Pes cavus

Pes cavus
Pes cavus is a foot by having an abnormally high plantar longitudinal arche. Those who have this condition will place an excessive amount of weight and force on the ball and heel from the foot while standing and/or walking.
The etiology could be attributed to the brain, spinal-cord, peripheral nerves, or structural problems from the foot. When motor imbalance begins before maturation from the skeleton, there can be a considerable change in healthy bone morphology. When cavus is acquired after skeletal maturity, there might be little or no change in the morphology. Sixty-six per cent of adults with symptomatic cavus foot come with an underlying neurologic condition, most often : Charcot-Marie-Tooth (CMT) disease.
Characteristics
Throughout the gait cycle, the foot remains kept in hindfoot inversion and forefoot varus through the stance phase, causing less anxiety dissipation. This can result in metatarsalgia, stress fracture from the fifth metatarsal, this problem, medial longitudinal arch pain, ilio-tibial band syndrome and instability. This locking and unlocking from the Chopart-joint is a critical aspect in the cavus-foot.
In an cavus foot, the calcaneus is rotated internally underneath the talus, resulting in an narrow anterior-posterior talo-calcaneal angle. Because the cuboid follows the calcaneus, the cuboid is plantar towards the navicular, instead of beside it. This locks the midfoot and overloads the lateral side from the foot.
Another way to take a look at he chopart function would be to view the foot in the front with the forefoot removed. If the axis, drawn through the two joints, is parallel down, there will be relatively free flexion. The greater the axis approaches a vertical orientation, the less flexion is going to be possible.
In extremely high-arched feet, the load bearing is distributed unevenly across the metatarsal heads and also the lateral border from the feet. This type of disorder causes the foot to vulnerable to metatarsal head and calcaneal contusions, brought on by the excessive pressure of standing and walking. Also the foot is vulnerable to osteophyte formation at the junction from the metatarsal bases and also the cuneiforms.
Clinically relevant Anatomy
Clinically it's an abnormal elevation from the medial arch in standing and walking. Biomechanically, cavus is defined as a varus hindfoot, high calcaneal pitch, high-pitched midfoot and plantarflexed and adducted forefoot.
Once the angle between the talus and calcaneus is narrowed, the os naviculare moves to some superior position towards the cuboid, instead of medial into it. This makes it difficult for the Chopart-joint to operate.
The talus is the connector from the foot and the ankle. Inside a neutral foot, the foot rotates round the talus and the cuboid follows the calcaneus.
Medical management
Medical management would be to allow the patient to ambulate with no problems. It is important the individual to understand that surgical reconstruction doesn't provide a normal foot. The primary goal of surgical reconstruction would be to produce a plantigrade foot and pain alleviation. Repeated surgical procedures could be necessary, especially if the deformity is progressive. Surgical treatments can be broadly categorized into soft-tissue and bony procedures. Tendon transfers and osteotomies can offer correction of the deformity without requiring an arthrodesis.
Physiotherapy
Suggested conservative control over patients with painful pes cavus typically involves ways of reduce and redistribute plantar pressure loading, with utilization of foot orthoses and specialized cushioned footwear. The orthoses for pes cavus must accomplish to several specific goals:
• Increasing plantar surface contact area
The overload around the metatarsal heads is because of limited plantar surface contact because of high arch and limited ankle-joint dorsiflexion. Enhancing the plantar surface contact ensures the foot to deal with more weight in the arch as the metatarsal heads bear less weight during activity.
• Resisting against excessive supination
Lateral ankle stability and laterally deviated subtalar joint axis (STJ) are often associated with high-arched feet. It results in an excessive supinator torque round the subtalar joint axis.
• Resisting against recessive pronation and supination forces
Rearfoot instability is brought on by an extension of the laterally deviated subtalar axis. In flexible pes cavus, midtarsal flexibility complicates the later area of the stance pgase of gait. The forefoot pathology produces midtarsal joint supination, leading to excessive pronation from the rearfoot. Some pes cavus are afflicted by both lateral ankle instability at midstance and rearfoot pronation at late midstance.