1. Pes Cavus

2. What is Pes Cavus? Excessive Elevation of Longitudinal Arch High Arch
Foot is relatively inflexible
Much less common than Pes Planus
Also referred to as hollow foot or claw foot

5. Causes of Pes Cavus Neurological Disorders (60% of time)
Spina Bifidia
Poliomyelitis
Charcot-Marie-Tooth Disease
Talipses Equinovarus (Clubfoot)
Muscle Imbalance
Weak calf muscles
Tight Plantar Fascia

6. Excessive Supination Claw Toes Traumatic Incidents
Compartment Syndrome
Crushing Injury
Burns
Iatrogenic( overlengthing of the Achilles Tendon)
Malunion of Calcaneal or Talar fracture

7. Signs and Symptoms Pain during running, walking, or standing
Painful toes that can’t be straighten
Poor shock absorption
Foot length shorten
Callus on ball and heel of foot due to uneven weight distribution

8. Abnormal shortening of the achilles tendon
Tight plantar faciitis
In frontal plane forefoot in varus and heel in valgus
May experience overuse symptoms in the knees, ankles, and back

10. Examination History to determine any neurological conditions
Observation of foot and toes
Examine Gait
MMT and Flexibility
ROM of Foot
Neurological Exam

11. Colman Block Test
Patient is to stand on cm block with heel and lateral border of the foot on the block. Bear full weight while the 1st, 2nd, and 3rd metatarsal hang freely into plantarflexion and pronation. Test is looking for hindfoot flexibility.

12. Two Common Patterns Calcaneocavus Cavovarus Hindfoot abnormalities
No pronation of forefoot; no varus deformity of hindfoot
Dorsiflexion of calcaneum
Cavovarus
Forefoot abnormalities
Forefoot pronated and heel in varus
Claw toes

13. Classification Systems
Mild
Longitudinal arch appears increased NWB
Longitudinal arch appears almost normal WB
Toes clawed NWB
Toes normal WB
Hindfoot varus

14. Moderate Longitudinal arch increases NWB and WB Claw toes NWB and WB
Calluses under prominent metatarsal head
Dorsiflexion limited
Forefoot plantarflexed on hindfoot

15. Severe Calcaneos can’t pronate past 5 degrees varus
Heel in varus and foot in valgus
Decrease ROM in foot

16. Classification Type Forefoot Hindfoot Simple Balanced Neutral
Cavovarus
Plantarflexuion
Varus
Calcaneous
Fixed Equinus
Equinovarus
Equinus

17. Diagnostic Procedures
X-Ray foot
X-Ray Spine
Nerve Conduction Studies

18. Treatment Orthodics Corrective/Better Supporting Shoes
Stretch Achilles Tendon/Plantar Fascia
Surgical Procedures in severe cases

19. Return to Play
Arch Supports
Correct Shoes
Avoid Excessive Long Runs

20. References
Gallaspy, J.B. May J.D. Signs and Symptoms of Athletic Injuries. Mosby-Year Book: St. Louis,1996. p.406.
Arneheim, D. Prentice, W. Principles of Athletic Training. McGraw Hill: Boston th ed. P464
Greene, W.B. Essentials of Musculoskeletal Car. American Academy of Orthopedic Surgery nd ed.