Cavovarus Talipes Cavus Define

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Pes cavus is a high arch of the foot that does not flatten with weight bearing. No specific radiographic definition of pes cavus exists. The deformity can be located in the forefoot, the midfoot, the hindfoot, or a combination of these sites. The spectrum of associated deformities observed with pes cavus includes clawing of the toes, posterior hindfoot deformity (described as an increased calcaneal angle), contracture of the plantar fascia, and cock-up deformity of the great toe. This can cause increased weight-bearing for the metatarsal heads and associated metatarsalgia and calluses.

Causes
In many people, we do not know the cause of their cavus foot. These people tend to have milder deformities and the foot appearance sometimes runs in the family. Many medical conditions which cause weakness or lack of co-ordination of muscles can result in a cavus foot. Examples of such conditions include spina bifida, muscular dystrophy and conditions in which the small nerves in the legs do not work properly. It is thought that even when no definite medical condition can be found, cavus feet are probably due to very slight weakness of muscles in the legs and feet.

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
Diagnosing the cause of the cavus foot position is essential prior to surgical planning. Usually, performing a laterally based calcaneal osteotomy and a distally based metatarsal osteotomy together or each procedure alone can help position the foot properly.

Non Surgical Treatment
If a considerable part of the deformity is flexible, a corrective orthosis should be used. For example, in forefoot-driven cavovarus, the hindfoot is flexible, and so an orthotic shoe insert incorporating lateral forefoot posting (support) and recessing under the first metatarsal will allow the hindfoot to correct. For ankle instability, the lateral side of the hindfoot post can be built up as well as the lateral forefoot post, creating a pronatory moment on the forefoot that counteracts the excessive supinatory moment in the hindfoot.

Surgical Treatment
The surgical procedures involved with the correction of the cavus foot are varied. Theses may include correction of the bony deformity, ankle looseness and the muscle imbalances that cause the deformity. The goal is to provide a foot that evenly distributes weight along both inside and outside edges. A variety of incisions may be needed to perform the procedures related to the correction of the cavus foot.