What is Pes Cavus? • Excessive Elevation of Longitudinal Arch • High Arch • Foot is relatively inflexible • Much less common than Pes Planus • Also referred to as hollow foot or claw foot
Causes of Pes Cavus • Neurological Disorders (60% of time) • Spina Bifidia • Poliomyelitis • Charcot-Marie-Tooth Disease • Talipses Equinovarus (Clubfoot) • Muscle Imbalance • Weak calf muscles • Tight Plantar Fascia
Excessive Supination • Claw Toes • Traumatic Incidents • Compartment Syndrome • Crushing Injury • Burns • Iatrogenic( overlengthing of the Achilles Tendon) • Malunion of Calcaneal or Talar fracture
Signs and Symptoms • Pain during running, walking, or standing • Painful toes that can’t be straighten • Poor shock absorption • Foot length shorten • Callus on ball and heel of foot due to uneven weight distribution
Abnormal shortening of the achilles tendon • Tight plantar faciitis • In frontal plane forefoot in varus and heel in valgus • May experience overuse symptoms in the knees, ankles, and back
Examination • History to determine any neurological conditions • Observation of foot and toes • Examine Gait • MMT and Flexibility • ROM of Foot • Neurological Exam
Colman Block Test • Patient is to stand on 2.5-4 cm block with heel and lateral border of the foot on the block. Bear full weight while the 1st, 2nd, and 3rd metatarsal hang freely into plantarflexion and pronation. Test is looking for hindfoot flexibility.
Calcaneocavus Hindfoot abnormalities No pronation of forefoot; no varus deformity of hindfoot Dorsiflexion of calcaneum Cavovarus Forefoot abnormalities Forefoot pronated and heel in varus Claw toes Two Common Patterns
Classification Systems • Mild • Longitudinal arch appears increased NWB • Longitudinal arch appears almost normal WB • Toes clawed NWB • Toes normal WB • Hindfoot varus
Moderate • Longitudinal arch increases NWB and WB • Claw toes NWB and WB • Calluses under prominent metatarsal head • Dorsiflexion limited • Forefoot plantarflexed on hindfoot
Severe • Calcaneos can’t pronate past 5 degrees varus • Heel in varus and foot in valgus • Decrease ROM in foot
Diagnostic Procedures • X-Ray foot • X-Ray Spine • Nerve Conduction Studies
Treatment • Orthodics • Corrective/Better Supporting Shoes • Stretch Achilles Tendon/Plantar Fascia • Surgical Procedures in severe cases
Return to Play • Arch Supports • Correct Shoes • Avoid Excessive Long Runs
References • Gallaspy, J.B. May J.D. Signs andSymptoms of Athletic Injuries. Mosby-Year Book: St. Louis,1996. p.406. • Arneheim, D. Prentice, W. Principles of Athletic Training. McGraw Hill: Boston. 2000. 10th ed. P464 • Greene, W.B. Essentials of Musculoskeletal Car. American Academy of Orthopedic Surgery. 2001 2nd ed.
www.sportsinjuryclinic.net/cybertherapist/front/foot/clawfoot.htmwww.sportsinjuryclinic.net/cybertherapist/front/foot/clawfoot.htm • www.emedicine.com/orthoped/topic539.htm • www.nlm.nih.gov/medlineplus/ency.article/001261.htm • www.ortho-u.net/011/203.htm