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PubMed2004

Correction of the cavus foot using external fixation.

Cavus deformity is of soft tissue, bony, or combined origin and is either static or progressive. The treatment algorithm depends on these factors. Bony deformities are treated by acute osteotomy or gradual distraction osteotomies, whereas soft tissue contractures are treated by soft tissue releases or distraction. External fixation is a powerful tool to obtain correction of the cavus deformity. It must be supplemented with soft tissue balancing procedures, such as tendon transfer and orthotic management, to maintain the correction in progressive cavus deformities.

Algorithms↗

PubMedDate not supplied

Cavus foot deformity in children.

A cavus deformity of the foot is easily recognizable, but appropriate neurologic assessment can help to determine the etiology. Cavovarus, the most frequent type of cavus foot, presents with an elevated medial longitudinal arch, first ray plantarflexion, and, if rigid, a fixed heel varus. Common causes include progressive motor sensory conditions, typically Charcot-Marie-Tooth disease, and nonprogressive conditions such as cerebral palsy and poliomyelitis. A calcaneocavus foot may be seen in poliomyelitis, spinal dysraphism, and peripheral neuropathy. Initially, the cavus deformity is flexible, but if left untreated, it becomes a fixed bony deformity. Physical examination should include the cavovarus block test, which assesses flexibility of the hindfoot deformity and can direct surgical treatment. Standing radiographs of the feet and spine, magnetic resonance imaging, and electrodiagnostic studies may be useful. Management goals are to obtain a plantigrade, mobile, pain-free, stable, motor-balanced foot. Surgical options include soft-tissue and plantar fascia releases for a flexible deformity, osteotomy for a fixed deformity, and tendon transfers to restore muscle balance. Triple arthrodesis has poor long-term results in patients with progressive deformity and sensory impairment.

Child↗

PubMedDate not supplied

Pes cavus.

Pes cavus is a complex deformity with various components. The etiology is multifaceted, which can result in changes to the rearfoot, forefoot, or both areas. Proper patient evaluation is crucial to understanding the deformity and its management. Various soft-tissue and osseous procedures may be used in the reconstruction of the symptomatic cavus foot deformity. This article discusses the clinical and radiographic findings of pes cavus, as well as the various etiologies of this challenging foot deformity and the surgical principles of its correction.

Arthrodesis↗

PubMed1976

Peroneus longus tendon lengthening as an adjuvant measure in cavus foot surgery.

Lengthening of the peroneus longus tendon is very important when performing cavus foot surgery. This tendon directly affects all three components (varus heel, increased arch height, and forefoot adduction) of the idiopathic cavus foot which can be accounted for by increased strength and activity of the peroneus muscle. The deforming force is removed or weakened according to the degree, duration and rigidity of the cavus foot by lengthening or transferring the tendon.

Foot↗

PubMed1980

An evaluation for compensated anterior cavus.

Anterior cavus is a multiplane structural deformity that can originate from different areas within the foot. Differentiation of these areas is a necessary examination in order to determine the effect of proper treatment. A depressed fourth and fifth ray or lateral column is a major deformity in anterior cavus. The lateral column deformity is a pronatory force that causes a premature medial shift of weight. The premature shift can cause a breakdown of the medial column of the foot. We have developed an examination of the compensated anterior cavus deformity that enables the practitioner to isolate better the pronatory forces within the foot.

Biomechanical Phenomena↗

PubMed1982

Roentgenographic study of cavus foot deformity in Friedreich ataxia patients: preliminary report.

The preliminary results based on a three year retrospective study in cavus foot deformity of forty-four Friedreich ataxia patients regularly seen at the Neuromuscular Disease Clinic of Sainte-Justine Hospital have been presented. An accurate "weight-bearing" foot stereoradiographic technique has been recently developed by our group. Since the follow-up period with this device is not sufficient to provide statistical information, the conventional non-weight bearing technique has been utilized in this study to enable a possible comparison between the radiographs of ambulant and non-ambulant patients. Due to the present technique, the results of this study must be interpreted with caution. For 132 pairs of radiographs, 28 parameters have been analyzed. Four of these, namely the calcaneal inclination angle, the first metatarsal inclination angle, the inferior cortex of calcaneus-first metatarsal angle and the first-fifth metatarsals angle, were of particular interest. From these parameters, a preliminary quantitative description of cavus foot deformity in Friedreich's ataxia has been attempted. Three stages of evolution have been tentatively identified for this type of neurological disorder.

Adolescent↗

PubMed1987

Pes cavus and pes planus. Analyses and treatment.

The arch of the foot serves as an adaptable, supportive base for the entire body. This article discusses how the arch of the foot affects the normal biomechanics of the lower limb. An anatomical overview of the three components of the arch of the foot is presented, identifying the medial longitudinal arch as the arch mainly responsible for related structural problems throughout the lower limb. Deviations in the normal structure of the medial longitudinal arch produce unbalanced, functionally unstable conditions of the foot such as pes cavus or pes planus. Specific evaluation criteria for both pes cavus and pes planus are discussed, in addition to the adverse effects these two disorders have on weight bearing, force dissipation, and normal gait. Compensatory pronation associated with pes planus is one of the most common lower extremity disorders seen currently by physical therapists working in sports medicine, and its causes and related lower limb disorders are discussed. Most of these structural deformities can be corrected through the use of various orthotic devices. Specific guidelines are presented for using both soft and permanent orthoses, which offer the foot increased shock absorption and proper structural alignment.

Biomechanical Phenomena↗

PubMedDate not supplied

The present status of the problem of pes cavus.

Notable historical aspects relating to the etiology and treatment of pes cavus have been critically examined. The characteristic features of the deformity are described and an explanation offered for the mechanism of their production. Although its etiology remains uncertain, a study of the literature and a great deal of clinical material has established certain well supported conclusions regarding the etiology and pathology of the condition. Certain aspects of cerebral palsy serve to strengthen impressions of earlier authors that the primary center of origin of pes cavus lies somewhere in the central nervous system. Localized foci of partial damage lying adjacent to tracts of nerve cells more seriously affected by a neurological disease could emit irritating stimuli capable of producing degrees of over-action of the invertor muscles varying from obvious spasm to clinically undetectable increase in muscle tone. Biral or other factors which stop short at creating nothing more than such a focus of irration could explain the insidious onset of the deformity in the idiopathic group. Over-action of invertor muscles for one reason or another, including ischemia, is almost certainly responsible for initiating the deformity, though primary contracture of the plantar fascia could possibly do so. With the appearance of supination of the heel, the calcanean tendon becomes an active invertor adding its force to that of the plantar fascia to produce structural varus of the calcaneum. Contracture of the plantar fascia and supination of the heel are regarded as features of major importance. Correction of the latter can be achieved more effectively by suitable osteotomy than by subtaloid fusion, which is regarded with great disfavor. Conservative treatment consists of exercises and shoe appliances. Surgical correction is based on calcanean osteotomy and plantar fasciotomy supplemented where necessary by suitable tendon transplantations, correction of clawing of the toes, and tarsal or metatarsal wedge resections. Preservation of the midtarsal subtaloid joint complex is essential. With the heel correctly aligned the degree of improvement to be expected in the forefoot deformity is such that any structural operation on it should be deferred until a fair period of walking has been tried.

Adolescent↗

PubMed1977

Osteotomy of the metatarsals for pes cavus.

Described is a surgical procedure for pes cavus which includes multiple osteotomies of the metatarsals, usually combined with Steindler fasciotomy and extensor tenotomy. This method permits the correction of the cavus deformity and preserves the length of the foot without disturbing any joint. A total of 11 patients with 14 procedures have been followed up for an average of more than three years. Results of 12 of the 14 operations were favorable according the the criteria used.

Adolescent↗

PubMed1996

Cerebellar ataxia, areflexia, pes cavus, optic atrophy, and sensorineural hearing loss (CAPOS): a new syndrome.

There are a large number of well recognised syndromes comprising cerebellar ataxia in association with other neurological features. We report three family members who presented with a relapsing, early onset cerebellar ataxia, associated with progressive optic atrophy and sensorineural deafness. All three patients have areflexia (in the absence of a peripheral neuropathy), a pes cavus deformity, and show varying degrees of severity. Extensive neurological investigations have been normal, and the aetiology and pathophysiology of this disorder remain unclear. This may represent a separate syndrome of early onset cerebellar ataxia with associated features ("cerebellar ataxia plus"), which is likely to either have an autosomal dominant or maternal mitochondrial pattern of inheritance. The recognition of this association under the acronym of CAPOS (cerebellar ataxia, areflexia, pes cavus, optic atrophy, and sensorineural deafness) may help in the delineation of a new syndrome.

Abnormalities, Multiple↗

PubMed2003

Biomechanical differences among pes cavus, neutrally aligned, and pes planus feet in subjects with diabetes.

The purpose of this study was to quantify differences in joint range of motion, foot deformity, and foot morphology among pes cavus, neutrally aligned, pes planus rigid, and pes planus flexible feet. A cohort of 1047 veterans with diabetes (contributing 2047 feet) was enrolled in a prospective study of diabetic ulcer risk factors (the Seattle Diabetic Foot Study). Significant differences between foot types were found. Pes cavus feet had an increased percentage of prominent metatarsal heads, bony prominences, and hammer/claw toes (p < .0001), as well as significantly increased amounts of hallux dorsiflexion and decreased amounts of hallux plantarflexion (p < .0001) with a total range of motion equal to the other foot types (p = .3). Neutrally aligned feet had a lower percentage of intrinsic muscle atrophy, bony prominences, and hammer/claw toes (p < .0001). Pes planus feet had an increased lateral talometatarsal angle (p < .0001) and an increased second metatarsal length. These data demonstrate structural differences between foot types in a population with diabetes.

Biomechanical Phenomena↗

PubMed1979

[Plantar release in the treatment of pes cavus in childhood. Technique and indications (author's transl)].

The authors have operated on forty instances of pes cavus in children. Ten were idiopathic, nine poliomyelitic, five hemiplegic and five as a sequel of club foot. Others cases were of various neurological cause. In all cases, the plantar fasciae and ligaments were released; the technique of this procedure is fully described. In a number of cases, soft tissue release was associated with an osteotomy of the first metatarsal, a transplant of the extensor hallucis longus to the neck of the first metatarsal, an osteotomy of the calcaneus or various muscle transplants depending on the etiology of the cavus deformity. The results are analysed as are the complications. They were satisfactory in 66 p. 100 of cases. It is concluded that plantar release procedures may either avoid arthrodesis or may lead to it later but with the foot in a more satisfactory condition.

Adolescent↗

PubMed1991

[Appraisal of outcomes of the treatment of equinus-cavus-varus deformities of the foot in adults].

There is presented the experience of treatment of 81 patients with equinus-cavus-varus deformation of 102 feet of different etiology by means of closed application of Volkov-Oganesyan-Povarov's hinged-distraction apparatus to restore the form and function of foot and talocrural articulation. For impartial assessment of the outcomes of treatment there has been developed and applied the scheme of multimark grading system of clinico-functional state of feet. The grade of the foot form and function restoration is appraised by 15 indices in comparison with the same in normal state. The sum of marks equals to 100 in case of optimum outcome. In accordance with the developed scheme there have been appraised 54 feet with the sum of marks obtained from 45 to 91 and their statistic reliability. The proposed scheme allows to make an impartial assessment of the outcomes of treatment of the equinus-cavus-varus deformation of feet and can be applied in practical institutions.

Adult↗

PubMed1991

[The rafter osteotomy of the first metatarsal with immediate weight bearing in the treatment of anterior and medial pes cavus in adults].

The difficulty of the exact adjustment of the first metatarsal's raising by dorsal cuneiform cutting and osteosynthesis, brought the authors to prefer proximal rafter osteotomy of the first metatarsal in the treatment of adult's anterior and medial pes cavus. Early weight bearing with a plaster cast or a wooden-shoe allowed the spontaneous raising of the metatarsal and an equal distribution of load between all the metatarsals. The excellent results reached by that single procedure in nine cases during ten years justify to suggest it for treatment of adult's anterior and medial pes cavus.

Adolescent↗

PubMed1990

Metatarsal osteotomy for the cavus foot.

Thirty-nine patients with pes cavus-type deformities were treated with osteotomy of the proximal metatarsals for the cavus component of the deformity. Fifty operations were followed for an average of 15 years, many for up to 26 years. Of the 39 patients, 11 had bilateral involvement. Each patient was clinically evaluated for postoperative mobility and categorized according to the Massachusetts General Hospital rating scale. Excellent or good results were obtained in 84% of the proximal metatarsal osteotomies.

Adolescent↗

PubMed1989

Assessment and management of pes cavus in Charcot-Marie-tooth disease.

The sequential approach to evaluating the cavus foot is integrated with a description and assessment of the various treatment options. Decision making in the treatment of these cases is complicated by the progressive neurologic condition that underlies many of these deformities. An effort is made to recommend the most appropriate surgical intervention based on the nature of the deformity and its rigidity. Although these principles apply to all cavus feet, the deformity in Charcot-Marie-Tooth disease is the most difficult to treat and the most prone to recurrence because of the progressive nature of the muscular imbalance causing it.

Charcot-Marie-Tooth Disease↗

PubMed1986

Pes cavus: treatment by naviculo-cuboid osteotomy.

The treatment of pes cavus in the adult by the V osteotomy of Japas has several advantages if performed before the onset of secondary arthritic degeneration. The correction is carried out at the apex of the cavus and is technically simple. Consolidation is rapid, and correction is achieved with no significant sacrifice of movement. The authors describe a modification of the medial part of the osteotomy line which was devised because of the difficulty of controlling the various fragments of navicular and cuboid during reduction in the original technique, as well as a significant incidence of osteonecrosis in some of these fragments. This modification involves only the naviculo-cuboid joint and spares the other joints, thus reducing postoperative articular stiffness to a minimum.

Adult↗

PubMed1985

[Failure of Dwyer's procedure in internal pes cavus in children. Physiopathological considerations and therapeutic deductions].

The authors have performed 34 Dwyer's calcaneal osteotomies in children with pes cavus confined to the medial arch in non-paralytic lesions (poliomyelitis and spina bifida were excluded). In 12 cases it was associated with osteotomy of the 1st metatarsal or with plantar release. No arthrodeses were performed in these 34 cases. After an average follow-up of five years the results were doubtful: in 24 instances the deformity was the same or worse. In 21 cases a secondary operation was necessary. The authors considered that the Dwyer's procedure corrects only the varus of the heel which is a secondary deformity. They believe that, in pes cavus, there is a dynamic clawing of the toes in the swing phase of gait. This produces secondary deformities. In the sagittal plane there is a synergic or paralytic imbalance at the metatarso-phalangeal level leading to vertical displacement of the 1st metatarsal and deepening of the medial arch. In the frontal plane, this vertical displacement leads to an irreducible pronation of the forefoot with secondary varus of the heel. In the horizontal plane a lateral rotation of the talus results in varus of the calcaneum.

Adolescent↗