Bilateral flatfoot before Surgery and  Bilateral flatfoot after Surgery
Ankle Arthroscopy and Subtalar Arthroscopy
Ankle Arthritis in Rhuematoid patient and Ankle Replacement in Rhuematoid Arthritis
Diabetic foot before Surgery and Diabetic foot after Surgery
Claw toe deformity in Rhuematoid patient and Claw toe deformity in Rhuematoid patient after surgery
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Cavus Foot


The High Arch (Cavus) Foot

Cavus foot is a type of foot where shape of the foot changes as shown in picture. There are many causes for a high arch foot. One of the most common causes is Charcot Marie Tooth disease or CMT. This is a disease of the muscles and the nerves of the legs and occasionally of the hands, in which certain muscles weaken, while others retain their strength.

  Cavus foot   Cavus foot picture  
 
         

Problems in the Foot:-

       
1.
The muscle imbalance around the foot and ankle gives rise to the high arch in the foot (cavus).    
2.
This is associated with clenching of toes. (Like the toes of a pigeon). The deformity in toes is called claw toes.    
3.
Also the bones at the base of toes (metatarsal heads) become very prominent and giving rise to hard skin on the sole of the foot. This also causes pain in the foot.    
4.
This is also associated with curling in (Varus deformity) of the ankle bones which can give rise to ankle pain and ankle instability.    
5.
Plantar fascitis can also occur in High Arch Foot.    

Deformity in the feet & toes give rise to overload and callosity of lateral border of the foot. Sometimes stress fracture of fifth metatarsal can also occur because of the overload.   

 
Cavus foot as seen from front
  Cavus foot and heel varus as seen from behind  

X-ray Cavus foot

Why does deformities occur?

The deformity of the high arch foot develops because the muscles that pull the foot inward remain strong, while those that pull the foot outward are weak or absent.

Treatment

Depends upon the overall shape, flexibility, and strength of a patient’s foot and disability experienced. Nerve tests may occasionally need to be performed to help confirm the diagnosis. X-rays are needed to look at the state of underlying bones and joints.

Cavus foot occurs at any age. Once the deformity is present in a child it is going to be progressive. This means that the deformity will slowly get worse as a result of the muscle imbalance and weakness. Although the pattern of muscle and nerve damage may be similar through the generations in a family, this is not always the case. Every cavus foot is unique. Depending upon the symptoms, treatment may include changing the shoes, special orthotics support (devices that support, adjust, or accommodate the foot deformity), cushioning pads, foot and ankle braces, or surgery.

Surgery may be necessary in situations where the symptoms are likely to get worse over time, or when pain in ankle and instability cannot be corrected with external orthopaedic devices.

The main goals of surgery for Cavus Foot are:

       
1.
Correcting all the existing deformity of the toes, the high arch, the ankle and the muscle imbalance    
2.
Preserving as much motion as possible    
3.
Rebalancing the deforming muscle forces around the foot and ankle    
4.
Adding stability to the ankle    
5.
Preventing ankle arthritis from occurring as a result of the chronic deformity of the foot and the instability of the ankle    

The correction of cavus feet can be challenging. However, with appropriate care and management, the foot can usually be well corrected and balanced, with as much motion as possible maintained.

  Picture showing Cavus foot one after and one before surgical correction      
 

These are the appearance of the feet from behind in a patient with a high arch, with the heel twisted inwards. The foot on the right has already undergone surgical correction and is straight.

 
     
         
 
Cavus foot picture from side before surgery
     
         
 
Cavus foot picture from behind after surgery
     
         
 
Cavus foot picture from side after surgery
     
 

 This patient 23 years old patient with polio has cavus and equinus deformity of his feet. This was corrected with surgery. After surgery although his deformity was not fully corrected he was able to walk comfortably with a small shoe raise on his right foot.