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Pes Cavus Workup

  • Author: Norman S Turner, MD; Chief Editor: Jason H Calhoun, MD, FACS  more...
 
Updated: Oct 15, 2014
 

Imaging Studies

Standing radiography of the feet and ankles is essential (see the images below). 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 plantarflexed.

Pes cavus with severe hindfoot involvement. Pes cavus with severe hindfoot involvement.
Pes cavus with plantarflexion of the first ray. Pes cavus with plantarflexion of the first ray.

Magnetic resonance imaging (MRI) of the spine should be performed if unilateral progressive cavus is present in a patient without a history of trauma.

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Other Tests

After the initial evaluation, a neurologic consultation is recommended in order to determine the etiology. Electromyography (EMG) and nerve conduction studies are performed to evaluate for Charcot-Marie-Tooth disease, polio, and other abnormalities that can cause muscle imbalances that lead to cavus deformities.

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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, Mid-America Orthopaedic Association, American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Foot and Ankle Society, Minnesota Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Jason H Calhoun, MD, FACS Department Chief, Musculoskeletal Sciences, Spectrum Health Medical Group

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, Michigan State Medical Society, Missouri State Medical Association, Southern Medical Association, Southern Orthopaedic Association, Texas Medical Association, Texas Orthopaedic Association, Musculoskeletal Infection Society

Disclosure: Nothing to disclose.

Additional Contributors

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, Florida Medical Association

Disclosure: Nothing to disclose.

References
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Pes cavus with severe hindfoot involvement.
Pes cavus with plantarflexion of the first ray.
 
 
 
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