Cavus foot

The cavus foot is the foot that presents an abnormal increase in the height of the arch, also called the plantar vault. Due to this, the footprint of the pes cavus will differ from the normal footprint.

The normal footprint being one that has a complete heel support, oval in shape, which continues with the support of the outer edge or isthmus of the footprint, which must be at least one third and maximum half of the total width of the footprint. foot. Continuing forward you reach the forefoot area. And finally, the supports of the five toes, which should be located slightly away from the footprint.

In addition to the footprint, it is essential to obtain the outline of the footprint, which is taken by marking the entire edge of the entire foot with a pencil perpendicular to the ground.

Depending on the degree of elevation of the plantar arch and the affectation that we can find when we talk about the pes cavus, we can make a classification of the plantar footprints:

• Slight decrease in the isthmus or Grade 1
• Severe decrease in the isthmus of the foot or Grade 2.
• Complete disappearance of the isthmus or Grade 3.
• Complete disappearance of the isthmus of the foot with only supports made on the heel and forefoot or Grade 4.

It is important to know that during the normal development of the foot, it goes through several phases of development and that in babies we generally find a flattened appearance due to the presence of fatty tissue in the plantar region of the foot. That does not mean that the foot is flat, over time, as it grows, that fat tissue will disappear, leaving the real shape of the foot. This occurs around the third year of life.

Associated with the pes cavus, we can sometimes find how, in addition to the increase in the arch, deformed claw toes appear and the heel is turned outwards or inwards.

Causes of pes cavus

When talking about pes cavus it is difficult to know the cause that produces it since there are many and they differ from each other.

Among the most frequent causes of pes cavus we can find:

• Causes related to neurological problems
• Causes related to osteoarticular alterations
• Causes related to alterations in the soft parts of the foot (skin, muscles, circulatory vessels …)
• Causes that are unknown, also called idiopathic.

Lately, there are many studies that reveal that many cavus feet are of genetic origin and therefore are passed from parents to children.

Depending on one cause or another, the severity of the cavus deformity will vary greatly.

Why and how is it produced?

Among the causes related to neurological problems and that usually cause pes cavus we can find the following:

1. Poliomyelitis
2. Friedreich disease
3. Other neurological diseases (pyramidal syndromes, extrapyramidal syndromes …)

These neurological diseases affect the nerves that control the muscles of the foot, so there is an abnormal imbalance of forces causing some muscles to have more strength than others. In this way, the muscular actions produce an alteration in the shape of the foot, increasing the plantar arch. Depending on whether the neurological cause is one or the other (polio or another disease), the muscles of the foot will be paralyzed, rigid or flaccid.

In the event that the cavus foot is produced by causes related to osteoarticular alterations, we see how the affectation in the skeletal structure of the foot predominates and not in the nerves and muscles of the foot. Among these causes we can find the “congenital” pes cavus that appears at birth and is quite rare, cavus feet produced by external mechanisms that deform the foot, such as the use of inappropriate footwear, or caused by a blow . Those cavus feet that are the result of an osteoarticular disease such as rheumatoid arthritis.

Among the causes related to alterations in the soft parts of the foot, we can find large scars or burns on the sole that deform the foot in this position.

Pes cavus symptoms

The most frequent symptoms for which patients come for consultation are:

• Alterations in the shape of the foot.
• Pain.
• Alterations in the way you walk.
• Repeated sprains

The most common is that the alterations in the form occur in childhood, but it is not until adolescence when they begin to be noticeable. The patient then comes in reporting that he has suffered repeated sprains, a deformity of the arch of the foot that is very high, and a protrusion appears on the dorsum of the foot that coincides with the highest part of the arch (dorsal hump). For this reason the child deforms the footwear on the back and it is more difficult for him to put on and find a suitable shoe. In addition, the child runs and walks in a strange, “unsafe” way, falling easily.

Over time, this deformity progresses and the muscles and soft tissues are structured first, and definitely the skeleton.

Subsequently, lesions appear on the plant that end up becoming corns and calluses. Pain occurs in the support area of ​​the feet and sometimes the structures on the bottom of the feet become inflamed (sesamoiditis, bursitis ).

How is it diagnosed?

To make a correct diagnosis of pes cavus, a clinical examination by the professional usually begins.

These tests mainly consist of evaluations of the bone, joint and muscular state of the individual and then a complete study of the gait. In a second section, some complementary tests are carried out that confirm the diagnosis:

Diagnostic tests

• Photopodogram: this technique consists of taking the footprint and contour of the foot on photographic paper. The cavism or excavation of the footprint is studied and can be classified in one of the degrees described above (excavated footprint of grade 1, grade 2, grade 3 or grade 4).
• Gait study: which tries to see the way of walking in the different phases of the gait cycle. In cavus foot of neurological origin, a gait is observed in which the foot rests in an altered way. In normal conditions, when walking the foot supports first with the heel and then the rest of the foot until it is propelled with the toes. In this case, the foot rests first with the forefoot or forefoot and then with the heel.
• Radiological study: generally when you want to confirm a diagnosis of pes cavus, x-rays of the feet are usually performed to see, among other things, the position of the bones, thus assessing the severity of the deformity.
• It is imperative when diagnosing pes cavus that a complete examination of the nerves, nerve conduction, and reflexes be performed. With this exploration we will see if there is or is not nerve involvement and we will be able to see if the cause of the pes cavus is neurological.

Treatment of pes cavus

The treatment of pes cavus will naturally depend on the age of the person suffering from it, the cause that produces it and the severity of the deformity.

Thus, for example, in a newborn child with a structured cavus foot, produced by an alteration in the position of the bones, it will surely be necessary to perform a treatment by surgery and with the implantation of a splint to correct the abnormal position of the bones. .

The cavus feet caused by neurological problems need early treatment. The sooner the deformity of the feet begins to be treated, the sooner we will be able to stop the deformity and correct it whenever we can.

In addition, it is necessary that the neurological disease is controlled by the medical specialist.

In less serious cases, which are the most frequent, it is necessary to put a corrective insole when it comes to a child and an insole that avoids pain in the case of adults.

As a general rule, in addition to the insoles for cavus foot, it is necessary to use appropriate footwear, the correct size of the foot, with a straight last, that is held well with laces or buckles, made of a material that is as noble as possible (leather) and with a sturdy buttress to keep the foot in good position.

It is also necessary on many occasions to support the treatment with insoles and footwear with a series of exercises that help us to strengthen and stretch the muscles responsible for keeping the arch of the foot so high.

Therefore, sometimes, it is necessary to have the help of other professionals such as the physiotherapist.

How to avoid it?

To prevent cavus foot, it is advisable to periodically go to the doctor, pediatrician or podiatrist so that they carry out reviews of the condition of the feet during the child’s development.

Some tips that help prevent pes cavus are:

• Wear straight-last shoes.
• Do not use excessive heels. The maximum recommended is 2 cm for men and 4 cm for women.
• Put your child on shoes only when he begins to walk. It is good that children are free to move their feet without wearing a shoe that limits their movement.
• Do not use clothing that compresses the feet.

If you suspect this cavus foot deformity, you should see your podiatrist. This will diagnose and treat you if necessary.

If you have small children, it is advisable to go to the podiatrist in a preventive way, so that if there is a deformity it is diagnosed early.