Pes Cavus Vs Pes Planus Surgery

Overview
In direct pes cavus, the deformity occurs only in the sagittal plane (in the forefoot, hindfoot, or both). Direct pes cavus may be related to a variety of causes, although neurological diseases predominate in posterior pes cavus. Pes cavovarus is a three-dimensional deformity characterized by rotation of the calcaneopedal unit (the foot minus the talus). This deformity is caused by palsy of the intrinsic foot muscles, usually related to Charcot-Marie-Tooth disease.

Causes
Cavus foot commonly occurs as a result of an underlying medical or neurological condition, such as polio, muscular dystrophy or cerebral palsy. Cavus foot may also occur as a result of congenital defects. They may be inherited from a parent, or they may result from an orthopedic condition or a disease of the nerves or muscles.

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
Identifying the underlying reason for a high arch is important to help your doctor plan the right treatment. Some neurological conditions can cause high arches to worsen progressively. Your doctor will ask about family history of high arches and neurological conditions. In examining your foot, he?ll look at arch height and any calluses, hammer toes and claw toes. The doctor also will watch how you walk (your gait). To help discern bone conditions and see if degenerative arthritis is present, your doctor may refer you for foot and ankle X-rays. An X-ray of your spine also might be needed to determine if a tumor or other spinal problem exists. If clearer images of your spine are needed, your doctor may order an MRI (magnetic resonance imaging). In this diagnostic test, a magnetic field and radio waves are combined via computer to produce exceptionally detailed images. Electromyography determines the health of muscles and the nerves controlling those muscles. A needle-shaped electrode is inserted into the muscle and an oscilloscope displays the muscle?s electrical activity. Nerve-conduction studies measure the speed of signals traveling through nerves. Several electrodes are placed on the skin above a nerve. An electrode emits a mild electrical impulse to activate the nerve. The activity then continues down the length of the nerve. The distance between electrodes and the time it takes them to move from one electrode to the next determines how fast nerve signals travel.

Non Surgical Treatment
Your podiatrist may use some external devices to stabilize your foot, and provide support for your extra-high arches. These devices may include orthotics (which are prescription shoe inserts specially designed for you, braces (worn outside the foot, these will help keep your foot and ankle stable), and special shoes (usually ones with high tops and wide bases to add stability and support). The podiatrist may also treat secondary symptoms, trimming calluses or suggesting the use of pads to reduce pressure on certain areas of your foot.

Surgical Treatment
In patients with inflexibility, arthrodesis sacrifices little, and relieves joint pain. The foot can be re-orientated by excising wedge shaped portions of the joints. The triple arthrodesis of subtalar, talonavicular and calcaneocuboid joints is very commonly used. Midfoot arthrodeses barefoot contessa may be more appropriate, depending on the maximum site of pain and deformity.