SPOTTERS MEDICINE
PES CAVUS
🔹 Definition:
Pes cavus is a foot deformity
characterized by an abnormally high medial longitudinal arch of the
foot, often associated with neuromuscular or structural abnormalities.
🔹 Types:
1.
Flexible Pes Cavus – arch disappears when weight-bearing
2.
Rigid Pes Cavus
– arch remains high in both weight-bearing and non-weight-bearing positions
🔹 Causes:
🔸 Neurological (most common):
- Charcot-Marie-Tooth disease
- Friedreich's ataxia
- Spinal cord tumors
- Cerebral palsy
- Poliomyelitis (post-polio
residual)
🔸 Orthopedic:
- Talocalcaneal coalition
- Residual clubfoot
- Idiopathic (familial, unknown
cause)
🔹 Pathophysiology:
- Muscle imbalance: Weakness of
intrinsic foot muscles and overactivity of peroneus longus/tibialis posterior
- Leads to forefoot
plantarflexion, hindfoot varus, and toe clawing
🔹 Clinical Features:
- High medial longitudinal arch
- Clawing of toes (especially 1st
toe)
- Callosities under metatarsal
heads or heel
- Heel varus deformity
- Shortened foot
- Foot pain, instability, frequent
ankle sprains
- May be bilateral
(neurological) or unilateral (trauma/tumor)
🔹 Diagnosis:
- Clinical examination – inspect arch, claw toes, heel
alignment
- Foot radiograph – increased calcaneal pitch,
metatarsal drop
- Neurological assessment – muscle power, sensory loss
- EMG/Nerve conduction study – if neuropathy suspected
- MRI spine/brain – to rule out central causes if
neurological signs present
🔹 Differential Diagnosis:
- Pes planus (flatfoot)
- Residual clubfoot
- Claw toe deformities due to
rheumatoid arthritis
🔹 Treatment:
🔸 Conservative:
- Footwear modification – arch supports, custom insoles
- Orthotic devices – ankle-foot orthosis for
instability
- Stretching & physiotherapy – Achilles and plantar fascia
🔸 Surgical (for severe/rigid cases):
- Soft tissue release (plantar fascia, tendons)
- Osteotomy (e.g., Dwyer calcaneal
osteotomy)
- Tendon transfers – to correct muscle imbalance
- Arthrodesis – for fixed deformities
🔹 Prognosis:
- Depends on underlying cause
- Progressive in neuromuscular
diseases
- Functional improvement possible
with early intervention
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