Supinated Foot Types

Overview
Pes cavus, defined as a high arch in the sagittal plane, occurs in various clinical situations. A cavus foot may be a variant of normal, a simple morphological characteristic, seen in healthy individuals. Alternatively, cavus may occur as a component of a foot deformity. When it is the main abnormality, direct pes cavus should be distinguished from pes cavovarus.

Causes
Cavus foot commonly occurs as a result of an underlying medical or neurological condition, such as polio, muscular dystrophy or cerebral palsy. Cavus foot may also occur as a result of congenital defects. They may be inherited from a parent, or they may result from an orthopedic condition or a disease of the nerves or muscles.

Symptoms
Forefoot plantaris leads to increased pressure on the metatarsal heads. This pressure is maintained for a greater proportion of the gait cycle than in normal feet. A high arch reduces the size of the footprint and increases plantar pressure. Plantar pain and callus formation may give way to ulceration, particularly in the neuropathic patient who lacks protective sensation.

Diagnosis
Coleman block test helps guide treatment, evaluates flexibility of hindfoot by putting block under lateral foot you eliminate the contribution by the first ray, a first ray that is overly flexed can contribute to a varus deformity, flexible hindfoot will correct to neutral or valgus when block placed under lateral aspect of foot, a rigid hindfoot will not correct into neutral, always remove shirt and look for spinal dysraphism.

Non Surgical Treatment
Careful investigation is needed to rule out any neurological condition that is causing the high arched foot. This will depend on what is causing the pain, if anything. For instance, flexible high arches may not need any treatment. Wear shoes with a good cushioning, depth and arch support. Control body weight to decrease load on the feet. Over-the-counter arch supports may be helpful for mild cases of pes cavus, but they are often a poor shoe fit for persons with severe pes cavus.

Surgical Treatment
In severe cases of cavus, surgical intervention is often necessary. The main consideration for surgical planning is the cause of the cavus deformity. Consider whether it is a structural deformity or one caused by an underlying traumatic event such as a peroneal tendon tear or ankle instability. Furthermore, in either a structural or traumatic case, it is important to consider if the cavus is from a plantarflexed first ray only, a calcaneal varus only or a combination of the two deformities together. After considering all the information, one can plan for surgery.