Pes Cavus Deformity (Theory )
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
(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
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