Pes cavus, also known as high arch, is a human
foot type in which the sole of the foot is distinctly hollow when bearing weight. That is, there is a fixed
plantar flexion
Motion, the process of movement, is described using specific anatomical terms. Motion includes movement of organs, joints, limbs, and specific sections of the body. The terminology used describes this motion according to its direction relative ...
of the foot. A high arch is the opposite of a
flat foot and is somewhat less common.
Signs and symptoms
Pain and disability
As with certain cases of
flat feet, high arches may be painful due to
metatarsal
The metatarsal bones, or metatarsus, are a group of five long bones in the foot, located between the tarsal bones of the hind- and mid-foot and the phalanges of the toes. Lacking individual names, the metatarsal bones are numbered from the me ...
compression; however, high arches— particularly if they are flexible or properly cared-for—may be an
asymptomatic condition.
People with pes cavus sometimes—though not always—have difficulty finding shoes that fit and may require support in their shoes. Children with high arches who have difficulty walking may wear specially-designed insoles, which are available in various sizes and can be made to order.
Individuals with pes cavus frequently report foot pain, which can lead to a significant limitation in function. The range of complaints reported in the literature include metatarsalgia, pain under the first metatarsal, plantar fasciitis, painful callosities, ankle arthritis, and Achilles tendonitis.
[Burns J. Landorf KB. Ryan MM. Crosbie J. Ouvrier RA. Interventions for the prevention and treatment of pes cavus. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD006154. ]
There are many other symptoms believed to be related to the cavus foot. These include shoe-fitting problems,
[Aktas S, Sussman MD. The radiological analysis of pes cavus deformity in Charcot Marie Tooth disease. J Pediatr Orthop 2000; 9: 137-40] lateral ankle instability, lower limb stress fractures, knee pain, iliotibial band friction syndrome, back pain and tripping.
Foot pain in people with pes cavus may result from abnormal plantar pressure loading because, structurally, the cavoid foot is regarded as being rigid and non-shock absorbent and having reduced ground contact area. There have previously been reports of an association between excessive plantar pressure and foot pathology in people with pes cavus.
Cause
Pes cavus may be hereditary or acquired, and the underlying cause may be
neurological
Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of") is the branch of medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the brain, the spinal c ...
,
orthopedic, or
neuromuscular. Pes cavus is sometimes—but not always—connected through Hereditary Motor and Sensory Neuropathy Type 1 (
Charcot-Marie-Tooth disease) and
Friedreich's Ataxia
Friedreich's ataxia (FRDA or FA) is an autosomal-recessive genetic disease that causes difficulty walking, a loss of sensation in the arms and legs, and impaired speech that worsens over time. Symptoms generally start between 5 and 20 year ...
; many other cases of pes cavus are natural.
The cause and deforming mechanism underlying pes cavus is complex and not well understood. Factors considered influential in the development of pes cavus include muscle weakness and imbalance in neuromuscular disease, residual effects of congenital clubfoot, post-traumatic bone malformation, contracture of the plantar fascia, and shortening of the Achilles tendon.
[Burns J. Redmond A. Ouvrier R. Crosbie J. Quantification of muscle strength and imbalance in neurogenic pes cavus, compared to health controls, using hand-held dynamometry. Foot & Ankle International. 26(7):540-4, 2005.]
Among the cases of neuromuscular pes cavus, 50% have been attributed to Charcot-Marie-Tooth disease, CMT, which is the most common type of inherited neuropathy with an incidence of 1 per 2,500 persons affected. Also known as Hereditary Motor and Sensory Neuropathy (HMSN), it is genetically heterogeneous and occasionally idiopathic. (See CMT Association website) There are many different types and subtypes of CMT, and as a result, it can present from infancy through to adulthood. CMT is a peripheral neuropathy, affecting the distal muscles first as weakness, clumsiness, and frequent falls. It usually affects the feet first, but can sometimes begin in the hands. Charcot-Marie-Tooth disease can cause painful foot deformities such as pes cavus. Although it is a relatively common disease, many doctors and laypersons are not familiar with it. There are no cures or effective courses of treatment to halt the progression of any form of Charcot-Marie-Tooth disease at this time.
The development of the cavus foot structure seen in Charcot-Marie-Tooth disease has been previously linked to an imbalance of muscle strength around the foot and ankle. A hypothetical model proposed by various authors describes a relationship whereby weak evertor muscles are overpowered by stronger invertor muscles, causing an adducted forefoot and inverted rearfoot. Similarly, weak dorsiflexors are overpowered by stronger plantarflexors, causing a plantarflexed first metatarsal and anterior pes cavus.
Pes cavus is also evident in people without neuropathy or other neurological deficit. In the absence of neurological, congenital, or traumatic causes of pes cavus, the remaining cases are classified as being ‘idiopathic’ because their aetiology is unknown.
Diagnosis
On weightbearing
projectional radiography
Projectional radiography, also known as conventional radiography, is a form of radiography and medical imaging that produces two-dimensional images by x-ray radiation. The image acquisition is generally performed by radiographers, and the images a ...
, pes cavus can be diagnosed and graded by several features, the most important being medial peritalar subluxation, increased calcaneal pitch (variable) and abnormal ''talar-1st metatarsal angle'' (Meary's angle).
[ Last modified: 2016/08/14] Medial peritalar subluxation can be demonstrated by a medially rotated talonavicular coverage angle.
[
File:Talonavicular coverage angle.jpg, Dorsoplantar ]projectional radiograph
Projectional radiography, also known as conventional radiography, is a form of radiography and medical imaging that produces two-dimensional images by x-ray radiation. The image acquisition is generally performed by radiographers, and the images ...
of the foot showing the measurement of the talonavicular coverage angle.
File:Calcaneal pitch.jpg, Weight-bearing lateral X-ray
An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10 picometers to 10 nanometers, corresponding to frequencies in the range 30&nb ...
showing the measurement of calcaneal pitch, which is an angle of the calcaneus
In humans and many other primates, the calcaneus (; from the Latin ''calcaneus'' or ''calcaneum'', meaning heel) or heel bone is a bone of the tarsus of the foot which constitutes the heel. In some other animals, it is the point of the hock.
...
and the inferior aspect of the foot, with different sources giving different reference points. Calcaneal pitch is increased in pes cavus, with cutoffs ranging from 20° to 32°.[
File:Talar-1st metatarsal angle (Meary's angle).jpg, Same lateral X-ray showing the measurement of Meary's angle, which is the angle between the long axis of the talus and first metatarsal bone.][ This example is slightly convex downward. An angle greater than 4° convex upward is considered pes cavus.][
File:Pes cavus and os peroneum on lateral foot X-ray.jpg, Foot with pes cavus (and os peroneum).
]
Types
The term pes cavus encompasses a broad spectrum of foot deformities. Three main types of pes cavus are regularly described in the literature: pes cavovarus, pes calcaneocavus, and ‘pure’ pes cavus. The three types of pes cavus can be distinguished by their aetiology, clinical signs and radiological appearance.[Meehan PL. The cavus foot in: Morrisy, RT, (Eds), Lovell and Winter's Pediatric Orthopaedics, J.B. Lippincott, Philadelphia, 1990]poliomyelitis
Poliomyelitis, commonly shortened to polio, is an infectious disease caused by the poliovirus. Approximately 70% of cases are asymptomatic; mild symptoms which can occur include sore throat and fever; in a proportion of cases more severe sym ...
, the calcaneus is dorsiflexed and the forefoot is plantarflexed.
Treatment
Surgical treatment is only initiated if there is severe pain, as the available operations can be difficult. Otherwise, high arches may be handled with care and proper treatment.
Suggested conservative management of patients with painful pes cavus typically involves strategies to reduce and redistribute plantar pressure loading with the use of foot orthoses and specialised cushioned footwear. Other non-surgical rehabilitation approaches include stretching and strengthening of tight and weak muscles, debridement of plantar callosities, osseous mobilization, massage, chiropractic manipulation of the foot and ankle, and strategies to improve balance. There are also numerous surgical approaches described in the literature that are aimed at correcting the deformity and rebalancing the foot. Surgical procedures fall into three main groups:
# soft-tissue procedures (e.g. plantar fascia release, Achilles tendon lengthening, tendon transfer);
# osteotomy (e.g. metatarsal, midfoot or calcaneal);
# bone-stabilising procedures (e.g. triple arthrodesis).
Epidemiology
There are few good estimates of prevalence for pes cavus in the general community. While pes cavus has been reported in between 2 and 29% of the adult population, there are several limitations of the prevalence data reported in these studies.
History
The term ''pes cavus'' is Latin for "hollow foot" and is synonymous with the terms talipes cavus, cavoid foot, high-arched foot, and supinated foot type. Pes cavus is a multiplanar foot deformity characterised by an abnormally high medial longitudinal arch. Pes cavus commonly features a varus (inverted) hindfoot, a plantarflexed position of the first metatarsal, an adducted forefoot, and dorsal contracture of the toes. Despite numerous anecdotal reports and hypothetical descriptions, very little rigorous scientific data exist on the assessment or treatment of pes cavus.[Burns J. Landorf KB. Ryan MM. Crosbie J. Ouvrier RA. Interventions for the prevention and treatment of pes cavus. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD006154. .]
See also
* Arches of the foot
The arches of the foot, formed by the tarsal and metatarsal bones, strengthened by ligaments and tendons, allow the foot to support the weight of the body in the erect posture with the least weight.
They are categorized as longitudinal and tran ...
* Foot type
* En pointe
* Foot binding
* Rocker bottom foot
References
External links
{{Authority control
Congenital disorders of musculoskeletal system
Foot