Flexible Pes Cavus Foot Type
|Date Added: December 20, 2015 04:07:43 PM
|Author: Jacques Mares
The term pes cavus encompasses a broad spectrum of foot deformities. Three main types of pes cavus are regularly described in the literature, pes cavovarus, pes calcaneocavus and ?pure? pes cavus. The three types of pes cavus can be distinguished by their aetiology, clinical signs and radiological appearance. Pes cavovarus, the most common type of pes cavus, is seen primarily in neuromuscular disorders such as Charcot-Marie-Tooth disease, and in cases of unknown aetiology, conventionally termed as ?idiopathic?. Pes cavovarus presents with the calcaneus in varus, the first metatarsal plantarflexed and a claw-toe deformity. Radiological analysis of pes cavus in Charcot-Marie-Tooth disease shows the forefoot is typically plantarflexed in relation to Black Toenails the rearfoot. In the pes calcaneocavus foot, which is seen primarily following paralysis of the triceps surae due to poliomyelitis, the calcaneus is dorsiflexed and the forefoot is plantarflexed. Radiological analysis of pes calcaneocavus reveals a large talo-calcaneal angle. In ?pure? pes cavus, the calcaneus is neither dorsiflexed nor in varus, and is highly arched due to a plantarflexed position of the forefoot on the rearfoot. A combination of any or all of these elements can also be seen in a ?combined? type of pes cavus that may be further categorized as flexible or rigid. Despite various presentations and descriptions of pes cavus, all are characterised by an abnormally high medial longitudinal arch, gait disturbances and resultant foot pathology.
An inherited disorder called Charcot-Marie-Tooth disease (CMT) is the most common cause of cavus foot. But there is a long list of disorders that may cause the problem. Children who have muscular dystrophy (MD) Cavus foot can affect only one foot, too. Cavus foot in one foot is more common in children with injuries to the nerves in their legs or spinal cord or to the muscles in their legs. Other conditions that make it more likely a child will develop cavus foot are poliomyelitis, cerebral palsy and spinal cord tumor.
Symptoms may vary from a mild problem with shoe fitting to significant disability such as 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. 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.
General examination may reveal features of neurological conditions such as ?champagne bottle legs? (Charcot-Marie-Tooth disease), scoliosis in Friedreich ataxia, or a naevus, dimple or patch of hair over the spine in spina bifida occulta. The neurological examination should include a search for signs of peripheral nervous disease, such as muscle wasting, weakness and sensory deficit, and signs of central nervous disease, such as pyramidal signs, cerebellar signs or cranial nerve abnormalities. Accurate serial recording of power in individual muscle groups will allow the clinician to follow the disease over time and detect neurological progression.
Non Surgical Treatment
Any fixed deformity must be accommodated, for example by cupping and supporting the varus heel and providing a small heel raise to compensate for forefoot plantaris. It has been shown that an orthosis that allows the first metatarsal to drop can decrease calcaneal dorsiflexion, and that this coincides with a reduction in foot pain.
Surgery for cavus foot is complex. It often requires two operations performed two weeks apart.
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