5 Causes of Pes Cavus Neurological Disorders (60% of time) Spina BifidiaPoliomyelitisCharcot-Marie-Tooth DiseaseTalipses Equinovarus (Clubfoot)Muscle ImbalanceWeak calf musclesTight Plantar Fascia
6 Excessive Supination Claw Toes Traumatic Incidents Compartment SyndromeCrushing InjuryBurnsIatrogenic( 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 straightenPoor shock absorptionFoot length shortenCallus on ball and heel of foot due to uneven weight distribution
8 Abnormal shortening of the achilles tendon Tight plantar faciitisIn frontal plane forefoot in varus and heel in valgusMay experience overuse symptoms in the knees, ankles, and back
10 Examination History to determine any neurological conditions Observation of foot and toesExamine GaitMMT and FlexibilityROM of FootNeurological Exam
11 Colman Block TestPatient 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 hindfootDorsiflexion of calcaneumCavovarusForefoot abnormalitiesForefoot pronated and heel in varusClaw toes
13 Classification Systems MildLongitudinal arch appears increased NWBLongitudinal arch appears almost normal WBToes clawed NWBToes normal WBHindfoot varus
14 Moderate Longitudinal arch increases NWB and WB Claw toes NWB and WB Calluses under prominent metatarsal headDorsiflexion limitedForefoot plantarflexed on hindfoot
15 Severe Calcaneos can’t pronate past 5 degrees varus Heel in varus and foot in valgusDecrease ROM in foot
16 Classification Type Forefoot Hindfoot Simple Balanced Neutral CavovarusPlantarflexuionVarusCalcaneousFixed EquinusEquinovarusEquinus
18 Treatment Orthodics Corrective/Better Supporting Shoes Stretch Achilles Tendon/Plantar FasciaSurgical Procedures in severe cases
19 Return to PlayArch SupportsCorrect ShoesAvoid Excessive Long Runs
20 ReferencesGallaspy, 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. P464Greene, W.B. Essentials of Musculoskeletal Car. American Academy of Orthopedic Surgery nd ed.