Cavus Foot
What is Cavus Foot?
Cavus foot, also known as Pes cavus, occurs when the arch in the foot is too high, causing pain and difficulty during walking and standing. And due to this high arch in your foot, the majority of your body’s weight is borne by the ball and heel, rather than being evenly distributed between the toes and the rest of your feet. This condition can lead to various issues such as pain, instability, and even cause you to walk with a limp. It may also cause difficulty in wearing shoes over a while.
The occurrence of cavus foot among young children is not very common, but it still holds the possibility of occurring at any age and affecting one or both feet. If and when it happens, it can look different in people depending on how high the arch is with any individual.
Cavus feet can be characterized depending on how high the arc is, the factors that caused them, and whether it is most prominent in the forefoot or the hindfoot. In some cases, it is present in both the anatomical areas.
For some, the high arch will place an excessive amount of pressure on the ball and heel of the foot, making it difficult to walk and stand due to the pain it causes. This is true especially for those who are overweight. The condition can also lead to foot instability as they become prone to sprains. For others, their feet get a severe deformity, and they have to walk on the outside of their feet, which becomes painful.
Causes of Cavus Foot
The causes of the cavus foot are varied and can be linked to an underlying condition or injury. It can be caused by a neurologic disorder or other medical conditions such. A few of these conditions are:
● Cerebral palsy
● Charcot-Marie-Tooth disease,
● Spina bifida
● Polio
● Muscular dystrophy
● Stroke
● Friedrich’s ataxia
● Residual effects of congenital clubfoot
● Contracture of the plantar fascia
● Bone malformation due to trauma
From the above, it is clear that the root cause can lie in congenital, developmental, or neuromuscular origins. Over 50% of instances where cavus foot is caused by neuromuscular disorders can be attributed to Charcot-Marie-Tooth disease. But still, the actual causations of the condition remain undiscovered.
Treatment for this condition is based on the diagnosed cause. Cavus foot caused by a neurologic disorder or other medical conditions, for instance, typically worsen over time. Other cases of cavus foot that do not result from neurologic disorders usually remain unchanged in their appearance.
Signs and Symptoms
Cavus foot is defined by a high arch in the foot that remains high even when you are standing upright. Apart from this, there are additional symptoms caused by cavus foot. Some of them are:
● Calluses forming on the side of the foot, near the ball or heel due to excessive pressure and friction.
● Frequently experiencing pain while walking or standing
● Foot drop, a weakness in the foot and ankle muscles, usually causes somebody to drag their foot across the ground when walking. It is typically a sign of an underlying neurologic condition.
● Frequent ankle sprains due to an unstable foot
● Being unable to find shoes that fit properly.
● In children, it could lead to severely restricted mobility
Classification of Cavus Foot Based on Anatomy
Based on where in the foot it presents itself, cavus foot can be classified into cavus foot of the forefoot and cavus foot of the hindfoot. Radiographical imaging can help identify which one of these categories the condition falls in.
Cavus Foot of the Forefoot
Almost all cases affecting the forefoot stem from neuromuscular disorders.
In the early stages of this type of the condition, the foot remains flexible as although the soft parts of the foot are still elastic, and the deformity has not progressed too much. Unfortunately, as time progresses, this type of cavus foot often causes secondary hindfoot cavus foot as well.
Cavus Foot of the Hindfoot
When the cavus is seen in the hindfoot, it is mostly caused by a muscular imbalance caused by the triceps surae muscle’s weakening. As this condition progresses, the plantar arch worsens and is characterized by the angle of the grip of the heel or pitch exceeding 30 degrees.
This condition is also compounded by contracture of the Achilles tendon, therefore weakening the stability of the ankle and affecting gait significantly.
Diagnosis
Early detection and treatment of cavus feet are critical to properly managing the condition.
During the diagnosis of cavus foot, the doctor will inquire about the patient’s family history. The doctor will also look for a high-arched foot or signs of other problems like calluses or hammertoe. Your feet will be tested to see how strong they are. The examiner will also take note of your walking pattern and coordination.
In case there’s any indication that you have a neurologic condition, the doctor may examine the entire limb, and if the need arises, will refer you to a neurologist for a complete neurologic evaluation. The doctor may also study your shoes to evaluate the wear pattern.
If you are experiencing pain in your foot, doctors may also order imaging tests such as:
X-rays
This will produce detailed images of your bones.
Magnetic Resonance Imaging (MRI)
This uses strong magnetic fields and radio waves to produce detailed images of the inside of your body.
Computed Tomography (CT) scan
This scan combines a series of X-ray images and uses computer processing to create slice-like cross-sectional images (slices) of the bones, blood vessels, and soft tissues inside your body.
Treatments
In general, people with cavus feet will require treatment to get better or just manage the condition. Depending upon the severity, anatomy, and causes, the treatment for cavus feet can range from wearing more supportive footwear to surgery. Although non-surgical treatments work effectively in most cases, severe cases require surgery to fix.
Non-surgical Treatment
Non-surgical treatment options for those with cavus foot include:
Orthotic Devices
The doctor may recommend custom orthotic devices that can fit into your shoes. This can be beneficial as they provide stability and cushioning to the foot.
Shoe Modifications
Shoes with higher tops and broader heels provide stability and support your ankle.
Bracing
In some cases, the doctor may recommend wearing a brace to help keep the ankle, foot, and toes stable to prevent any future pain. Wearing a brace can also help you manage foot drops.
Surgical Remedies
Non-surgical treatments may not be enough to alleviate your pain in certain cases. In such cases, surgery is needed to help decrease your pain and improve stability and overall strength. It also reduces the risk of other injuries, such as ankle sprains, common with a cavus foot. Moreover, surgery provides relief for longer terms when compared to non-surgical remedies.
There are several different surgical procedures to treat cavus foot. Your surgeon will discuss which one of them will best suit you.
Orthopedic surgery might involve correcting muscle imbalances, loosening the ligaments around joints to provide more even weight distribution in the foot, or even correcting bone deformities. Minimally invasive techniques may help leave only minor scars, surgical incisions, and a shorter recovery time.
In some cases, if the disorder progresses even after surgery due to the worsening of its underlying neurological cause, it’s possible that the procedure may need to be carried out again.
Follow-up Care
As with most surgeries, you will be advised to follow up with your physician post-surgery. You will need to visit them according to the schedule they provide you. This is usually two weeks postoperatively and again a month after surgery to gauge your recovery.
