane of the foot and see if the calcaneus is everted or inverted. They will also check the patient’s passive ankle range of motion to determine if they have dorsiflexion or eversion. A positive Helbing’s sign can indicate that a person has flat feet or a high arch. However, it is important to note that Helbing’s sign is a frontal plane observation and does not necessarily correlate with sagittal or transverse plane observations of foot posture. Therefore, Helbing’s sign can have limited clinical usefulness.
What Treatment Options Are Available for Helbing’s Sign?
Helbing’s sign has long been a descriptive term for the medial bowing of the Tendo Achilles seen in the frontal plane associated with an everted (compensated) valgus position of the calcaneus on relaxed weightbearing. However, it has been shown that rearfoot varus and a neutral subtalar joint position of the calcaneus can lead to a more vertical position of the calcaneus on weightbearing without Helbing’s sign present. Helbing’s sign is therefore of limited diagnostic value.