May 30, 2024

Pes Cavus or High arch foot is characterized as it is not flattened on weight-bearing or during the gait cycle

Etiology of Pes Cavus

Neuromuscular causes

Muscular dystrophy

  • Becker’s
  • Duchenne’s

Neuropathies

  • Hereditary motor and sensory neuropathy I and II

Cord lesion

  • Poliomyelitis
  • Syringomyelia
  • Diastomatomyelia
  • Tethered cord

Cerebral disorder

  • Cerebral palsy
  • Friedreich ataxia

Tripod analogy of high arch foot

Tripod analogy
Tripod analogy

Early on deformity is mobile: Later fixed with MTP joint permanently extended

Mobility is checked by

  • Coleman’s block test
  • Subtalar joint mobile

Investigations

X-ray reading

  • Meary’s angle
  • Calcaneal pitch angle = Normal (10-30 degrees)
    • Increase in pes cavus

See Meary’s angle in: Foot Arch Deformity and Flat Foot and Congenital Vertical Talus

Treatment of Pes Cavus

In physiological and Nonprogressive cases=> No treatment

If the patient has symptoms; treatment is necessary

Non-operative treatment

Customs made shoes

Strengthing exercises

Surgical treatment for Pes cavus

Equinus Contracture

Options:

  1. Tendoachillies lengthening
  2. Posterior capsulotomy

Varus Hindfoot

Options are:

  • Superficial plantar medial release
  • Plantar fascia release
  • Abductor hallucis release
  • Flexor hallucis brevis release
  • Lateral close wedge osteotomy
  • Lateral translation osteotomy
Diagnosis and treatment of Pes cavus

Calcaneocavus deformity

Options are:

  • Tendon transfer
  • Tenodesis of TA tendon
  • Calcaneal osteotomy
  • Triple arthrodesis
Pes cavus

Midfoot deformity

Options are:

  • Jones transfer
  • Dorsal close wedge osteotomies
  • Planar open wedge osteotomy
  • Plantar fascia release
  • Other osteotomies
Pes cavus

Often peroneus tendon is active, divides PL, and reattachs to perineous Brevis

Severe cases

Salvage surgery (Ilizarov)

Detail on Ilizarov Principles

For Claw toes

For Hallux

  • Jones transfer
  • Tenodesis and fusion of IP joint

For lesser toes:

  • Flexor tendon transfer to extensor hood
  • MTP joint capsulotomies
  • Proximal IP fusion is needed

See more on Claw toes and Hammer’s toe