Pes Cavus - Causes, Symptoms, Diagnosis, and Treatment

Introduction:

Pes cavus is an orthopedic condition that affects younger children and adults of any age; the main characteristic of this condition is the elevation of the foot's arch, called a high-arched foot. An abnormally high longitudinal arch characterizes it, and this unique feature is also called a clawed foot, hollow foot, or large foot. The pes cavus condition may vary based on acquired, congenital, and hereditary neurological or musculoskeletal disorders. People affected by this condition will experience sore feet during walking and standing as more force is applied to the heel and ball of the foot. Proper treatment can help to deal with this condition.

What Is the Etiology of Pes Cavus?

Pes cavus can affect both children and adults of any age. When this condition affects bilaterally, the cause will be hereditary or congenital, but if it involves any of the feet, it may be caused due to some traumatic condition. Without any known cause, a pes canvas on one foot will require an MRI (magnetic resonance imaging) scan of the brain and spinal cord, which helps rule out treatable conditions such as brain tumors. There are mainly four primary sources that cause pes cavus; these are:

• Neurological Conditions:

  • Hereditary motor and sensory neuropathies.

  • Cerebral palsy is a muscle tone, posture, and movement disease.

  • After stroke symptoms.

  • Anterior horn condition is a disease of motor neurons.

  • Lesions in the spinal cord.

  • Parkinson's disease is a brain issue characterized by uncontrolled movements.

  • Leprosy, which is a long-term infectious disease caused by bacteria.

  • Huntington's disease, which causes uncontrolled movements.

  • Poliomyelitis is a severe condition caused due to poliovirus.

• Traumatic:

  • Knee dislocation.

  • Scar tissue.

  • Burns.

  • Vascular lesions.

  • A condition occurs when there is a dangerous pressure buildup within the muscle, called compartment syndrome.

  • Talar neck malunion:

  • Nerve injury.

  • Hindfoot instability.

  • Fracture of the tibia.

• Untreated or not adequately treated clubfoot.

• Other causes include

  • Rheumatoid arthritis.

  • Ankle problems.

  • Plantar fibromatosis is characterized by the formation of nodules along the plantar fascia.

  • Diabetic foot syndrome.

Many causes of pes cavus in children are due to inherited genetic conditions. In adults, the underlying neurological disorder is responsible for two-thirds of symptomatic pes cavus, as any spinal cord lesion can result in muscle imbalance in the feet that causes a high-arched foot. Those adults who experience pes cavus in one foot without the cause of trauma should screen for spinal tumors.

What Are the Signs and Symptoms Associated with Pes Cavus?

Some common signs and symptoms are

• Claw toe when the feet are clenched like a fist.

• Bent toe, called Hammertoes.

• Pain is caused during walking or standing as excess force is applied over the ball and heel of the foot.

• Instability.

• Frequent ankle sprain is very common in children with pes cavus.

• Need help finding footwear.

What Are the Types of Pes Cavus?

• Pes Cavovarus: The most common variant of pes cavus is associated with neuromuscular disorders.

• Pes Calcaneocavus: This condition is caused by paralysis of the triceps, which is caused as a result of poliomyelitis.

How Is Pes Cavus Diagnosed?

The doctors first review the patient's family medical history to rule out any inherited condition that may result in pes cavus disorder. A physical examination checks for the high arch, hammertoes, claw toes, and calluses. The doctors (foot specialists) will examine the strength of the ankle and leg muscles and observe the affected person's walking pattern and coordination. Some of the tests performed to rule out pes cavus conditions are

• X-rays, which are electromagnetic radiations that help examine most body areas.

• Blood test for CMT (charcot marie tooth disease).

• Radiographs during weight bearing.

• Electromyography, which monitors the muscles and nerves' electrical activity.

• The nerve conduction velocity study measures how quickly the nerve impulse passes through the nerves.

• If the underlying cause is suspected to be a neurological condition, the doctors recommend an MRI (magnetic resonance imaging) of the spine and brain.

How Is Pes Cavus Managed?

Nonsurgical treatment helps relieve pain and manage stability for children and adults with foot deformities. This non-surgical method involves orthotic devices such as

• Cavus foot inserts help maintain the strength of the foot and ankle.

• Cavus foot shoes with wider heels and high-top ankle help to reduce pain.

When the nonsurgical treatment methods do not cause any good, doctors recommend surgical methods to deal with this condition. There are various surgical methods to manage this condition; the doctors will recommend which surgical procedure or combination of approaches will help the person to manage pes cavus. Some surgical procedures involve

• Correction of a cavovarus foot.

• Many surgical corrections include tendon transfer and facial and capsular release.

• Joint spraying surgery is commonly performed when the cavus foot is flexible.

What Is the Differential Diagnosis of Pes Cavus?

• Charcot-Marie-Tooth Disease: CMT is a combination of many inherited conditions which attacks the peripheral nerves.

• Congenital Hypomyelinating Neuropathy: It is a hereditary condition that attacks the peripheral nerves, which causes non-progressive weakness, slower nerve conduction, and hypomyelination.

• Dejerine-Sottas Condition: It is a neurological condition inherited and affects movements.

• Distal Hereditary Motor Condition: This condition attacks the nerves present in the spinal cord.

What Is the Prognosis of Pes Cavus?

The prognosis of pes cavus depends on the underlying cause of the condition. If the underlying cause is CMT, it results in progressive deformity, whereas pes cavus caused due to poliomyelitis is non-progressive. Management and prognosis of these underlying causes vary.

What Are the Risk Factors Associated With Pes Cavus?

The risk factor associated with pes cavus is usually genetic. Many genetic mutations are linked with CMT and can be inherited as autosomal dominant, recessive, or X-linked. Without the neurological cause, this condition is also hereditary, but the mutated gene and inheritance pattern is unclear.

Conclusion:

Pes cavus is a condition characterized by an arched foot, seen in children and adults. People affected will experience pain in the foot as more force is applied to the ball and the heel of the foot during walking and standing. This condition needs to be diagnosed earlier before the condition worsens and can be treated non-surgically. If nonsurgical treatment does not help, then surgery will be required.