Pes cavus questionnaire
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Pes cavus is the presence of an abnormally high arch that can occur in either one or both feet and develop at any age. It results in pressure being placed on the heel.
What is pes cavus?
Pes cavus is the presence of an abnormally high arch that can occur in either one or both feet and develop at any age. It results in significant pressure being placed on the ball or heel of the foot when walking or standing. Pes cavus is often due to an underlying neurological condition.
Symptoms predominantly include a high arch of the foot resulting in pain and possible fractures, tripping, a loss of sensation in the lower leg, or dragging one's affected foot or feet.
Treatments usually focus on alleviating pain as well as the use orthotics, corrective footwear, and braces. Surgery may occur when more conservative methods are ineffective. Recovery and restructuring of the affected foot or feet occurs gradually and may take months or years.
You should visit your primary care physician if you are experiencing a lot of foot pain. Surgical treatment is only used when there is severe pain.
Pes cavus symptoms
Symptoms of pes cavus include the characteristic high arch, tripping, pain and other complications, as well as stress fractures.
Pes cavus is characterized by a high arch that places stress on both the ball of the foot and the heel of the foot. The high arch can lead directly to:
- Bone damage: Structurally, the arch is too high to flex and absorb the shock of a normal step, so the bones of the heel (e.g. calcaneus) and the ball of the foot (e.g. metatarsals) are damaged during normal use.
- Further injury: Normally, a foot flattens with weight-bearing, and the absence of this can lead to numerous injuries in joints and long bones from the ankle and lower leg through the lower back.
- Bent toes: Toes that are bent, also called hammertoes or claw toes, can also develop.
Tripping in itself can be caused or described by:
- Loss of sensation: Pes cavus is often accompanied by a lack of proper neurological connection to the lower leg, which co-occurs with this symptom.
- Loss of proprioception: Proprioception is an understanding of where your body is in space. Losing track of where the borders of one's feet are during normal activity can cause tripping and falling.
- Drop foot: This is described by difficulty lifting (dorsiflexing) the foot, causing you to occasionally drag your foot on the ground, which likely results in tripping.
Pain and other complications
Pes cavus is not always painful but can cause a significant amount of pain. It can be specifically caused by other complications of pes cavus, such as:
- Fractures: Fractures of the metatarsals, calcaneus, and the tibia or fibula (e.g. bones of the lower leg), are common in individuals with pes cavus.
- Plantar fasciitis: This condition, involving significant pain in the heel, can be caused by the inflammation of connective tissues associated with pes cavus.
- Ankle breakages or strains: These conditions can also be caused by the excess of inflammation and strain on the foot structures, leading to significant pain.
Stress fractures are another main complication of pes cavus. Stress fractures can be caused and described by:
- Lessened ability to absorb shock: Since the foot cannot flex from an arch toward the horizon, this limits the ability of feet to absorb the shock and impact of walking.
- Pain and limited activity: Shocks can lead to small "hairline" repetitive stress fractures (e.g. shin splints).
- Resulting bone damage: Stress fractures can cause serious damage to the bone if they are not allowed to heal properly.
- Healing process: A stress fracture generally requires a reduction in the impact for two to four weeks depending on the nature of the impact. If complete rest is possible, you should rest; if not, a padded shoe may be a helpful adjunct to care.
What causes pes cavus?
Common causes of pes cavus include Charcot-Marie-Tooth disorder and other neurologic disorders, as well as spinal tumors.
This is one of the most common causes of pes cavus. In this disease, nerve development is hindered, specifically in nerves that connect to the limbs.
- How the nerves are hindered: Mutated genes cause the body's inability to produce functional neuronal proteins (proteins used by the nerves).
- How this condition affects function: Loss of proper neuronal function can cause the legs to be very thin and lead to the loss of sensation or ability to move and step correctly.
- How abnormal foot structure develops: Over time, the lack of muscle and improper or insufficient experience walking leads to development of an abnormal foot structure.
Other neurologic disorders
Pes cavus is most commonly associated with a neurological disorder and more frequently associated with a neurological disorder that is present at birth. In addition to Charcot-Marie-Tooth disorder, these may include:
- Spina bifida
- Muscular atrophy
A spinal tumor can affect foot development and cause foot deformity similarly to how other neurological conditions can cause the development of pes cavus.
- How this condition affects function: If the spinal tumor impinges on a nerve that runs to the lower leg, the leg may lose sensation, strength, or both.
- How abnormal foot structure develops: The loss of sensation or strength can lead to a lack of awareness when damaging the foot as well as an altered gait. Over time, this damage can lead to development of pes cavus.
Treatment options and prevention for pes cavus
Treatment is focused mostly on alleviating associated pain. Nonsurgical methods, in the form of corrective devices, are the first-line of treatment. Surgery may also be needed in some cases.
Corrective devices include insoles, orthotics, or corrective shoes. In practice, they function similarly to braces for teeth.
- Details: Each corrective shoe, insole, or orthotic supports and alters the foot shape slightly and slowly.
- Duration: Depending on when orthotics are applied and how severe the pes cavus is, it may take anywhere from months to years to recover.
- Prognosis: Orthotics are proven, albeit with four studies, to reduce the amount of pain experienced by individuals with pain due to pes cavus. Custom-made devices are shown to offer more relief than other alternatives.
If other methods fail to provide an adequate recovery or pain relief, surgery may be completed to correct foot weakness, discomfort, and instability. Specific procedures may include a combination of:
- Soft-tissue releases
- Tendon transfers
- Osteotomies: Cutting or removing pieces of bone
When to seek further consultation for pes cavus
While it is possible to eliminate pain, and pain is a common reason for seeking additional care, early intervention can prevent many of the consequences of pes cavus.
If you notice loss of sensation, severe pain, or progressive deformity
Although it is absolutely necessary to seek consultation if you have lost sensation in your feet, are experiencing severe pain, or have noticed a progression in the deformity of your foot, pes cavus can be intervened in its early stages.
Suspected pes cavus in children
It is important to seek care if you suspect your child has pes cavus, as orthotic shoes and low acuity interventions work especially well if applied at early ages before bone has taken on its mature shape.
Suspected pes cavus in adults
For adults, you should seek further consultation if you wish to improve the cosmetic appearance of your feet, if you are experiencing pain, ankle instability, or gradually increasing weakness in your legs. The latter especially is a cause of concern because it may further contribute to pes cavus and may also continue to ascend, affecting structures necessary for life maintenance.
Questions your doctor may ask to determine pes cavus
- Is your fatigue getting any better or worse?
- How fatigued are you?
- Is your fatigue constant or come-and-go?
- How long has your fatigue been going on?
- Do you have trouble sleeping?
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.
Ezekiel Richardson is a fourth-year medical student at UPenn, currently applying into Emergency Medicine. He completed an undergraduate degree with a concentration in health disparities at Stanford University. After graduation, he spent a year working in the Maryland Department of Health as a John Gardner Public Service Fellow. Between his third and fourth year of medical school, he completed multiple publications on public health and health accessibility through the Center for Emergency Care and Policy Research Fellowship. He has participated as a teaching assistant in anatomy, histology, and doctoring ethics courses at UPenn. Outside of medical school, he enjoys cooking, volunteering, and traveling in support of his partner’s work on girls’ education in Africa.
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- Burns J, Landorf KB, Ryan MM, Crosbie J, Ouvrier RA. Interventions for the prevention and treatment of pes cavus. Cochrane Database Syst Rev. 2007(4). PubMed Link
- Maynou C, Szymanski C, Thiounn A. The adult cavus foot. EFORT Open Reviews. 2017;2(5):221-229. doi:10.1302/2058-5241.2.160077. NCBI Link