Talipes Cavus Foot Pain

Overview
A foot deformity characterized by an elevated longitudinal arch, caused by fixed plantar flexion of the forefoot, may be seen in both pediatric and adult populations. 2/3 of patients have neurologic condition, when bilateral, often hereditary. deformity caused by contracted plantar fascia, weak tibialis anterior being over-powered by peroneous longus, table of foot deformity muscle imbalances.

Causes
The cause and deforming mechanism underlying pes cavus is complex and not well understood. Factors considered influential in the development of pes cavus include muscle weakness and imbalance in neuromuscular disease, residual effects of congenital clubfoot, post-traumatic bone malformation, contracture of the plantar fascia and shortening of the Achilles tendon.

Symptoms
Symptoms may vary from a mild problem with shoe fitting to significant disability such as difficulty finding proper fitting footwear because the shoes are not deep enough due to high arch and the clawed toes. Shortened foot length. Foot pain with walking, standing, and running. Metatarsalgia with pain in the forefoot/ ball of the foot (usually 1st and 5th metatarsal heads), with or without calluses/corns. Pain and stiffness of the medial arch or anywhere along the mid-portion of the foot. Morton's neuroma with pain in the ball of the foot and lesser toes. Pain in the heel and sole of the foot from plantar fasciitis. Stress fractures of the metatarsals and other foot bones. Particularly in diabetics and those with compromised circulation, abnormal pressure may result in chromic ulcers of the heel and ball of the foot. Strain and early degenerative joint disease (osteoarthritis) of lower extremity joints. ?Pump bumps" (Haglund's deformity) on the back of the heel. Associated discomfort within and near the ankle joint. Ankle instability with frequent sprains. Tight Achilles tendons. The knees, hips, and lower back may be the primary source of discomfort. Chronic lower extremity pain my lead to inactivity and diminished well-being.

Diagnosis
The diagnosis of symptoms occurs through conducting a history and physical in combination with diagnostic testing. A history of familial high arches and any muscular dystrophy type symptoms in the family are important to consider. The type of pain and what causes the pain to begin are also important to consider. For example, patients who have pain with walking in comparison to only having pain when running may need more aggressive treatment than patients who only have pain with high impact exercises.

Non Surgical Treatment
Depending on the severity and presence of debilitation, non-surgical and surgical treatment options are extensively reviewed by your Weil foot and ankle physician. Non-surgical treatment options we provide include, but are not limited to: shoe gear modifications, bracing and/or strappings, custom-molded arch supports; all of which assist in positioning the foot properly and provide improved shock absorption.

Surgical Treatment
Toe deformities can be effectively treated with the Jones and Hibbs procedures. These correct the cock-up deformities by fusion of the interphalangeal (IP) joints, combined with transfer of the EHL and EDL tendons to the metatarsal necks to assist with ankle dorsiflexion. The EHL and EDL transfers remove the deforming force on the MTP joint, and relax the plantar fascia.