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Bilateral Cavus Foot Deformity

Автор: LawannaPomeroy от 26-09-2017, 00:32
Pes cavus is a high arch of the foot that does not flatten with weight bearing. No specific radiographic definition of pes cavus exists. The deformity can be located in the forefoot, the midfoot, the hindfoot, or a combination of these sites. The spectrum of associated deformities observed with pes cavus includes clawing of the toes, posterior hindfoot deformity (described as an increased calcaneal angle), contracture of the plantar fascia, and cock-up deformity of the great toe. This can cause increased weight-bearing for the metatarsal heads and associated metatarsalgia and calluses.

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 How do you strengthen your Achilles tendon? tendon.Bilateral Cavus Foot Deformity

Forefoot plantaris leads to increased pressure on the metatarsal heads. This pressure is maintained for a greater proportion of the gait cycle than in normal feet. A high arch reduces the size of the footprint and increases plantar pressure. Plantar pain and callus formation may give way to ulceration, particularly in the neuropathic patient who lacks protective sensation.

General examination may reveal features of neurological conditions such as ?champagne bottle legs? (Charcot-Marie-Tooth disease), scoliosis in Friedreich ataxia, or a naevus, dimple or patch of hair over the spine in spina bifida occulta. The neurological examination should include a search for signs of peripheral nervous disease, such as muscle wasting, weakness and sensory deficit, and signs of central nervous disease, such as pyramidal signs, cerebellar signs or cranial nerve abnormalities. Accurate serial recording of power in individual muscle groups will allow the clinician to follow the disease over time and detect neurological progression.

Non Surgical Treatment
Non-surgical treatment of cavus foot may include one or more of the following options. Orthotic devices. Custom orthotic devices that fit into the shoe can be beneficial because they provide stability and cushioning to the foot. Shoe modifications. High-topped shoes support the ankle, and shoes with heels a little wider on the bottom add stability. Bracing. The surgeon may recommend a brace to help keep the foot and ankle stable. Bracing is also useful in managing foot drop.

Surgical Treatment
Ideally, surgeons should first repair the source of the traumatic event such as the ankle instability or peroneal tear in order to stabilize the laxity about the ankle and subsequently judge the level of deformity in the foot. For example, a varus talus position caused by ankle instability will often make the cavus foot position look worse prior to repair of the lateral collaterals than after repair of the collaterals. After repositioning and stabilizing the talus, one can better judge the varus of the heel and first metatarsal position.Bilateral Cavus Foot Deformity
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