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
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:
- Tendoachillies lengthening
- 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
Calcaneocavus deformity
Options are:
- Tendon transfer
- Tenodesis of TA tendon
- Calcaneal osteotomy
- Triple arthrodesis
Midfoot deformity
Options are:
- Jones transfer
- Dorsal close wedge osteotomies
- Planar open wedge osteotomy
- Plantar fascia release
- Other osteotomies
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
