The term "cavus foot" is used to describe a spectrum of foot shapes that have in common a high arch. The components of cavus are increased pitch and varus of the hindfoot, plantar flexion of the midfoot, and varus and adduction of the forefoot. The cavus shape is associated with changes in the mechanics of the foot. It is less flexible and balanced than a neutral foot. Although one fifth to one quarter of the population has a cavus foot, there is little anatomic description in the literature.
Pes Cavus is typically a result of a fixed plantar flexion of the foot. Plantar Flexion is the movement of the ankle, pointing the toes away from the shin (think pressing a gas pedal in your car). However, a fixed plantar flexion does not guarantee that a person has pes cavus.
Cavus foot is often caused by a neurologic disorder or other medical condition, such as cerebral palsy, Charcot-Marie-Tooth disease, or stroke. A high-arched foot pain between toes (http://vivabednarek.blog.fc2.com/blog-entry-8.html) may cause one or more of the following symptoms. Discomfort when walking barefoot on hard surfaces. Hammertoes (bent toes). Claw toes (toes clenched like a fist). Frequent ankle sprains. Haglund?s Deformity (bony enlargement of the back of the heel bone). Calluses on the ball, side, or heel of the foot.
Diagnosing the cause of the cavus foot position is essential prior to surgical planning. Usually, performing a laterally based calcaneal osteotomy and a distally based metatarsal osteotomy together or each procedure alone can help position the foot properly.
Non Surgical Treatment
Initially a careful investigation is needed to rule out any neurological condition that is causing the high arched foot. This will depend on what is causing the pain, if anything. For instance, flexible high arches may not need any treatment. Wear shoes with a good cushioning, depth and arch support which may help relieve pain and improve walking. Debridement of corns and calluses. Various pads made from silicone or felt can be used to get pressure off the painful areas. Control body weight to decrease load on the feet. Physical therapy modalities such as laser therapy for associated tendonitis. Foot and ankle joint manipulations to help increase joint range of motion. Foot orthotic devices can provide support for stressed joints and soft tissues.
Soft tissue surgery
Cavus foot is caused in part by an over-pull of one of the lateral ankle muscles. A release of this tendon can be performed on the outside of the ankle. Additionally, a transfer of this tendon can be performed to help in correcting deformity of the ankle joint.
Too much pull of certain muscles and tendons is often the cause of the deformity related with a cavus foot. Moving one of these muscles or tendons may help the foot work better. In addition, patients with a cavus foot may have weakness in moving the foot up, which is sometimes called a foot drop. In these cases, a tendon from the back of the ankle may be moved to the top of the foot to help improve strength.
Correcting the deformity of the foot may not be possible with soft tissue procedures alone. In these instances, one or more bone cuts (osteotomies) may be needed. Instead of a bone cut, a fusion (arthrodesis) procedure may be used. A fusion removes the joint between two bones so they grow together over time. During a fusion the bones may be held in place with plates or screws. Dorsiflexion osteotomy of the first metatarsal. This procedure flattens out the arch.
This procedure is performed to bring the heel bone back under the leg. This is needed if correction of the deformity in the front of the foot does not also correct the back of the foot or ankle. A calcaneal osteotomy can be performed several ways and is often held in place with one or more screws. Fusion. Sometimes patients have a deformity that has caused damage to the joints. In these cases, soft tissue procedures or bone cuts may not be enough, and it may be necessary to eliminate the joint.
Clawed toes are a common problem with cavus foot deformity. This can be treated with tendon surgery, fusion or removal of part of the toe bones. Following surgery the toes are often temporarily held in place with pins.
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