Pes Cavus

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Pes Cavus
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What is Pes Cavus?

• Excessive Elevation of Longitudinal Arch
• High Arch
• Foot is relatively inflexible
• Much less common than Pes Planus
• Also referred to as hollow foot or claw foot

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Causes of Pes Cavus

• Neurological Disorders (60 of time)
• Spina Bifidia
• Poliomyelitis
• Charcot-Marie-Tooth Disease
• Talipses Equinovarus (Clubfoot)
• Muscle Imbalance
• Weak calf muscles
• Tight Plantar Fascia

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• Excessive Supination
• Claw Toes
• Traumatic Incidents
• Compartment Syndrome
• Crushing Injury
• Burns
• Iatrogenic( overlengthing of the Achilles Tendon)
• Malunion of Calcaneal or Talar fracture

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Signs and Symptoms

• Pain during running, walking, or standing
• Painful toes that cant be straighten
• Poor shock absorption
• Foot length shorten
• Callus on ball and heel of foot due to uneven
  weight distribution

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• Abnormal shortening of the achilles tendon
• Tight plantar faciitis
• In frontal plane forefoot in varus and heel in
  valgus
• May experience overuse symptoms in the knees,
  ankles, and back

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Examination

• History to determine any neurological conditions
• Observation of foot and toes
• Examine Gait
• MMT and Flexibility
• ROM of Foot
• Neurological Exam

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• Colman Block Test
• Patient is to stand on 2.5-4 cm block with heel
  and lateral border of the foot on the block. Bear
  full weight while the 1st, 2nd, and 3rd
  metatarsal hang freely into plantarflexion and
  pronation. Test is looking for hindfoot
  flexibility.

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Two Common Patterns

• Calcaneocavus
• Hindfoot abnormalities
• No pronation of forefoot no varus deformity of
  hindfoot
• Dorsiflexion of calcaneum

• Cavovarus
• Forefoot abnormalities
• Forefoot pronated and heel in varus
• Claw toes

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Classification Systems

• Mild
• Longitudinal arch appears increased NWB
• Longitudinal arch appears almost normal WB
• Toes clawed NWB
• Toes normal WB
• Hindfoot varus

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• Moderate
• Longitudinal arch increases NWB and WB
• Claw toes NWB and WB
• Calluses under prominent metatarsal head
• Dorsiflexion limited
• Forefoot plantarflexed on hindfoot

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• Severe
• Calcaneos cant pronate past 5 degrees varus
• Heel in varus and foot in valgus
• Decrease ROM in foot

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Classification
Type Forefoot Hindfoot
Simple Balanced Neutral
Cavovarus Plantarflexuion Varus
Calcaneous Fixed Equinus Calcaneous
Equinovarus Equinus Equinus
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Diagnostic Procedures

• X-Ray foot
• X-Ray Spine
• Nerve Conduction Studies

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Treatment

• Orthodics
• Corrective/Better Supporting Shoes
• Stretch Achilles Tendon/Plantar Fascia
• Surgical Procedures in severe cases

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Return to Play

• Arch Supports
• Correct Shoes
• Avoid Excessive Long Runs

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References

• Gallaspy, J.B. May J.D. Signs and Symptoms of
  Athletic Injuries. Mosby-Year Book St.
  Louis,1996. p.406.
• Arneheim, D. Prentice, W. Principles of Athletic
  Training. McGraw Hill Boston. 2000. 10th ed.
  P464
• Greene, W.B. Essentials of Musculoskeletal Car.
  American Academy of Orthopedic Surgery. 2001 2nd
  ed.

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• www.sportsinjuryclinic.net/cybertherapist/front/fo
  ot/clawfoot.htm
• www.emedicine.com/orthoped/topic539.htm
• www.nlm.nih.gov/medlineplus/ency.article/001261.ht
  m
• www.ortho-u.net/011/203.htm