eMedicine Specialties > Orthopedic Surgery > Foot & Ankle

Pes Cavus: Workup

Author: Norman S Turner, MD, Assistant Professor, Department of Orthopedic Surgery, Mayo Clinic School of Medicine
Contributor Information and Disclosures

Updated: Feb 11, 2010

Workup

Imaging Studies

  • Standing radiography of the feet and ankles is essential. Radiographs should be inspected for evidence of degenerative arthritis, the positioning of the calcaneus, and forefoot alignment. A calcaneal pitch angle can be measured by drawing a line along the plantar aspect of the calcaneus and the ground. An angle greater than 30° is significant for hindfoot varus. The positioning of the first ray compared to the axis of the talus viewed on lateral radiographs determines if the first ray is plantar flexed.
  • A magnetic resonance image (MRI) of the spine should be obtained if unilateral progressive cavus is present in a patient without a history of trauma.

Other Tests

  • After the initial evaluation, a neurologic consultation is recommended in order to determine the etiology.
  • Electromyography and nerve conduction studies are obtained to evaluate for CMT disease, polio, and other abnormalities that can cause muscle imbalances that lead to cavus deformities.

More on Pes Cavus

Overview: Pes Cavus
Workup: Pes Cavus
Treatment: Pes Cavus
Follow-up: Pes Cavus
Multimedia: Pes Cavus
References
Further Reading
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References

  1. Wapner KL, Myerson MS. Pes cavus. In: Myerson MS, ed. Foot and Ankle Disorders. Philadelphia, Pa: WB Saunders; 2000:919-941.

  2. Sugathan HK, Sherlock DA. A modified Jones procedure for managing clawing of lesser toes in pes cavus: long-term follow-up in 8 patients. J Foot Ankle Surg. Nov-Dec 2009;48(6):637-41. [Medline].

  3. Naudi S, Dauplat G, Staquet V, Parent S, Mehdi N, Maynou C. Anterior tarsectomy long-term results in adult pes cavus. Orthop Traumatol Surg Res. Jun 2009;95(4):293-300. [Medline].

  4. Gallardo E, García A, Combarros O, Berciano J. Charcot-Marie-Tooth disease type 1A duplication: spectrum of clinical and magnetic resonance imaging features in leg and foot muscles. Brain. Feb 2006;129(Pt 2):426-37. [Medline].

  5. Holmes JR, Hansen ST Jr. Foot and ankle manifestations of Charcot-Marie-Tooth disease. Foot Ankle. Oct 1993;14(8):476-86. [Medline].

  6. Sabir M, Lyttle D. Pathogenesis of Charcot-Marie-Tooth disease. Gait analysis and electrophysiologic, genetic, histopathologic, and enzyme studies in a kinship. Clin Orthop. Apr 1984;(184):223-35. [Medline].

  7. Sabir M, Lyttle D. Pathogenesis of pes cavus in Charcot-Marie-Tooth disease. Clin Orthop. May 1983;(175):173-8. [Medline].

  8. Mann DC, Hsu JD. Triple arthrodesis in the treatment of fixed cavovarus deformity in adolescent patients with Charcot-Marie-Tooth disease. Foot Ankle. Jan 1992;13(1):1-6. [Medline].

  9. Schuberth JM, Babu-Spencer N. The impact of the first ray in the cavovarus foot. Clin Podiatr Med Surg. Jul 2009;26(3):385-93, Table of Contents. [Medline].

  10. Burns J, Crosbie J, Hunt A, Ouvrier R. The effect of pes cavus on foot pain and plantar pressure. Clin Biomech (Bristol, Avon). Nov 2005;20(9):877-82. [Medline].

  11. Burns J, Landorf KB, Ryan MM, Crosbie J, Ouvrier RA. Interventions for the prevention and treatment of pes cavus. Cochrane Database Syst Rev. 2007;(4):CD006154. [Medline].

  12. Crosbie J, Burns J. Predicting outcomes in the orthotic management of painful, idiopathic pes cavus. Clin J Sport Med. Sep 2007;17(5):337-42. [Medline].

  13. Alexander IJ, Johnson KA. Assessment and management of pes cavus in Charcot-Marie-tooth disease. Clin Orthop. Sep 1989;(246):273-81. [Medline].

  14. Jahss MH. Evaluation of the cavus foot for orthopedic treatment. Clin Orthop. Dec 1983;(181):52-63. [Medline].

  15. Paulos L, Coleman SS, Samuelson KM. Pes cavovarus. Review of a surgical approach using selective soft-tissue procedures. J Bone Joint Surg Am. Sep 1980;62(6):942-53. [Medline].

  16. Mubarak SJ, Van Valin SE. Osteotomies of the foot for cavus deformities in children. J Pediatr Orthop. Apr-May 2009;29(3):294-9. [Medline].

  17. Mann RA. Pes cavus. Pes cavus. In: Mann RA, Coughlin MJ, eds. Surgery of the Foot and Ankle. 6th ed. St. Louis, Mo: Mosby-Year Book; 1993:785-801.

  18. Mulier T, Dereymaeker G, Fabry G. Jones transfer to the lesser rays in metatarsalgia: technique and long-term follow-up. Foot Ankle Int. Oct 1994;15(10):523-30. [Medline].

  19. Watanabe RS. Metatarsal osteotomy for the cavus foot. Clin Orthop. Mar 1990;(252):217-30. [Medline].

  20. Groner TW, DiDomenico LA. Midfoot osteotomies for the cavus foot. Clin Podiatr Med Surg. Apr 2005;22(2):247-64, vi. [Medline].

  21. Chatterjee P, Sahu MK. A prospective study of Japas' osteotomy in paralytic pes cavus deformity in adolescent feet. Indian J Orthop. Jul 2009;43(3):281-5. [Medline].

  22. Siffert RS, del Torto U. "Beak" triple arthrodesis for severe cavus deformity. Clin Orthop. Dec 1983;(181):64-7. [Medline].

  23. Wetmore RS, Drennan JC. Long-term results of triple arthrodesis in Charcot-Marie-Tooth disease. J Bone Joint Surg Am. Mar 1989;71(3):417-22. [Medline].

  24. Roper BA, Tibrewal SB. Soft tissue surgery in Charcot-Marie-Tooth disease. J Bone Joint Surg Br. Jan 1989;71(1):17-20. [Medline].

  25. Gould N. Surgery in advanced Charcot-Marie-Tooth disease. Foot Ankle. Mar-Apr 1984;4(5):267-73. [Medline].

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Keywords

pes cavus, high arch, cavus foot, cock-up deformity, clawtoe deformity, foot pain, talipes cavus, contracted foot, exaggerated arch

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Contributor Information and Disclosures

Author

Norman S Turner, MD, Assistant Professor, Department of Orthopedic Surgery, Mayo Clinic School of Medicine
Norman S Turner, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Foot and Ankle Society, Mid-America Orthopaedic Association, and Minnesota Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Heidi M Stephens, MD, MBA, Associate Professor, Department of Surgery, Division of Orthopedic Surgery, University of South Florida College of Medicine; Courtesy Joint Associate Professor, Department of Environmental and Occupational Health, University of South Florida College of Public Health
Heidi M Stephens, MD, MBA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Foot and Ankle Society, and Florida Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Shepard R Hurwitz, MD, Executive Director, American Board of Orthopaedic Surgery
Shepard R Hurwitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for the Advancement of Science, American College of Rheumatology, American College of Sports Medicine, American College of Surgeons, American Diabetes Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Association for the Advancement of Automotive Medicine, Eastern Orthopaedic Association, Orthopaedic Research Society, Orthopaedic Trauma Association, and Southern Orthopaedic Association
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Jason H Calhoun, MD, FACS, Frank J Kloenne Chair in Orthopedic Surgery, Professor and Chair, Department of Orthopedics, The Ohio State University Medical Center
Jason H Calhoun, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Diabetes Association, American Medical Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Missouri State Medical Association, Musculoskeletal Infection Society, Southern Medical Association, Southern Orthopaedic Association, Texas Medical Association, and Texas Orthopaedic Association
Disclosure: Nothing to disclose.

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