Typically the arch of the foot will change shape during the gait cycle, and the shock absorption of the midstance phase is negatively affected by the tightening of the plantar fascia leading to decreased shock absorption. In gait, the cavovarus foot demonstrates a compensatory heel varus, a locked midfoot, and a reduction of the flexible phase and decreased shock absorption as a result of plantar fascial tightening. The unopposed contracture of the tibialis posterior and peroneus longus will lead to subtalar joint inversion. Īs the deformity develops, the Achilles tendon may eventually act as an invertor of the foot and will shorten over time. When a foot with fixed forefoot pronation bears weight, the hindfoot is forced to counter-correct into supination, or varus, in order to restore the tripod. The attachment of the peroneus longus at the metatarsals and medial cuneiform results in plantar flexion of the first ray and forefoot pronation. Later these muscles may also weaken but remain in a state of contracture, producing the same effect. A weak tibialis anterior, intrinsic foot muscles, and peroneus brevis are overpowered by a stronger peroneus longus and posterior tibialis. įorefoot driven pes cavus is most often caused by neurological diseases and is the result of muscular imbalances. In the cavus foot, flexion of one element of the tripod, the first ray, leads to tilting and overload of the other two elements. The foot normally forms a tripod with the first metatarsal head, calcaneus, and fifth metatarsal head forming the three points of contact with the ground. The cavovarus foot can be the result of forefoot driven pathology (a flexed first ray), a deformity of the hindfoot, or some combination of both pathologies. With the understanding that most cases are related to these underlying neurological processes, it becomes necessary to not only understand the intricacies of the care of the foot deformity itself but to ensure that adequate patient history, family history, clinical exam, radiographic exam, and other necessary testing is performed to ensure that the clinician has adequately diagnosed the underlying cause before initiation of treatment. Pes cavus is frequently a manifestation of an underlying neurological process, but there has been literature that discusses a subset of patients in whom a more subtle form of the cavus foot may present without an underlying disease process.
Pes cavus is a deformity that is typically characterized by cavus (elevation of the longitudinal plantar arch of the foot), plantar flexion of the first ray, forefoot pronation, and valgus, hindfoot varus, and forefoot adduction. Pes cavus and pes cavovarus are often used interchangeably as the most common manifestation of the cavus foot is the cavovarus presentation. Pes cavus is an orthopedic condition that manifests in both children and adults.
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