Pes Cavus Workup

Updated: Nov 14, 2018
  • Author: Norman S Turner, MD; Chief Editor: Thomas C Dowd, MD  more...
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Workup

Imaging Studies

Weightbearing 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 (CMT) disease, polio, and other abnormalities that can cause muscle imbalances that lead to cavus deformities.

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