Cavus foot deformity in children

A cavus deformity of the foot is easily recognizable, but appropriate neurologic assessment can help to determine the etiology.

Cavovarus, the most frequent type of cavus foot, presents with

·        an elevated medial longitudinal arch,

·        first ray plantarflexion, and,

·        if rigid, a fixed heel varus.

The cavovarus foot deformity causes an increase in anteromedial ankle joint pressure which may lead to anteromedial arthrosis in the long term, even in the absence of lateral hindfoot instability.

Common causes include

·        progressive motor sensory conditions, typically Charcot-Marie-Tooth disease, and

·        NON progressive conditions such as cerebral palsy and poliomyelitis.

A calcaneocavus foot may be seen in

·        poliomyelitis,

·        spinal dysraphism, and

·        peripheral neuropathy.

Initially, the cavus deformity is flexible, but if left untreated, it becomes a fixed bony deformity.

Physical examination should include the cavovarus block test, which assesses flexibility of the hindfoot deformity and can direct surgical treatment.

·        Standing radiographs of the feet and

·        spine, magnetic resonance imaging, and

·        electrodiagnostic studies

may be useful.

Management goals are to obtain a

1.      plantigrade,

2.      mobile,

3.      pain-free,

4.      stable,

5.      motor-balanced

foot.

Post-operative dynamic measurement of plantar peak pressures and contact area offers limited information about functional and anatomical improvement after surgery.

The heel pressures displays an inverse relationship to ankle power generation.

The amount of correction achieved radiographically does not correlate with pedobarographic measurements.

The increased heel pressure is not addressed by treatment.

Normalization of pressure patterns should be the goal in treating children with symptomatic cavovarus feet.

Although the foot deformity may be completely corrected in neuromuscular disorders, pressure distribution is not normalized, and therefore, symptoms may persist.

Surgical options include

1. soft-tissue and plantar fascia releases for a flexible deformity,

2.      osteotomy (plantar opening wedge, cuneiform bones, Dwyer) for a fixed deformity, and

3.      tendon transfers (modified Jones procedure) to restore muscle balance.

Triple arthrodesis has poorer long-term results than soft-tissue procedures and first metatarsal osteotomy to correct cavovarus foot deformity in patients with progressive deformity and sensory impairment.

Explore posts in the same categories: Foot & Ankle

Tags: Deformation, Diseases of the osteoarticular system, Etiology, Health, Human, Idiopathic, lower limb, Pes cavus

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