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Hallmark of pes cavus deformities are high arches.
Simplistic as it is, cavus deformities are far more complicated. Patients may have the apex of their arch in the midfoot
or rearfoot. There maybe a significant varus deformity.
In any case, cavus deformities bring a whole group of associated
problems, whether it be plantar fasciitis, muscle cramping, callouses or hammertoes.
Those with varus deformities
often suffer from ankle instability, peroneal subluxation, tenosynovitis and/or tears.
Hallmark of pes cavus is increased
calcaneal inclination and increased metatarsal declination on xray.
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Surgical options:
- Dwyer calcaneal osteotomy
(closing wedge)
- Midfoot osteotomies
- 1st met-cun fusion
- Plantar fascial release
- Jones tenosuspension
Goals
of surgery:
- reduce the stress on the arch
- reduce the forefoot pressure on the ball of the foot
- reduce the calcaneal
inclination
- restore a rectus heel
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Varus heel with normal calcaneal inclination
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CT-SCAN illustrates the varus deformity
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After taking out a 7mm wedge, dwyer calcaneal osteotomy can restore a rectus heel
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Signifcant cavus deformity with even greater varus deformity of over 15 degrees, with Charcot-Marie-Tooth
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Goals of surgery need to be realistic, and in this case reducing the varus was far more important
then correcting each and every part of this complex deformity.
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This patient is so inverted that the medial column is not even on the ground, and you can see almost
the entire cuboid
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