Talipes Cavus Foot Reconstruction

Overview
A high arch foot is known in medical terms as a ?subtle cavus foot?. People with high arch feet tend to be very stiff through the midfoot, with very little movement through the main midfoot joints (ex. the talo-navicular joint). The heel tends to be pointed inward in what is known as a varus position (Figure 1a). This foot position can be easily identified on examination by looking at the feet head on with the patient standing. If the inside edge of the heel is visible from the front (this is known as a peek-a-boo heel), then the individual likely has an inwardly pointed heel (varus heel).

Causes
The exact cause of pes cavus is unknown. However, the medical community has settled on three likely scenarios that lead to pes cavus. Neuromuscular Condition. A neuromuscular condition may affect nerves and muscles that cause the hollowing of the foot. There are a number of neuromuscular conditions that could be the culprit, the most likely of which is Charcot-Marie Tooth disease. Congenital. Congenital causes may be derived from familial history of residual club foot as well as cases where the condition happens spontaneously. Trauma. As common sense would dictate, severe foot trauma could cause pes cavus through fractures, burns etc.

Symptoms
Patients often complain of pain, instability, difficulty walking or running and also problems with footwear. There is often a range of other foot deformities also present eg, claw toes, increased calcaneal angle, 'cocked-up' big toe.

Diagnosis
Upon meeting with your podiatrist he or she will likely recommend either an orthotic insert, new shoes for pes cavus, or both. X-Rays may be taken as well to determine the bone structure?s contribution to the ailment.

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
The surgeries can be, Tendon transfers to correct muscle weakness. Bone cuts (called osteotomies) to correct bone deformity. Soft tissue releases to reposition the arch of the foot. Any and all of the four main areas of the foot can be affected by cavus deformity or CMT. Generally, a combination of a calcaneal (hindfoot) osteotomy, a first metatarsal (forefoot) osteotomy, and a plantar fascia (the thick connective tissue on the bottom of the foot that helps support the arch) release is performed. Occasionally, additional bone cuts (including midfoot osteotomies) and soft tissue procedures (including ankle ligament reconstruction and tendon transfers) are necessary to complete the correction.