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PubMed1983

Evaluation of the cavus foot for orthopedic treatment.

Each case of cavus and equinovarus foot must be thoroughly assessed prior to operation. Assessment includes diagnosis; electrodiagnostic and muscle testing; and evaluation of the type, location, and severity of the deformities and whether they are flexible or fixed. The vascular status must also be ascertained. The sites of plantar callus are noted, as well as the amount of correction that will be necessary. The integrity of the metatarsal fat pads must be noted. Muscle power is charted, and any sensory loss is mapped. Joints are evaluated clinically to determine the amount of fixed deformity and pain and roentgenographically to determine mainly the effect of prior surgical procedures, the presence of nonunion, and secondary osteoarthritic changes in noninvolved joints. Bone wedges are obtained proximal to any painful callus and should be taken from joints that are painful, stiff, arthritic, unstable, or functionless. Flexible and functional joints, e.g., the subtalar complex, should not be sacrificed for arthrodesis unless the cavus deformity is very severe or fusion is necessary to obtain necessary motors. Appropriate tendon transfers are usually done only after bony correction of fixed deformities but may also be used (along with soft tissue releases) to balance muscle power before deformities become fixed.

Arthrodesis↗
PubMed1983

"Beak" triple arthrodesis for severe cavus deformity.

Attention is called to the principles of a technique described more than 20 years ago that has proved clinically useful in the correction of severe cavus and cavovarus deformities when foot stabilization by triple arthrodesis is indicated. The method obtains correction of the cavus deformity by depressing the anterior aspect of the foot beneath a beak or ledge created in the talus, thereby preserving the vascularity to the talus and the integrity of the anterior ankle joint without shortening the foot.

Arthrodesis↗
PubMed1983

Pathogenesis of pes cavus in Charcot-Marie-Tooth disease.

Of 22 persons from a single kinship of known Charcot-Marie-Tooth (CMT) disease, 12 were found to be affected. All 12 had a pes cavus deformity. The insidious atrophy of the intrinsic musculature of the foot progressed to a fixed soft tissue and bony cavus deformity.

Adolescent↗
PubMed1980

Tarsometatarsal truncated-wedge arthrodesis for pes cavus and equinovarus deformity of the fore part of the foot.

The indications, contraindications, technique, and end results of thirty-four tarsometatarsal truncated-wedge arthrodeses performed for cavus and equinovarus deformity of the fore part of the foot were reviewed. The etiology of deformity included idiopathic pes cavus, equinus deformity of the fore part of the foot, residual club foot, poliomyelitis, and compartment syndromes. With th truncated-wedge arthrodesis the subtalar joint is not violated and selective correction of any combination of depression of the metatarsal head is readily accomplished. By strict adherence to the indications and exacting surgical technique, complications are rare and the end results are uniformly excellent.

Adolescent↗
PubMed1993

[Pes cavus in children].

There are several forms of pes cavus with specific anatomical features and different outcomes. Medial pes cavus is often due to a neurological disorder and causes severe symptoms. The causal disease is responsible for gradual deepening of the arch and deformities of the toes and hindfoot. Surgery is warranted in severe deformities with functional impairment. Procedures performed in younger patients involve the soft tissues; an example is plantar release with or without osteotomy of the calcaneus. In older children, osteotomy or fusion is required.

Adolescent↗
PubMed1993

[Chronic inflammatory demyelinating polyneuropathy in childhood--a case with markedly hypertrophic nerves and pes cavus].

We describe a 9-year-old boy with chronic inflammatory demyelinating polyneuropathy (CIDP), whose distal dominant, slowly progressive motor sensory involvement developed since infancy. Thickened peripheral nerves were visible in his neck and palpable in the extremities. The hand muscles were atrophic and both feet showed pes cavus deformity. He was unable to walk. Nerve conduction study revealed no sensory potentials. Compound muscle potential (CMP) was absent in the legs. In the arms, CMP showed markedly low amplitude and temporal dispersion. Motor conduction velocities were 1.7 to 2.7 m/sec, showing extremely high threshold to electrical stimuli. Conduction block was not convincing, nevertheless the asymmetric conduction abnormalities strongly suggested multifocality of the lesion. In the biopsied sural nerve no myelinated fibers were found. Considerable improvements in muscle power and electrophysiological findings were brought about by corticosteroid therapy. CIDP in childhood may masquerade hereditary neuropathies presenting hypertrophic peripheral nerves and pes cavus deformity. A careful nerve conduction study is thus desirable to find out electrophysiological multifocality.

Child↗
PubMedDate not supplied

Computed tomographic analysis of pes cavus.

Patterns of muscle degeneration in patients with peripheral neuropathies exhibiting pes cavus deformity were studied by computed tomography (CT). Twenty-six patients attending the muscle disease clinic at Newington Children's Hospital with hereditary sensory motor neuropathies (HSMN) I, II, or III had clinical and radiographic assessment in addition to CT scans of the feet and legs at designated levels. The pattern of muscle degeneration was analyzed with other variables, including age, sex, tibial torsion, cavus, heel varus, and claw toes. Multiple regression/correlation analysis clearly demonstrated earlier and more severe involvement of the intrinsic muscles of the foot as compared with the extrinsic muscles. The most consistent early degeneration occurred in the pedal lumbricals and interossei, which have the most distal innervation. The order of muscle degeneration is a centripetal pattern, with two types of degeneration occurring in the leg muscles: type P patients had earlier degeneration of the leg muscles innervated by the peroneal nerve, and type T patients showed earlier degeneration of those extrinsics innervated by the posterior tibial nerve.

Adolescent↗
PubMed1977

Mechanism and reconstruction of pes cavus.

Many important factors are involved in the surgical treatment of pes cavus. Among these factors are the location of the deformity--frontal, sagittal, or transverse planes--and whether there is an associated muscle weakness. Biomechanical analysis will help to determine whether the cavus foot is rigid or nonrigid and how it functions. Neurologic and radiologic tests must also be used to determine the type of operative procedure required for correction of the deformity.

Biomechanical Phenomena↗
PubMed1985

Weaver syndrome with pes cavus.

Few cases have been described of the Weaver syndrome, an overgrowth syndrome with advanced skeletal age. Here we report bilateral pes cavus in an affected girl.

Bone Diseases, Developmental↗
PubMed1985

The long-term results of the surgical management of paralytic pes cavus by soft tissue release and tendon transfer.

Twenty-six patients with paralytic pes cavus were managed by early soft tissue correction and tendon transfer. Eighteen had spina bifida, 6 had peroneal muscular atrophy and two had cerebral palsy. The most frequent operations were flexor hallucis longus tenodesis, Girdlestone's flexor to extensor tendon transfer and plantar release. The indications for these procedures are discussed and the results presented, with particular reference to static and dynamic foot pressure studies performed at review. Follow-up averaged 5.2 years. Toe correction was found to be successful in most cases but plantar release failed in 55% of feet, with many progressing to fusion. Many failed feet had presented at an earlier age and it was felt that the initial procedures had delayed the need for bony correction thus minimising growth disturbance.

Adolescent↗
PubMed2000

The radiological analysis of pes cavus deformity in Charcot Marie Tooth disease.

Charcot Marie Tooth (CMT) is a progressive hereditary peripheral neuropathy. The most prevalent subtype is CMT-1A, wherein patients develop a characteristic cavovarus deformity. We have reviewed a series of standing lateral foot radiographs of patients with foot deformity due to CMT, and found that the hind foot of these patients is in dorsiflexion, not equinus, and that the apparent equinus is due to plantar flexion of the forefoot on the midfoot, and actually represents a cavus deformity.

Adolescent↗
PubMedDate not supplied

The Akron midtarsal dome osteotomy in the treatment of rigid pes cavus: a preliminary review.

This study reviews the preliminary results of a previously unreported midtarsal "dome" osteotomy, all operations being performed by a single surgeon. The procedure is centered at the apex of the deformity and allows for extensive angular and rotational correction of the midfoot. The initial review has demonstrated 67% satisfactory results in 22 patients representing 35 feet. Satisfactory results were obtained in 15 of 16 feet (94%) in patients greater than 8 years of age. Careful short-term analysis suggests that the midtarsal "dome" osteotomy is best indicated for the child greater than 8 years of age with a rigid cavus or cavovarus foot.

Adolescent↗
PubMed1978

Zosteriform lentiginous naevus with ipsilateral rigid cavus foot.

A patient is presented with a rigid cavus deformity associated with a painful linear keratotic lesion on the lateral plantar border. A unilateral zosteriform lentiginous naevus is found on the same side as the foot deformity. Electrodiagnostic evaluation suggests the presence of a non-specific neuromuscular process on the affected side. This association has not previously been reported.

Adult↗
PubMed2002

Cavus foot correction in adults by dorsal closing wedge osteotomy.

Twelve patients (13 feet) who underwent dorsal closing wedge osteotomy for cavus foot deformity were re-examined clinically and radiographically 46 months after surgery (range, 24 to 80 months). A dorsally based bone wedge, sized according to the deformity on the preoperative radiographs, was excised between the Lisfranc and Chopart joint lines. Eight patients (nine feet) were satisfied with the procedure. Although significant improvement of both symptoms and foot alignment was achieved, most patients continued to experience mild to moderate pain postoperatively. The outcome seems not to be directly related to the achieved surgical correction.

Adult↗
PubMed2005

The subtle cavus foot, "the underpronator".

Subtle cavus foot deformity is ubiquitous, yet it continues to be commonly missed. Simple physical examination maneuvers can provide information that allows well-planned nonoperative care and selection of operative procedures to correct the underlying cause as well as presenting pathology.

Biomechanical Phenomena↗