Background

Pes cavus is a form of human foot disorder where the sole is visibly hollow and may affect both adults and children. The terms pes cavovarus and pes cavus are used interchangeably since the cavovarus appearance is the most prevalent expression of the cavus foot.

Pes cavus is a foot deformity represented by cavus (elevation of the longitudinal plantar arch of the foot), hindfoot varus, forefoot pronation, forefoot adduction, and first ray plantar flexion.

Epidemiology

The actual prevalence of cavus foot in the general population is unclear; however, efforts have been made to determine the frequency in particular categories. Studies provide varying statistics depending on the topographical region and patient care and the criteria of cavus utilized.

According to research, an individual with bilateral cavovarus feet has a 78% likelihood of CMT (Charcot Marie tooth), while those with a family history of cavovarus feet have a 91% risk of CMT.

Anatomy

Pathophysiology

The unopposed tension (or passive contracture) of the peroneus longus and the resulting plantar flexion of the first ray represent the essential lesion in the forefoot-driven pes cavus. Hindfoot-driven pes cavus is caused by varus malalignment of the hindfoot, which is frequently a compensating tendency.

Pes calcaneocavus, a condition in which the hindfoot is dorsiflexed, and the forefoot is plantarflexed as a compensatory mechanism, is triggered by calves’ weakness and is commonly seen following polio.

Finally, cerebral palsy-related spasticity can result in a range of foot morphologies, including various forms of cavus.

Etiology

Pes cavus can occur in both adults and children. It is usually due to a genetic or congenital cause when it is discovered to be bilateral. Post-traumatic disorders are more likely to develop unilaterally.

A unilateral appearance of pea cavus necessitates an MRI of the brain and spinal cord to rule out treatable progressive diseases such as a brain tumor or, during growing, a tethered spinal cord. The cavovarus foot is caused by three major factors.

• Idiopathic

The tarsal coalition, ankle osteoarthritis, rheumatoid arthritis, plantar fibromatosis, diabetic foot disease, and varus subtalar joint axis are the idiopathic causes of the condition.

• Neurological conditions

HMSN, anterior horn disease, post-stroke symptoms, cerebral palsy, spinal cord lesions, myelomeningocele, poliomyelitis, polyneuritic syndromes, Huntington chorea, amyotrophic lateral sclerosis, Parkinson’s disease, Friedreich ataxia, leprosy, Roussy-Levy syndrome, Pierre-Marie hereditary, Stumpell-Lorrain disease

• Traumatic

Talar neck malunion, compartment syndrome, peroneal nerve injury, scar tissue, knee dislocation burns, vascular lesions, calcaneal malunion, tibial fractures, or hindfoot instability

Genetics

Prognostic Factors

The prognosis is determined by the underlying condition that caused the cavovarus foot. Some diseases, such as CMT, cause progressive deformity; however, other causes of cavovarus foot, such as poliomyelitis, are largely nonprogressive.

These disorders’ treatment and prognosis differ. CMT type 1 has a young onset and progresses faster than CMT type 2. Hands are impacted later than feet, which might lead to disability.

Rare forms of CMT might cause further neurological issues involving the cranial nerves.

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

Future Trends

Media Gallary

References

https://www.ncbi.nlm.nih.gov/books/NBK556016/