Pes cavus


Pes cavus

Description, Causes and Risk Factors:

The inner edge of the foot is raised off the floor in the middle to form the arch of the foot. The height of the arch varies from person-to-person. When it is higher than normal the shape of the foot is called "cavus".

When a person with a cavus foot stands, the middle of the foot seems to be raised higher off the ground than normal. The heel may be drawn in towards the inner side, and the toes may also be drawn inwards. Some people with cavus feet also have curled-up "claw" toes.

Although the most obvious thing about a cavus foot is usually the high arch, this appearance is actually produced by other more basic deformities in the foot. In all cavus feet the front part of the foot is drawn downwards more than normal, and the part on the side of the big toe (first ray) is usually drawn down most of all. The result is to tip the arch upwards, and also to tip the foot onto its outer side. It is this combination that produces the appearance of a high arch and a large space under the foot.

In a few people with cavus feet who have weak calf muscles, the heel is also drawn down and this adds to the height of the arch. Other people, whose Achilles tendons become tight, have their heel drawn up. This tends to increase the pressure on the ankle and the ball of the foot. Other people's heels are neither drawn up or down. The heel of any cavus foot may also turn inwards because of the tilting of the rest of the foot. To start with, the heel tilting is flexible but with the passage of time the tissues and joints may become stiff and the heel tilt may become fixed.

In approximately 20 percent of all cases, pes cavus is idiopathic, meaning the cause cannot be determined. For the other 80 percent, the condition can be attributed to one of the following:

    Fracture of the calcaneus (the largest tarsal bone; forms the human heel).

  • Fracture of the talus.

  • Clubfoot.

  • Neuromuscular diseases such as cerebral palsy or CMT Charcot-Marie-Tooth Disease.

  • Heredity.

Symptoms:

Common symptoms of this condition include:

    Shortened length of foot.

  • Difficulty fitting into shoes.

  • Pain when walking, running or standing.

  • Pain in calves due to overworking and contraction of the calf musculature.

  • Symptoms such as weakness and fatigue may also appear, especially if the victim also suffers from a neuromuscular disease such as muscular dystrophy. Unstable ankles may also be a symptom, especially for someone whose hindfoot is twisted inward or who has weak peroneus brevis muscles (this is the muscle that extends up the calf from the outside of the ankle).

Diagnosis:

If you feel like you have pes cavus and are experiencing any of the symptoms listed above, you should see a podiatrist (A specialist in care for the feet). Your doctor will ask you questions about your medical and family history. He or she will also perform a physical exam and imaging tests to determine the severity of the condition. X-rays and MRIs (magnetic resonance imaging) of the feet and spine may also be conducted, along with an electromyography—which checks the health of the muscles and the nerves that control the muscles—or a nerve conduction study, which measures the speed of electrical signals through a nerve.

Treatment:

Treatment for pes cavus is usually determined by the severity of the condition and the symptoms involved. Your podiatrist will want to increase the degree of contact between your arch and the ground and prevent excessive supination (movement of the subtalar joint) and pronation. The goal of treatment will be to provide stability and support to the arch during weight-bearing activities such as walking or running. Additionally, the relationship of the heel to the lowered forefoot will be addressed with appropriate heel elevations or counseling on appropriate footwear.

Corrective shoes may improve walking ability and reduce pain. Orthotics such as arch inserts and supportive insoles can help with mild to moderate cases. In severe cases, surgery may be performed to flatten the foot. If there are any other problems, such as a neurological disorder, the patient will be referred to a specialist in that particular field. If an underlying condition exists, your doctor may recommend a change in footwear or orthotics in conjunction with treatment for the underlying condition. In severe cases of Pes Cavus an ankle foot orthotic may be needed to treat the foot, ankle, and lower leg weakness or instability.

Stretching or strengthening exercises may be prescribed to neutralize the effect of contracted posterior leg musculature and weakened muscles in the front of the leg. Your long-term outlook will depend heavily on the cause and severity of the condition. You may begin to experience relief within hours of changing your shoes or adding orthotics such as arch supports, but your recovery time may be weeks or months if you have an underlying condition such as cerebral palsy.

For more severe possible operations include:

    Straightening your toes to stop them rubbing on your shoes and to take the pressure off the ball of your foot.

  • Breaking and re-shaping one or more bones in the front, middle or heel of your foot to straighten the deformity.

  • Re-shaping and stiffening one or more joints, usually in the middle or heel of your foot, to straighten the deformity and make your foot more stable.

  • Moving one or more of the tendons of your foot to another part of the foot to give more strength to a weak area.

  • Tightening the ligament of your ankle or strengthening it with another bit of tissue to stop your ankle going over.

NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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