Pes Cavus, known also as a high instep, talipes cavus or supinated foot, is a foot condition classified by an arch that does not fall flat upon bearing weight. In Latin, pes cavus stands for ?hollow foot?. It is medically described as a multi-planar foot deformity most recognized by the presence of a noticeably high arch. Pes Cavus is known to occur in approximately 8-15% of the population, however, it is far less recognized than its counterpart, Pes Planus.
The cause and deforming mechanism underlying pes cavus is complex and not well understood. Factors considered influential in the development of pes cavus include muscle weakness and imbalance in neuromuscular disease, residual effects of congenital clubfoot, post-traumatic bone malformation, contracture of the plantar fascia and shortening of the Achilles tendon.
The arch of a cavus foot will appear high even when standing. In addition, one or more of the following symptoms may be present. Hammertoes (bent toes) or claw toes (toes clenched like a fist). Calluses on the ball, side, or heel of the foot. Pain when standing or walking. An unstable foot due to the heel tilting inward, which can lead to ankle sprains. Some people with cavus foot may also experience foot pain diabetes (drucillastarrick.hatenablog.com) drop, a weakness of the muscles in the foot and ankle that results in dragging the foot when taking a step. Foot drop is usually a sign of an underlying neurologic condition.
Investigations will be guided by the suspected aetiology. Weight-bearing radiographs are performed to assess the degree of bony deformity and look for arthritic changes. In cases of suspected HSMN, nerve conduction testing and electromyography may be useful. A CMT DNA duplication detection test may be performed for confirmation. If the onset is during adulthood, and especially if rapidly progressive or unilateral, a central disorder such as spinal dysraphism or a space occupying lesion must be excluded by magnetic resonance imaging of the brain and spinal cord.
Non Surgical Treatment
Initially a careful investigation is needed to rule out any neurological condition that is causing the high arched foot. This will depend on what is causing the pain, if anything. For instance, flexible high arches may not need any treatment. Wear shoes with a good cushioning, depth and arch support which may help relieve pain and improve walking. Debridement of corns and calluses. Various pads made from silicone or felt can be used to get pressure off the painful areas. Control body weight to decrease load on the feet. Physical therapy modalities such as laser therapy for associated tendonitis. Foot and ankle joint manipulations to help increase joint range of motion. Foot orthotic devices can provide support for stressed joints and soft tissues. Foot orthoses are constructed to increase shock absorption and aid in the redistribution of weight relieves stress placed on the metatarsals. Foot orthoses are usually custom-made semi-rigid or semi-flexible functional posted orthotics that helps prevent the foot from supinating. They often include shock absorbing material in the arch. These devices are prescribed based on a thorough biomechanical examination, gait analysis and if required having the patient walk or run over a pressure mat. Over-the-counter arch supports may be helpful for mild cases of pes cavus, but they are often a poor fit for persons with severe pes cavus.
The surgeries can be, Tendon transfers to correct muscle weakness. Bone cuts (called osteotomies) to correct bone deformity. Soft tissue releases to reposition the arch of the foot. Any and all of the four main areas of the foot can be affected by cavus deformity or CMT. Generally, a combination of a calcaneal (hindfoot) osteotomy, a first metatarsal (forefoot) osteotomy, and a plantar fascia (the thick connective tissue on the bottom of the foot that helps support the arch) release is performed. Occasionally, additional bone cuts (including midfoot osteotomies) and soft tissue procedures (including ankle ligament reconstruction and tendon transfers) are necessary to complete the correction.
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