Pes Cavus ICD-9
- 754.71 Talipes cavus (cavus foot congenital)
Pes Cavus Etiology / Epidemiology / Natural History
- Cavus deformity of the foot; longitudinal arch is elevated.
Pes Cavus Anatomy
- Forefoot is fixed in plantar flexion
Pes Cavus Clinical Evaluation
- Variable presentation:lateral foot pain, metatarsalgia, plantar keratosis, ankle instability.
- New-onset unilateral deformity is highly suggestive of a spinal cord tumor .
- Evaluate gait / stance for hindfoot varus and forefoot plantarflexion. Inspect shoes for lateral wear.
- Evaluate ankle, subtalar, midfoot, and forefoot ROM.
- Document strength of individual muscles; especially peroneus brevis and tibialis anterior.
- Neurologic workup is mandatory due to high assoication with neurologic disorders.
- Coleman's Block test: evaluates subtalar motion; a 1" block is placed under the lateral foot and heel. Flexible hindfoot corrects to neutral. Rigid deformity does not correct. (Coleman SS, CORR 1977;123:60)
- Consider Neurology consult if etiology is unknown.
Pes Cavus Xray / Diagnositc Tests
- A/P, lateral and oblique feet and A/P, lateral and mortise ankle views; evaluate for arthritis, calcaneus alignment, forefoot alignment. Forefoot plantar flexion is demonstrated by plantar flexion of the 1st ray complared to the axis of the talus on the lateral foot film.
- Calcaneal pitch angle: draw a line along the plantar aspect of the calcaneus and the ground. > 30° = hindfoot varus.
- MRI: spine MRI indicated for unilateral progressive cavus without history of trauma
- EMG/NCV: consider to evaluate for CMT, polio, etc.
Pes Cavus Classification / Treatment
- Goal: asymptomatic plantigrade foot.
- Nonoperative treatment: PT, Orthotics / extra-depth shoes. Varus deformity: add lateral wedge to sole. Pts with sensation deficits require Plastizote linings and frequent inspection for ulceration.
- Surgically generally required: procedure is dependent on deformity: plantar release, metatarsal osteotomies, tendon transfers. Rigid deformities require calcaneal osteotomy. Triple arthrodesis or calcaneal sliding osteotomy with multiple metatarsal extension osteotomies for skeletally mature pts with rigid deformities.
Pes Cavus Associated Injuries / Differential Diagnosis
Pes Cavus Complications
- Undercorrection / overcorrection
- Recurrence of the deformity / progression of the deformity
- Nerve injury
- Continued pain
Pes Cavus Follow-up Care
- Follow-up care varies and is dependent on surgical procedure performed.
Pes Cavus Review References