Pes Cavus Vs Pes Planus

Overview
The term pes cavus encompasses a broad spectrum of foot deformities. Three main types of pes cavus are regularly described in the literature, pes cavovarus, pes calcaneocavus and ?pure? pes cavus. The three types of pes cavus can be distinguished by their aetiology, clinical signs and radiological appearance. Pes cavovarus, the most common type of pes cavus, is seen primarily in neuromuscular disorders such as Charcot-Marie-Tooth disease, and in cases of unknown aetiology, conventionally termed as ?idiopathic?. Pes cavovarus presents with the calcaneus in varus, the first metatarsal plantarflexed and a claw-toe deformity. Radiological analysis of pes cavus in Charcot-Marie-Tooth disease shows the forefoot is typically plantarflexed in relation to the rearfoot. In the pes calcaneocavus foot, which is seen primarily following paralysis of the triceps surae due to poliomyelitis, the calcaneus is dorsiflexed and the forefoot is plantarflexed. Radiological analysis of pes calcaneocavus reveals a large talo-calcaneal angle. In ?pure? pes cavus, the calcaneus is neither dorsiflexed nor in varus, and is highly arched due to a plantarflexed position of the forefoot on the rearfoot. A combination of any or all of these elements can also be seen in a ?combined? type of pes cavus that may be further categorized as flexible or rigid. Despite various presentations and descriptions of pes cavus, all are characterised by an abnormally high medial longitudinal arch, gait disturbances and resultant foot pathology.

Causes
There are many causes for a high arch foot, known as cavus. In the United States, the most common cause for a high arch foot is a form of muscular dystrophy called hereditary sensorimotor neuropathy, more commonly known as Charcot Marie Tooth disease (CMT).

Symptoms
As with certain cases of flat feet, high arches may be painful due to metatarsal compression; however, high arches, particularly if they are flexible or properly cared-for-may be an asymptomatic condition. People with pes cavus sometimes though not always, have difficulty finding shoes that fit and may require support in their shoes. Children with high arches who have difficulty walking may wear specially designed insoles, which are available in various sizes and can be made to order.

Diagnosis
It is critical to establish whether there is a neurological diagnosis and whether it is progressive or static. In the growing foot, the deformity may be progressive although the neurological impairment may be static. The history should cover the onset of foot problems and how they have progressed. Pain, instability, difficulty walking or running and problems with footwear are frequent complaints. Neurological symptoms, such as sensory changes, weakness and clumsiness should be sought. Back pain or headaches may signify a central cause. Family history may suggest a hereditary cause.

Non Surgical Treatment
Conservative care is highly successful in the cavus high arch foot. An orthotic with a high lateral heel flange, a valgus post and a sub-first metatarsal cutout can balance the foot. Often, the first ray is plantarflexed and a cutout of the first metatarsal head is essential for forefoot balancing. In severe ankle instability cases, an over the counter ankle-foot orthotic or a custom ankle-foot orthotic can be beneficial in balancing the foot and ankle. Consideration of a first ray cutout should also be part of the bracing process.

Surgical Treatment
If non-surgical treatment fails to adequately relieve gout pain sufferers, improve stability, and compensate for any muscular imbalance or weakness, your physican may advocate surgery, also considered for cases that are predicted to progress in nature. In these instances, the goal of surgery is to help reduce the severity of future problems. There are various surgical procedures available, some of which combine both bony and tendon reconstruction. Your physician will review and recommend a procedure based on the patient?s individual case.