Elsevier

Orthopaedics and Trauma

Volume 30, Issue 1, February 2016, Pages 68-74
Orthopaedics and Trauma

Foot and ankle
Assessment and management of cavus foot deformity

https://doi.org/10.1016/j.mporth.2016.02.001Get rights and content

Abstract

The cavus foot, or pes cavus, is a deformity of the foot characterised by a high longitudinal arch. It is classically associated with neurological conditions and muscle imbalance. The deformity varies in severity and can affect any or all of the hindfoot, midfoot or forefoot. Careful examination should be performed and underlying neurological conditions sought. We outline an á la carte approach to surgical management, in which deformity of the ankle and hindfoot is addressed before moving on to assessment and correction of the mid- and forefoot. Flexible deformities can be corrected with ligament rebalancing and osteotomies whereas fixed deformity frequently requires arthrodesis. Dynamic muscle equilibrium should always be re-established using appropriate tendon transfers.

Introduction

The cavus foot, or pes cavus, is a deformity of the foot characterised by a high longitudinal arch. It is classically associated with neurological conditions and varies in severity, depending on the underlying cause. The deformity can affect any or all of the hindfoot, midfoot or forefoot. This paper outlines and approach to the clinical evaluation and management of the cavus foot.

Section snippets

Clinical presentation

Cavus feet may present at any point on a spectrum of severity and in order to detect the most subtle or early stages of deformity, careful history taking and physical examination are essential. Family history of foot deformity or neurological conditions should be sought. The presence of pain or progression of deformity should prompt further investigation.

Cavus deformity is complex, but considering the ankle, hindfoot, midfoot and forefoot in sequence aids the surgeon in making logical treatment

Aetiology

Cavus foot deformity occurs due to muscle dysfunction and imbalance between antagonist muscle groups. The term ‘subtle cavus foot’ was coined by Manoli et al. in 20052 and has gained popularity in the literature to describe a less severe deformity, in the absence of a clear underlying neurological course.4 This has been used interchangeably with idiopathic cavus foot where no recognisable cause has been identified. Otherwise, the deformity is unilateral or bilateral and classified as

Conservative treatment

The wide range of cavus foot deformities lay upon a spectrum of severity with variable presentations. Many can be managed non-operatively with orthotics6 and physiotherapy.4 Eccentric calf muscle stretches and lateral heel cup orthotics are commonly used adjuncts to reduce symptoms due to the cavus deformity itself. Burns et al. demonstrated in a randomised controlled trial that custom foot orthoses were more effective than a control orthotic at reducing foot pain scores: plantar pressure

Principles of surgical decision making

As for all patients with complex foot deformity, the aim of surgery is to attain a plantar-grade, painless, sensate foot, with as much flexibility as possible.

Given the nature of the aetiology of cavus foot, it is difficult to be prescriptive on the surgical management, as each case should be treated individually. We recommend an à la carte approach, with each case being assessed both clinically and radiologically, to determine the correct combination of hind, mid- and forefoot procedures

Conclusion

The cavus foot is a complex deformity that requires careful clinical assessment. Conservative treatment is an option, but progressive deformities frequently necessitate surgical correction. Surgical decision making is based on an à la carte approach, tailoring the procedures to the individual's diagnosis and deformity. Whilst osteotomies and fusions are often required, it is vital to achieve correct soft tissue balancing, with appropriate tendon transfers. Patients should be aware that recovery

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