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
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
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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