Interventions for the prevention and treatment of pes cavus

NewsBot · Jan 18, 2008

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Interventions for the prevention and treatment of pes cavus.
Burns J, Landorf KB, Ryan MM, Crosbie J, Ouvrier RA.
Cochrane Database Syst Rev. 2007 Oct 17;(4):CD006154.

BACKGROUND: People with pes cavus frequently suffer foot pain, which can lead to significant disability. Despite anecdotal reports, rigorous scientific investigation of this condition and how best to manage it is lacking. OBJECTIVES: To assess the effects of interventions for the prevention and treatment of pes cavus.

SEARCH STRATEGY: We searched the Cochrane Neuromuscular Disease Group Trials Register (April 2007), MEDLINE (January 1966 to April 2007), EMBASE (January 1980 to April 2007), CINAHL (January 1982 to April 2007), AMED (January 1985 to April 2007), all EBM Reviews (January 1991 to April 2007), SPORTdiscuss (January 1830 to April 2007) and reference lists of articles. We also contacted known experts in the field to identify additional published or unpublished data. SELECTION CRITERIA: We included all randomised and quasi-randomised controlled trials of interventions for the treatment of pes cavus. We also included trials aimed at preventing or correcting the cavus foot deformity. DATA COLLECTION AND ANALYSIS: Two authors independently selected papers, assessed trial quality and extracted data. MAIN RESULTS: Only one trial (custom-made foot orthoses) fully met the inclusion criteria. Two additional cross-over trials (off-the-shelf foot orthoses and footwear) were also included. Both studies assessed secondary biomechanical outcomes less than three-months after randomisation. Data used in the three studies could not be pooled due to heterogeneity of diagnostic groups and outcome measures. The one trial that fully met the inclusion criteria investigated the treatment of cavus foot pain in 154 adults over a three month period. The trial showed a significant reduction in the level of foot pain, measured using the validated 100-point Foot Health Status Questionnaire, with custom-made foot orthoses versus sham orthoses (WMD 10.90; 95% CI 3.21 to 18.59). Furthermore, a significant improvement in foot function measured with the same questionnaire was reported with custom-made foot orthoses (WMD 11.00; 95% CI 3.35 to 18.65). There was also an increase in physical functioning of the Medical Outcomes Short Form - 36 (WMD 9.50; 95% CI 4.07 to 14.93). There was no difference in reported adverse events following the allocation of custom-made (9%) or sham foot orthoses (15%) (RR 0.61; 95% CI 0.26 to 1.48).

AUTHORS' CONCLUSIONS: In one randomised controlled trial, custom-made foot orthoses were significantly more beneficial than sham orthoses for treating chronic musculoskeletal foot pain associated with pes cavus in a variety of clinical populations. There is no evidence for any other type of intervention for the treatment or prevention of foot pain in people with a cavus foot type.
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Admin2 · Jan 18, 2008

Related threads:
Foot orthoses and the cavus foot
Pes Cavus Surgery

Cochrane Database of Systematic Reviews

NewsBot · Jun 22, 2021

Options for Management Choice Evidence-Based Treatment
of Cavus Foot Deformity
Akram Ali Attaib Beshna et al
European Journal of Molecular & Clinical Medicine

Background:Cavus foot encompasses a wide range of deformities, from a subtle flexible
deformity to severe rigid cavus foot. The prevalence of cavus foot is reported to be 10 to 25% of
the population or as common as flat foot. With increasing awareness of the milder or subtle
cavus, the whole disease entity may be more prevalent. The term “pes cavus” or “cavus foot” is
used to describe a wide spectrum of foot shapes that have an abnormal elevation of the medial
longitudinal arch. High arch of the foot is frequently associated with hindfoot varus, forefoot
adduction and plantar flexion, and ankle equinus. The etiology is most frequently attributed to
the neuromuscular disorders involving brain, spinal cord, or the peripheral nerves. Two thirds
of adults with symptomatic cavus foot have an underlying neurological condition. Among them,
Charcot-Marie-Tooth (CMT) disease, a hereditary sensory motor neuropathy, is most frequently
reported. The probability of a patient who has bilateral cavovarus feet being diagnosed with
CMT is 78%. The surgical procedures are combinations of bony reconstructions and soft tissue
procedures. As for the joint-sparing corrective osteotomies, calcaneal osteotomy, 1st metatarsal
base dorsiflexion osteotomy (1MTDFO), and midfoot dorsal closing wedge osteotomy at
cuneiform-navicular and cuboid level are considered. As for the soft tissue procedures, mainly
plantar fascia release, Achilles' tendon lengthening, and peroneus longus to brevis tenodesis
are most frequent surgical procedures performed.
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NewsBot · Mar 21, 2022

Joint preserving procedures for painful plantar callosities in patients with flexible cavovarus foot
KoshoTogei et al
Foot and Ankle Surgery 19 March 2022

Background
The outcome of a constant joint preserving procedure for painful plantar callosities with cavovarus foot remains unclear.

Methods
Eleven patients (11 feet) who underwent lateral displacement calcaneal osteotomy (LDCO), dorsiflexion first metatarsal osteotomy (DFMO), and plantar fasciotomy (PF), simultaneously were included. The presence of painful callosities, heel alignment of standing (HA), and the Japanese Society for Surgery of the Foot ankle/hindfoot (JSSF) score were evaluated. Radiographically, the talonavicular coverage angle (TNCA), lateral talo-first metatarsal angle (LTMA), calcaneal pitch angle (CPA), and heel alignment angle (HAA) were measured.

Results
Postoperatively, painful plantar callosities disappeared in 10 patients and remained in one patient. The postoperative HA and JSSF score significantly improved. The postoperative TNCA, LTMA, CPA, and HAA significantly improved.

Conclusions
In patients with flexible cavovarus foot, LDCO, DFMO, and PF yielded good outcomes at mid-term follow-up with preservation of the foot and ankle joints.
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NewsBot · May 18, 2022

Evidence-Based Management Strategies for Pediatric Pes Cavus.
Rosenwasser, K. A., Judd, H., & Hyman, J. E.
JPOSNA®, 4(2). Retrieved from https://jposna.org/ojs/index.php/jposna/article/view/461

Pes cavus is defined as an abnormal elevation of the medial longitudinal arch of the foot. More than two-thirds of patients with pes cavus are found to have an underlying neurologic diagnosis driving a muscle imbalance within the foot. Expedient clinical diagnosis of underlying pathology is paramount to facilitate proper neuraxial imaging studies and a referral to pediatric neurology. Non-operative management is rarely sufficient and is typically indicated only in cases of mild deformity. Surgical management hinges heavily on physical and radiographic examination findings including the Coleman block test, which can help to determine the need for soft tissue or bony reconstruction. The goal of treatment in pes cavus is to obtain a painless, plantigrade, and supple foot.
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