[Talipes cavus and pes cavus with marked hammer toes].
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Clubfoot↗
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[SPINA BIFIDA OCCULTA AND PES CAVUS WITH MARKED HAMMER TOES. (ON THE PATHOGENESIS AND CAUSAL TREATMENT OF SO-CALLED IDIOPATHIC TALIPES CAVUS)].
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Clubfoot↗
Scoliosis and cavus foot. Is there a relationship? Study in referrals, with and without scoliosis, from school screening.
BACKGROUND: The correlation of idiopathic scoliosis and cavus foot has been previously reported. This has been ascribed to possible lesions related to muscular imbalance influenced by the central nervous system. The aim of this study is the assessment of this correlation. MATERIAL AND METHOD: 3,544 children were studied, (1,765 boys and 1,779 girls, aged from 6 to 18 years) from a school-screening program of our department. A number of measurements were assessed including the angle of trunk inclination (ATI) in standing and sitting forward bending positions using the Pruijs scoliometer and the morphology of the sole shape using the Harris & Beath footprint mat. The 6 types footprint classification was used for foot shape as it was elsewhere reported. Type 1 in this classification represents typical and type 2 light cavus foot. In a first main group, 317 children were referred, who presented with ATI> or =7 degrees, and were divided into 2 subgroups. The 1st subgroup included n=264 children with body asymmetry but with no scoliosis and the 2nd subgroup included n=53 scoliotic children (Cobb angle >10 degrees). The 2nd main group included 3 227 children without asymmetry. The presence of cavus foot (footprint type 1 and 2) in these 2 groups was searched. Statistical analysis was performed using SPSS package. RESULTS: n=4 (7.54%) out of the 53 scoliotics had cavus foot [n=1 (1.88%) typical and 3 (5.66%) light cavus foot], while n=55 (20.8%) out of 264 non-scoliotic referrals showed n=9 (3.4%) typical and n=46 (17.42 %) light cavus foot. These readings prove that there is no statistical correlation between idiopathic scoliosis and cavus foot. Additionally n=3227 normal symmetric children, n=620 (19.21%), presented cavus foot, [footprints type 1 n=106 (3.28%) and type 2 n= 514 (15.92%)], which is a percentage higher than that of the scoliotic population. CONCLUSIONS: The significant correlation between idiopathic scoliosis and cavus foot as it has been elsewhere reported was not verified in this study. On the contrary it is emphasized that the percentage of cavus foot was traced higher in the general healthy population than that in the small and moderate scoliotic curves studied.
Adolescent↗
The effect of pes cavus on foot pain and plantar pressure.
BACKGROUND: Clinical management of patients with painful pes cavus is challenging because the mechanism of foot pain is poorly understood. The purpose of this study was to explore the influence of various pes cavus aetiologies on foot pain and plantar pressure characteristics, and to identify the relationship between foot pain and plantar pressure. METHODS: Seventy subjects were recruited for this study. They included 30 subjects with pes cavus of unknown aetiology (idiopathic), 10 subjects with pes cavus of neurological aetiology (neurogenic) and 30 subjects with a normal foot type. The presence and location of foot pain was recorded and barefoot plantar pressures were measured using the EMED-SF platform for the whole foot, rearfoot, midfoot and forefoot regions. FINDINGS: Subjects with pes cavus of either idiopathic or neurogenic aetiology reported a higher proportion of foot pain (60%) compared to subjects with a normal foot type (23%) (P=0.009). Pressure-time integrals under the whole foot, rearfoot and forefoot regions in pes cavus, of both idiopathic and neurogenic origin, were higher than in the normal foot type (P<0.01). Pressure-time integrals in subjects reporting foot pain were higher than for pain free subjects (P<0.001). There was a significant correlation between pressure-time integral and foot pain (r=0.49, P<0.001). INTERPRETATION: Foot pain is a common finding among individuals with pes cavus. Regardless of aetiology, pes cavus is characterized by abnormally high pressure-time integrals which are significantly related to foot pain. An understanding of the relationship between pes cavus pressure patterns and foot pain will improve the clinical management of these patients.
Case-Control Studies↗
The relationship between pes cavus and idiopathic scoliosis.
STUDY DESIGN: The incidence of pes cavus and scoliosis was studied in three groups of patients. Group A contained 130 patients with idiopathic scoliosis, Group C contained 210 patients with idiopathic pes cavus, and Group B (control) contained 200 patients of similar age. OBJECTIVES: To investigate the joint presentation of pes cavus and idiopathic scoliosis, because both deformities may share a common etiology linked to muscle imbalance. SUMMARY OF BACKGROUND DATA: Sixty five percent of Group A patients (85 of 130) had an abnormally high plantar arch, compared to only 9.5% (19 of 200) of Group B control subjects. Nine percent (20 of 210) of the patients in Group C had scoliosis curves, compared to only four patients in Group B. METHODS: Radiographs were taken to determine the type of scoliosis curve, its location, and its magnitude, and to identify the incidence of spina bifida occulta in the three groups. The incidence and degree of pes cavus were established by means of foot prints. Statistical analyses were performed on all results. RESULTS: A statistically significant relationship (P < 0.01) was found for the incidence of pes cavus between Group A (scoliosis) and Group B (control), and for the incidence of scoliosis between Group C (pes cavus) and Group B (control). No statistical significance was observed for the other relationships investigated (sex, curve location, magnitude, spina bifida). CONCLUSIONS: There was a significant correlation between scoliosis and pes cavus--spina bifida was not an etiologic factor. Therefore, in certain patients where scoliosis and pes cavus present jointly, deformity may be secondary to altered balance or to disorders of the central nervous system.
Adolescent↗
Attraction of Dibrachys cavus (Hymenoptera: Pteromalidae) to its host frass volatiles.
The European grapevine moth, Lobesia botrana (Lepidoptera: Tortricidae), is a polyphagous insect able to develop on grapes and wild plants. We tested the hypothesis that the parasitoid Dibrachys cavus (Hymenoptera: Pteromalidae) uses the larval frass in its host search. A two-armed olfactometer was used to measure the attractiveness of L. botrana larvae, their silk, or their frass after larvae were fed on different host plants. Frass of three Lepidoptera (L. botrana, Eupoecillia ambiguella, Sphinx ligustri) and one Orthoptera (Chorthippus brunneus) was assayed, but only L. botrana was used to test an effect of the larval host plant (two grape cultivars and three other plant species) to D. cavus females. Larvae without frass did not attract D. cavus whatever their origin, but their frass was attractive at a dose of 2-3 days equivalent of larval frass production. The silk produced by a single larva (L. botrana) was not attractive to D. cavus. The parasitoid was most attracted to the odor of S. ligustri; the frass of L. botrana was more attractive than that of E. ambiguella, irrespective of the species on which D. cavus had been reared. There was no difference in attractiveness of frass collected from L. botrana raised on food containing different plants. Chemical extracts using five different polarity solvents (acetone, dichloromethane, hexane, methanol, and water) differed in attractiveness to D. cavus. Water and dichloromethane were the most attractive. This suggests that a complex volatile signal made from intermediate to polar volatiles may be involved in attraction. D. cavus used frass to discriminate between different potential host species. Our results revealed that the larval food of L. botrana did not modify frass attractiveness, but that the moth species did.
Animals↗
The pathology of the lower leg muscles in pure forefoot pes cavus.
Enlargement of the peroneus longus muscle is a common occurrence in patients with forefoot pes cavus, and may contribute to the cavus deformity. The present study compares the morphology of up to five lower leg muscles from 17 patients with forefoot pes cavus with those of normal muscles. Eight cases had an identifiable neurogenic cause for the cavus. In four cases of hereditary motor-sensory neuropathy, the tibialis anterior showed more severe damage than the peroneus longus. In two cases of cerebral palsy, fibre atrophy and increased oxidative enzyme activity were observed. In nine clinically idiopathic cases, the histological appearances ranged from normal to generalised fibre atrophy or hypertrophy in individual muscles. There was a trend for the mean fibre area to be greater in peroneus longus than in tibialis anterior in six of the idiopathic group of patients. The muscle cross-sectional area on magnetic resonance imaging was correlated closely with the mean fibre area measured on tissue sections. In idiopathic forefoot pes cavus, fibre hypertrophy in peroneus longus (relative to tibialis anterior) may contribute to the cavus deformity. Muscle fibre hyperplasia may contribute to the peroneal muscle enlargement in Friedreich's ataxia. In none of the cases was peroneus longus enlargement due to fat or fibrous tissue replacement.
Adolescent↗
Quantification of muscle strength and imbalance in neurogenic pes cavus, compared to health controls, using hand-held dynamometry.
BACKGROUND: Pes cavus foot deformity in neuromuscular disease is thought to be related to an imbalance of musculature around the foot and ankle. The most common cause of neurogenic pes cavus is Charcot-Marie-Tooth (CMT) disease. The aim of this investigation was to objectively quantify muscle strength and imbalance using hand-held dynamometry in patients diagnosed with CMT and pes cavus, compared to healthy controls. METHODS: Muscles responsible for inversion, eversion, plantarflexion, and dorsiflexion of the foot and ankle were measured in 55 subjects (11 CMT patients with a frank pes cavus, and 44 healthy controls with normal feet) using the Nicholas hand-held dynamometer (HHD). Test-retest reliability of the HHD procedure also was determined for each of the four muscle groups in the healthy controls. RESULTS: Test-retest reliability of the HHD procedure was excellent (ICC3,1 = 0.88 to 0.95) and the measurement error was low (SEM = 0.3 to 0.7 kg). Patients with CMT were significantly weaker than normal for all foot and ankle muscle groups tested (p < 0.001). Strength ratios of inversion-to-eversion and plantarflexion-to-dorsiflexion were significantly higher in the patients with CMT and pes cavus compared to individuals with normal foot types (p > 0.01). CONCLUSIONS: Hand-held dynamometry is an objective and reliable instrument to measure muscle strength and imbalance in patients with CMT and a pes cavus foot deformity.
Adult↗
Investigation of muscle imbalance in the leg in symptomatic forefoot pes cavus: a multidisciplinary study.
The cross-sectional areas of the peroneal and anterior muscle compartments at the same level in the upper leg were measured using magnetic resonance imaging in 41 cases of forefoot pes cavus. The pes cavus group included idiopathic cases and pes cavus associated with Charcot-Marie-Tooth disease, Friedreich's ataxia, cerebral palsy, status postpoliomyelitis, nerve trauma, and spinal cord tethering. Thirty-nine of these cases were symptomatic. The results were compared with studies of 11 normal controls. It was found that in the majority of cases of forefoot cavus, the peroneal compartment was enlarged relative to the anterior compartment when compared with the normal controls. Biopsies of the tibialis anterior and peroneus longus muscles in 18 patients with forefoot pes cavus showed that any relative expansion of the peroneus longus was not due to pseudohypertrophy. Overaction of the peroneus longus in comparison to its antagonist the tibialis anterior is proposed as an important factor in the pathogenesis of the majority of symptomatic cases of forefoot pes cavus.
Adolescent↗
[Clinical and radiologic comparison of "idiopathic" and "neurogenic" pes cavus].
41 patients with 66 cavus feet were reviewed clinically and radiologically according to the parameters of Dennemann at an average age of 41.3 years. The etiology was a so-called "idiopathic pes cavus" in 51 per cent of the cases, in the others, a neurological basic disease (15 per cent condition after poliomyelitis, 3 per cent meningocele, 6 per cent Friedreich's ataxia, 10.5 per cent other neurological disorders) or condition after congenital club foot or trauma. Exact neurological and electrodiagnostic examination of the cavus feet primarily staged as idiopathic revealed sensory or motor loss in 74 per cent of the cases. A comparison of the "idiopathic cavus feet" with the cavus feet in neurological basic diseases with respect to the radiological parameters showed no significant differences concerning progression and osteoarthritis. Conservative and surgical measures were carried out with roughly the same success. In 36 cases (55 per cent), however, complaints on the part of the ankle joint and the talo-calcaneonavicular joint and the metatarsal head were noted.
Adolescent↗
Effective orthotic therapy for the painful cavus foot: a randomized controlled trial.
Patients with a cavus or high-arched foot frequently experience foot pain, which can lead to significant limitation in function. Custom foot orthoses are widely prescribed to treat cavus foot pain. However, no clear guidelines for their construction exist, and there is limited evidence of their efficacy. In a randomized, single-blind, sham-controlled trial, the effect of custom foot orthoses on foot pain, function, quality of life, and plantar pressure loading in people with a cavus foot type was investigated. One hundred fifty-four participants with chronic musculoskeletal foot pain and bilateral cavus feet were randomly assigned to a treatment group receiving custom foot orthoses (n = 75) or to a control group receiving simple sham insoles (n = 79). At 3 months, 99% of the participants provided follow-up data using the Foot Health Status Questionnaire. Foot pain scores improved more with custom foot orthoses than with the control (difference, 8.3 points; 95% confidence interval [CI], 1.2 to 15.3 points; P = .022). Function scores also improved more with custom foot orthoses than with the control (difference, 9.5 points; 95% CI, 2.9 to 16.1 points; P = .005). Quality-of-life data favored custom foot orthoses, although differences reached statistical significance only for physical functioning (difference, 7.0 points; 95% CI, 1.9 to 12.1 points; P = .008). Plantar pressure improved considerably more with custom foot orthoses than with the control for all regions of the foot (difference, -3.0 N . s/cm(2); 95% CI, -3.7 to -2.4 N . s/cm(2); P < .001). In conclusion, custom foot orthoses are more effective than a control for the treatment of cavus foot pain and its associated limitation in function.
Female↗
[Anterior tarsectomy for cavus foot. Retrospective study of 52 cases].
The authors reviewed 34 patients treated by tarsectomy for idiopathic pes cavus deformity between 1977 and 1996. Fifty two feet were treated surgically. All patients had undergone previous conservative treatment. The average age was 40 years. Podoscopic examination revealed 24 cavus feet stage 2, 28 cavus feet stage 3, adduction of the forefoot in 15 cases and an equinus deformity in 8 cases. On radiographic examination, Djian-Annonier's angle was 108 degrees on average. All patients were evaluated with a minimum ot two years follow-up, according to the evaluation system of the Massachusetts General Hospital. With an average follow-up of six years and six months, overall results were; 65.5% very good and good, 21% fair, 13.5% poor. The morphological correction was poor in 9 cases. Djian-Annonier's angle was 125 degrees on average. A number of cavus feet do not justify surgical treatment, because they are well tolerated, sometimes with orthopedic orthoses. Tarsectomy must be avoided in neurological conditions. We do not advise release of soft tissue or Dwyer's calcaneal osteotomy. In our opinion, the choice indication for anterior tarsectomy is the nonrigid cavus foot. It must be combined with lengthening of the Achilles tendon when a deficit of dorsiflexion of the foot persists following tarsectomy. According to their importance, associated deformations will be treated in the same operative session or not.
Adolescent↗
Pes cavus and claw toes deformity in patients with spinal cord injury and multiple sclerosis.
Patients with spinal cord injury or multiple sclerosis were surveyed for the presence of extreme foot deformities and spasticity. Pes cavus and claw toes were found in eight of 80 spastic spinal cord injury and two of 20 multiple sclerosis patients. Pes cavus and claw toes were not found in 29 flaccid spinal cord injury patients. Pes cavus and claw toes were associated with flexor reflexes which could be elicited by pin prick proximal to the knee, suggesting extreme spasticity--and by low excitatory thresholds for the anterior tibialis as indicated electromyographically. Complications of severe spasticity associated with spinal cord injury and multiple sclerosis include pes cavus and claw toes, mediated in part by spasms of the anterior tibialis.
Adult↗
The congenital cavus foot. A follow-up report.
Congenital cavus feet are not commonly related to central nervous system disease or associated with other significant congenital anomalies. The authors believe that the congenital variety of cavus foot is probably the most common etiology of cavus deformity, although it is usually noted only in later life when it becomes symptomatic. The vast majority of these feet can be managed conservatively; only rarely is surgical intervention warranted. Early recognition of the deformity and appropriate treatment is important. The Hibbs angle is a useful method of measuring the cavus deformity and can be employed in determining the degree of the deformity.
Casts, Surgical↗
Cavus, cavovarus, and calcaneocavus. An update.
Cavus, cavovarus, and calcaneocavus deformities are often related to neuromuscular disorders that result in intrinsic and/or extrinsic muscle imbalance in the foot. A careful search for intraspinal causes should be made, particularly in progressive cavus deformity in children. Plantar release is the most common procedure performed for correction of cavus feet and its variants. The choice among available surgical procedures is dictated by the age of the patient, the flexibility and cause of the deformity, an analysis of the deformity, and appropriate standing roentgenograms. Soft tissue procedures, including plantar fasciotomy and tendon transfers, are usually done in younger patients. Bony procedures, including calcaneal, midtarsal, and forefoot osteotomies, are performed in mature feet and are tailored to the apex of the deformity. Triple arthrodesis is a salvage operation for correcting cavus and its variants.
Adult↗
[Results of podoscope screening in 948 non-selected children, with special reference to cavus foot].
OBJECTIVE: To ascertain the prevalence of cavus foot in a non-selected pediatric population, the percentage of secondary forms and to establish criteria for remission to the specialist. PATIENTS AND METHODS: A randomized study of 948 healthy children older than four years, in which the sole footprint was studied through podoscope, was performed. RESULTS: Cavus foot of different grades was present in 16.3% of the children studied, with a statistically significant difference in favor of girls. There were family antecedents in 60%. Symptoms and/or exploratory abnormal signs were presented in 19.3%, mainly pain, limp and sole dermatitis. Of the diagnoses made, 7.7% were referred to the specialist, with the diagnosis confirmed in 75% and treatment implemented in 50%. There were no cases of secondary cavus foot. CONCLUSIONS: Cavus foot is very frequent in healthy children, has a familiar character and only exceptionally obeys the rules of a neuromuscular cause. We propose four criteria for the selection of patients for referral to the specialist.
Child, Preschool↗
[Historical development of arthrodesis of pes cavus].
In contrast to the present, the diagnosis and treatment of pes cavus was a major subject of research at the beginning of last century. This was due to the high incidence of certain neurological disorders (poliomyelitis, myelodysplasia) which led to the development of this foot deformity. Advances in anaesthetic technique and the establishment of antisepsis contributed largely to the development of the surgical treatment of pes cavus. Ladislaus Leo Freiherr von Lesser performed the first surgically induced ankylosis of the ankle by denuding the joint surfaces of cartilage followed by fixation with a metal nail. This procedure was then introduced as arthrodesis; a word derived from the Greek meaning "binding of the joint". Numerous methods and modifications of arthrodesis have been developed for the correction of foot deformities. With increasing knowledge of the pathogenesis of pes cavus, soft tissue and tendon transfer procedures were added to the surgical treatment. Today, the philosophy of arthrodesis in the treatment of foot deformity is the same, but the development of fixation techniques and implant materials could improve postoperative care and outcome.
Arthrodesis↗
Midfoot osteotomies for the cavus foot.
Midfoot osteotomies have long been used for a wide variety of congenital and acquired deformities. Severe pes cavus often necessitates some form of surgical correction, and no single procedure can be used exclusively. Midfoot osteotomies may be combined with adjunctive procedures to form an appropriate strategy for the treatment of these deformities. The authors present an overview of pes cavus, including evaluation and classification of the deformity, as well as associated conditions. Several soft tissue and osseous procedures for correction of the cavus foot are discussed. Special attention is directed at the use of various midfoot osteotomies and their ability to enhance such correction.
Foot↗