Bone Health

Study of the relationship between foot type and biomechanical factors likely to influence the development of ulcers in diabetic feet.

BioMechanics January 2001 By Arthur Manoli II, MD, and Brian Graham, CPed
Much less is known of the other common-"opposite"-pathologic disorder, the subtle cavus foot (SCF). In this disorder the foot assumes a posture of an inward tipping of the heel (heel supination or varus), and a related forefoot pronation (forefoot valgus). The first metatarsal is plantar-flexed and the arch is excessively high (cavus).

Objectives
1. Define cavus foot
2. Describe the mechanism( s) responsible for the development of cavus foot
3. Describe underlying conditions which can be heralded by a cavus foot deformity
4. Discuss treatment approaches to the cavus foot
Discussion point
1. Why is it so hard to delineate the pathology of the cavus foot?

Charcot-Marie-Tooth disease (CMT) is the most common inherited neurologic disorder. CMT is characterized by inherited neuropathies without known metabolic derangements.
Synonyms and related keywords: CMT, CMT 1, CMT 2, hereditary motor and sensory neuropathy, HMSN, peroneal muscular atrophy, PMA, peroneal progressive muscular atrophy, peroneal muscular atrophy with thickened nerves, Hoffman disease, Charcot-Marie-Tooth-Hoffman disease
Author: Divakara Kedlaya, MBBS 2007

Proc R Soc Med. 1969 March; 62(3): 270–271. Article by J. R. Heron (full text)

This lecture covers:
* Talipes deformities (clubfoot)
* Pes planus (flat feet)
* Congenital vertical talus
* Pes cavus
* Tarsal coalitions

An unusual familial syndrome. JBJS B VOL. 52 B, NO. 3, AUGUST 1970 (full text)

muscle weakness primarily affects peroneus brevis muscle and the tibialis anterior, w/ relative sparing of the peroneus longus;
- results in planatar flexion of first ray, resulting in hindfoot varus thru the tripod effect;
- w/ plantar flexed first ray and mobile lateral rays, in order for the foot to remain plantigrade, the heel must roll into varus inorder to get the lateral metatarsals on the ground;

East Lancashire Foot and Ankle Hyperbook account of Pes Cavus

Author: Norman S Turner, MD, Assistant Professor, Department of Orthopedic Surgery, Mayo Clinic School of Medicine
Pes cavus is a high arch that does not flatten with weightbearing. No specific radiographic definition of cavus foot exists. The deformity can be located in the forefoot, midfoot, or hindfoot or in a combination of these sites. Problem: The spectrum of associated deformities observed with pes cavus includes clawing of the toes, posterior hindfoot deformity (described as an increased calcaneal angle), contracture of the plantar fascia, and cock-up deformity of the great toe. This can cause increased weightbearing for the metatarsal heads and associated metatarsalgia and callus.
Synonyms and related keywords: high arch, cavus foot, cock-up deformity, clawtoe deformity, foot pain, talipes cavus, contracted foot, exaggerated arch

DEFINITION
High arched feet, Due to forefoot plantar flexion (plantaris), hindfoot dorsi-flexion or both
CAUSES
Muscular imbalance, variable in each case
Neuromuscular until proven otherwise, as up to 60% found to be neurological

• Congenital
  • Idiopathic
  • Arthrogryposis
  • Residual CTEV
• Acquired
  • Neuromuscular
  • Muscular disease eg. Muscular dystrophies
  • Peripheral nerve disease- HSMN
  • Spinal cord problems-Polio, diastematomyelia, tethered cord, syringomyelia, spina bifida
  • Long tract and central disease- Friedrichs ataxia, cerebral palsy
  • Traumatic
    • Compartment syndrome,
    • crush,
    • burns,
    • iatrogenic (overlengthening of achilles tendon)

Illustration and brief discussion

AUTHOR: Paul Griffin
This project was written as part of the undergraduate Podiatry course at Curtin University of Western Australia. The project adresses the surgical procedures involved in pes cavus deformity.
Introduction
Aetiology
Classification
Surgical Procedures for Pes Cavus
Conclusion
References
Other Links

Wheeless' Textbook of Orthopaedics
cavus deformity of the foot (elevated longitudinal arch) due to fixed plantar flexion of the forefoot;
- main type is the cavovarus and less frequent is the cavovarus;
- associated with spinal cerebellar degenerative dz;
- associated deformities: - claw toes

Summary This syndrome is characterized by telecanthus, hypertelorism, strabismus, pes cavus and variable anomalies. It has been described in a father and his son. The latter also had hypospadias, bilateral inguinal hernia, clinodactyly and camptodactyly of fingers, and radiographic findings including flared metaphyses of long bones and osteopenia.