Pes Cavus

If same problem in family runs , think of some neurological diseases, Also ask if its progressive .Ask

if they have any vision problem .


Look 

 Back 

 Toes callsities under metatarsal heads , lateral border of foot 

  Exagerrated Cavus 

 Foot drop 

 leg muscles wasting 

 hindfoot varus /valgus , equinus,forefoot plantaris , Ist ray PF 

 footwear problems 

 Feel - temperature, tenderness , deformity correctible or not 

 Neurovascular examination 

    sensation 

   motor - tone , power , reflexes . 


Movement 

     Active and passive 

Special tests 

    Varus Coleman block test 

     Silfverskiold test for Equinus deformity 

 How to proceed ? 

X-ray - Weight bearing lateral x-ray 

          to see calcaneal pitch (N< 30 degrees ) and lateral Meary's (N 0-5T degrees )

              normal - 20-30 degrees

               low - Pes Planus

               high - Pes Cavus 


PA - meary's angle N - 0 degrees

         it gives the apex of angle in Pes Planus and Pes Cavus 

Blood - Muscle enzymes 

              Genetic Screening 

Neurophysiology for underlying neurology 



What are causes of Pes Cavus ? 

Congenital 

           Idiopathic 

            CTEV 

            Arthrogryposis 

Acquired 

             Trauma 

             Neuromuscular 

                  Muscular Dystrophy 
                  HMSN 

                  
                










  HMSN (CMTD )

         Weak Tibialis Anterior 

              Normal Peroneus Longus leading to first Metatarsal drop 

          Weak Peroneus Brevis

                 leading to Varus hindfoot with normal Tibialis Posterior. 


          Weak TA 

               normal extensors leading to clawing 

            tight plantar fascia  leading to  Windlasss effect 


         Spina Bifida 

           Weak triceps Surae leads to Calcaneal Deformity

             owing to unopposed Dorsiflexion and reciprocally PF forefoot 

            Varus heel (Subtalar inversion ) locks midtarsal joints leading to rigid foot. 

              Excessive pressure leading to callosities . 



Treatment 

 Conservative 

 Operation 

     symptomatic 

    orthotics 

Release of plantar Fascia 

DF osteotomy  - Ist ray +/- 2nd 

Calcaneum sliding and closing wedge osteotomy 

 Transfer peroneum longus to brevis at level of distal fibula 

Clawing of toes leading to flexion of extension aponeurosis 

Jones Procedure 

Triple Arthrodesis 













           







          

  

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