Pes CavusPes Cavus

What is Pes Cavus?What is Pes Cavus?

• Excessive Elevation of Longitudinal Excessive Elevation of Longitudinal ArchArch

• High ArchHigh Arch

• Foot is relatively inflexibleFoot is relatively inflexible

• Much less common than Pes PlanusMuch less common than Pes Planus

• Also referred to as hollow foot or Also referred to as hollow foot or claw footclaw foot

Causes of Pes CavusCauses of Pes Cavus

• Neurological Disorders (60% of time)Neurological Disorders (60% of time)– Spina BifidiaSpina Bifidia– PoliomyelitisPoliomyelitis– Charcot-Marie-Tooth DiseaseCharcot-Marie-Tooth Disease– Talipses Equinovarus (Clubfoot)Talipses Equinovarus (Clubfoot)

• Muscle ImbalanceMuscle Imbalance– Weak calf musclesWeak calf muscles– Tight Plantar FasciaTight Plantar Fascia

• Excessive SupinationExcessive Supination

• Claw ToesClaw Toes

• Traumatic IncidentsTraumatic Incidents– Compartment SyndromeCompartment Syndrome– Crushing InjuryCrushing Injury– BurnsBurns– Iatrogenic( overlengthing of the Achilles Iatrogenic( overlengthing of the Achilles

Tendon)Tendon)– Malunion of Calcaneal or Talar fractureMalunion of Calcaneal or Talar fracture

Signs and SymptomsSigns and Symptoms

• Pain during running, walking, or Pain during running, walking, or standingstanding

• Painful toes that can’t be straightenPainful toes that can’t be straighten

• Poor shock absorptionPoor shock absorption

• Foot length shortenFoot length shorten

• Callus on ball and heel of foot due to Callus on ball and heel of foot due to uneven weight distributionuneven weight distribution

• Abnormal shortening of the achilles Abnormal shortening of the achilles tendontendon

• Tight plantar faciitisTight plantar faciitis

• In frontal plane forefoot in varus and In frontal plane forefoot in varus and heel in valgusheel in valgus

• May experience overuse symptoms May experience overuse symptoms in the knees, ankles, and backin the knees, ankles, and back

ExaminationExamination

• History to determine any History to determine any neurological conditionsneurological conditions

• Observation of foot and toesObservation of foot and toes

• Examine GaitExamine Gait

• MMT and FlexibilityMMT and Flexibility

• ROM of FootROM of Foot

• Neurological ExamNeurological Exam

• Colman Block TestColman Block Test– Patient is to stand on 2.5-4 cm block Patient is to stand on 2.5-4 cm block

with heel and lateral border of the foot with heel and lateral border of the foot on the block. Bear full weight while the on the block. Bear full weight while the 11stst, 2, 2ndnd, and 3, and 3rdrd metatarsal hang freely metatarsal hang freely into plantarflexion and pronation. Test is into plantarflexion and pronation. Test is looking for hindfoot flexibility. looking for hindfoot flexibility.

Two Common PatternsTwo Common Patterns

• CalcaneocavusCalcaneocavus– Hindfoot Hindfoot

abnormalitiesabnormalities– No pronation of No pronation of

forefoot; no varus forefoot; no varus deformity of deformity of hindfoothindfoot

– Dorsiflexion of Dorsiflexion of calcaneumcalcaneum

• CavovarusCavovarus– Forefoot Forefoot

abnormalitiesabnormalities– Forefoot pronated Forefoot pronated

and heel in varusand heel in varus– Claw toesClaw toes

Classification SystemsClassification Systems

• MildMild– Longitudinal arch appears increased NWBLongitudinal arch appears increased NWB– Longitudinal arch appears almost normal Longitudinal arch appears almost normal

WBWB– Toes clawed NWBToes clawed NWB– Toes normal WBToes normal WB– Hindfoot varusHindfoot varus

• ModerateModerate– Longitudinal arch increases NWB and WBLongitudinal arch increases NWB and WB– Claw toes NWB and WBClaw toes NWB and WB– Calluses under prominent metatarsal headCalluses under prominent metatarsal head– Dorsiflexion limitedDorsiflexion limited– Forefoot plantarflexed on hindfootForefoot plantarflexed on hindfoot

• SevereSevere– Calcaneos can’t pronate past 5 degrees Calcaneos can’t pronate past 5 degrees

varusvarus– Heel in varus and foot in valgusHeel in varus and foot in valgus– Decrease ROM in footDecrease ROM in foot

ClassificationClassification

TypeType ForefootForefoot HindfootHindfoot

SimpleSimple BalancedBalanced NeutralNeutral

CavovarusCavovarus PlantarflexuioPlantarflexuionn

VarusVarus

CalcaneousCalcaneous Fixed EquinusFixed Equinus CalcaneousCalcaneous

EquinovarusEquinovarus EquinusEquinus EquinusEquinus

Diagnostic ProceduresDiagnostic Procedures

• X-Ray footX-Ray foot

• X-Ray SpineX-Ray Spine

• Nerve Conduction StudiesNerve Conduction Studies

TreatmentTreatment

• OrthodicsOrthodics

• Corrective/Better Supporting ShoesCorrective/Better Supporting Shoes

• Stretch Achilles Tendon/Plantar Stretch Achilles Tendon/Plantar FasciaFascia

• Surgical Procedures in severe casesSurgical Procedures in severe cases

Return to PlayReturn to Play

• Arch SupportsArch Supports

• Correct ShoesCorrect Shoes

• Avoid Excessive Long RunsAvoid Excessive Long Runs

ReferencesReferences

• Gallaspy, J.B. May J.D. Gallaspy, J.B. May J.D. Signs andSigns and Symptoms of Athletic InjuriesSymptoms of Athletic Injuries. Mosby-Year . Mosby-Year Book: St. Louis,1996. p.406.Book: St. Louis,1996. p.406.

• Arneheim, D. Prentice, W. Principles of Arneheim, D. Prentice, W. Principles of Athletic Training. McGraw Hill: Boston. Athletic Training. McGraw Hill: Boston. 2000. 102000. 10thth ed. P464 ed. P464

• Greene, W.B. Essentials of Musculoskeletal Greene, W.B. Essentials of Musculoskeletal Car. American Academy of Orthopedic Car. American Academy of Orthopedic Surgery. 2001 2Surgery. 2001 2ndnd ed. ed.

• www.sportsinjuryclinic.net/cybertherwww.sportsinjuryclinic.net/cybertherapist/front/foot/clawfoot.htmapist/front/foot/clawfoot.htm

• www.emedicine.com/orthoped/topic5www.emedicine.com/orthoped/topic539.htm39.htm

• www.nlm.nih.gov/medlineplus/ency.awww.nlm.nih.gov/medlineplus/ency.article/001261.htmrticle/001261.htm

• www.ortho-u.net/011/203.htmwww.ortho-u.net/011/203.htm