Pes Cavus Foot Treatment

Submitted by cpgelvera00183472 on Mon, 06/12/2017 - 00:45.

Overview
All forms of pes cavus are characterised by a high arch in the sagittal plane of the foot. The corollary is a bulge on the dorsum of the foot. Weight is borne posteriorly on the calcaneal tuberosity and anteriorly on the heads of the metatarsal bones. Pes cavus is usually acquired, although a minority of cases are congenital.

Causes
Cavus foot is often caused by a neurologic disorder or other medical condition such as cerebral palsy, Charcot-Marie-Tooth disease, spina bifida, polio, muscular dystrophy, or stroke. In other cases of cavus foot, the high arch may represent an inherited structural abnormality. An accurate diagnosis is important because the underlying cause of cavus foot largely determines its future course. If the high arch is due to a neurologic disorder or other medical condition, it is likely to progressively worsen. On the other hand, cases of cavus foot that do not result from neurologic disorders usually do not change in appearance.

Symptoms
Difficulty finding proper fitting footwear because the shoes are not deep enough due to high arch and the clawed toes. Shortened foot length. Foot pain with walking, standing, and running. Metatarsalgia with pain in the forefoot/ ball of the foot (usually 1st and 5th metatarsal heads), with or without calluses/corns. Pain and stiffness of the medial arch or anywhere along the mid-portion of the foot. Morton's neuroma with pain in the ball of the foot and lesser toes. Pain in the heel and sole of the foot from plantar fasciitis. Stress fractures of the metatarsals and other foot bones. Particularly in diabetics and those with compromised circulation, abnormal pressure may result in chromic ulcers of the heel and ball of the foot. Strain and early degenerative joint disease (osteoarthritis) of lower extremity joints. ?Pump bumps" (Haglund's deformity) on the back of the heel spurs. Associated discomfort within and near the ankle joint. Ankle instability with frequent sprains. Tight Achilles tendons. The knees, hips, and lower back may be the primary source of discomfort. Chronic lower extremity pain my lead to inactivity and diminished well-being.

Diagnosis
Diagnostic testing often includes magnetic resonance imaging (MRI) if one suspects a peroneal tendon problem or ankle instability. Perform electromyography and nerve conduction velocity testing if you suspect Charcot Marie Tooth. If a high suspicion of muscular dystrophy is present, perform a sural nerve biopsy.

Non Surgical Treatment
Treatment for cavus foot varies depending on the severity of your condition. Mild cases of cavus foot can often be remedied with foot and ankle bracing, custom-made orthotics or wearing more comfortable shoes. If your condition remains unresponsive to the aforementioned treatment methods, surgical treatment may be necessary. Surgery for cavus foot aims to relieve pain and improve stability.

Surgical Treatment
In cases of severe Charcot Marie Tooth, there may be rare instances of excessive weakness of the anterior tibial tendon and peroneal tendons, resulting in a relatively strong posterior tibial tendon adding to the cavovarus foot position. In such cases, it may be beneficial for the surgeon to perform a posterior tibial tendon transfer through the interosseous membrane between the tibia and fibula to the dorsum of the foot.