Cavus Feet Deformity Correction

Overview
Pes cavus occurs in up to 15% of the population, of which 60% will develop foot pain (Burns 2005). Common complaints associated with pes cavus include pain under the metatarsal heads and the heel, lateral ankle sprains, and footwear issues. Custom orthoses should be designed to address the pathomechanics of problematic cavus foot based on the evidence in the literature.

Causes
Causes of a cavus foot type probably have some heredity origins making you more prone to have this type of foot. Ask your parents and siblings and see what kind of foot structure they have as well. There are multiple reasons this foot structure may cause symptoms to exist, most dealing with an imbalance of foot and leg muscles. Some neuromuscular diseases, such as Spina Bifida or muscular dystrophy can make one prone to a cavus foot type as the muscle become weaker. Having a weak calf muscle or a tight calf muscle can cause a cavus foot depending on the biomechanics involved.

Symptoms
Cavus foot is typically identified by a high arch that is noticeable when standing. Additional symptoms may include hammertoes, claw toes, foot instability, pain when walking or standing or calluses on the heel, ball or side of the foot. In some cases, individuals with cavus foot may also suffer from foot drop, which causes those affected to drag their feet when walking. As compared to a normally arched foot, high arches cause more pressure to be put on the metatarsals (the bones of the forefoot). Over time, this can result in pain, weakness and fatigue in the feet. High arches also shorten the feet, potentially making it difficult for a person to find shoes that fit. People with high arches may need special orthopedic shoes or inserts for support.

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
Suggested conservative management of patients with painful pes cavus typically involves strategies to reduce and redistribute plantar pressure loading weight fast with the use of foot orthoses and specialised cushioned footwear. Other non-surgical rehabilitation approaches include stretching and strengthening of tight and weak muscles, debridement of plantar callosities, osseous mobilization, massage, chiropractic manipulation of the foot and ankle and strategies to improve balance.

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.