Pes Cavus Deformity (Theory )

 Pes Cavus 


https://thetagoeclinic.co.uk/pes-cavus/

Important Causes

A. Heriditary Motor Sensory Neuropathy

  Also called as Charcot-Marie-Tooth Neuropathy 

   Characterized by motor and sensory neuropathy.

    

         1)           Weak Tibialis Anterior (TA)

                                &

                Normal Peroneus Longus 

                         leads to 

                    Ist Metatarsal Drop

    

           2)     Weak Peroneus Brevis and Varus Hindfoot leads to Varus Hindfoot (Normal TP )

                            leads to 

                            Varus hindfoot

            3) overactive extensors to compensate weak TA to clear ground leads to clawing leading to further tightening of Plantar fascia (windlass effect ) and hence worsening cavus deformity.

    

Clinical findings 

     Painless Polyneuropathy

     Muscle weakness, atrophy, sensory loss with involvement of CPN

    Sensorineural Hearing loss 

    

B .Spina Bifida / Poliomyelitis

    weak triceps surae lead to calcaneal deformity owing to unopposed DF and reciprocally PF forefoot.

     Varus Heel (subtalar inversion ) locks midtarsal joints making a rigid foot.

    Excessive pressure forms Callosities.

    Questions to be considered 

            when did the symptoms start, other family members affected, any neurological disease if present, are the symptoms progressing, any change in vision or hearing 

    Physical examination    

            Look

            Toes- deformities
                      callosities under MT head,              callosities on lateral border of foot

                      Ist ray - Plantar flexion

            Foot drop, leg muscles wasting 

                    Foot wear problems 

            Heel - varus/valgus, equinus, 

             Foot- Plantaris 

           Feel 

                tenderness, deformities correctable or.                  normal

                Sensation

             Movement 

                Active / Passive 

            Special Tests 

                Varus deformity- Coleman Block test

                Equinus Deformity- Silverskiold test

            Measure the deformity

            Neurological tests 

            Check lymph nodes, Vascularity, back 


        Investigations 

            X-ray - weight bearing lateral -                                 Calcaneus pitch



   https://www.nature.com/articles/s41598-022-16995-6      

    (Normal < 30 degrees) and lateral.                      Meary's angle (Normal 0-5   degrees)

                       PA -Meary's angle (N - 0 -5degrees)

            MRI - Muscle enzymes 

                        Genetic Screening

            Neurophysiology for underlying                              Neurology 

    Treatment 

            Conservative

                  Operation for symptomatic. 

                 Orthotics fail.

            Release of Plantar Fascia.

            DF osteotomy for Ist ray +/- 2nd ray.

            Calcaneum sliding and closing wedge.                    osteotomy 

            Transfer Peroneus Longus to Peroneus.                 Brevis at level of distal fibula.

            Clawing of toes - flexor transfer to.                         extensor aponeurosis 

            Jones Procedure 


https://musculoskeletalkey.com/47-transfer-of-the-long-toe-extensors-to-the-heads-of-the-metatarsals-jones-transfer/

             Triple Arthrodesis

                        

 http://www.boneschool.com/lower-limb/foot-and-ankle/foot-arthrodesis/triple-arthodesis

                

            

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