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.
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References
Wapner KL, Myerson MS. Pes cavus. In: Myerson MS, ed. Foot and Ankle Disorders. Philadelphia, Pa: WB Saunders; 2000:919-941.
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].
Holmes JR, Hansen ST Jr. Foot and ankle manifestations of Charcot-Marie-Tooth disease. Foot Ankle. Oct 1993;14(8):476-86. [Medline].
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].
Sabir M, Lyttle D. Pathogenesis of pes cavus in Charcot-Marie-Tooth disease. Clin Orthop. May 1983;(175):173-8. [Medline].
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].
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].
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].
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].
Alexander IJ, Johnson KA. Assessment and management of pes cavus in Charcot-Marie-tooth disease. Clin Orthop. Sep 1989;(246):273-81. [Medline].
Jahss MH. Evaluation of the cavus foot for orthopedic treatment. Clin Orthop. Dec 1983;(181):52-63. [Medline].
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].
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.
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].
Watanabe RS. Metatarsal osteotomy for the cavus foot. Clin Orthop. Mar 1990;(252):217-30. [Medline].
Groner TW, DiDomenico LA. Midfoot osteotomies for the cavus foot. Clin Podiatr Med Surg. Apr 2005;22(2):247-64, vi. [Medline].
Siffert RS, del Torto U. "Beak" triple arthrodesis for severe cavus deformity. Clin Orthop. Dec 1983;(181):64-7. [Medline].
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].
Roper BA, Tibrewal SB. Soft tissue surgery in Charcot-Marie-Tooth disease. J Bone Joint Surg Br. Jan 1989;71(1):17-20. [Medline].
Gould N. Surgery in advanced Charcot-Marie-Tooth disease. Foot Ankle. Mar-Apr 1984;4(5):267-73. [Medline].
Further Reading
Visit Medical Interventions Effectively Treat Overuse Injuries in Adult Endurance Athletes at Medscape for more on pes cavus.
Keywords
high arch, cavus foot, cock-up deformity, clawtoe deformity, foot pain, talipes cavus, contracted foot, exaggerated arch
Workup: Pes Cavus