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Pes Cavus Amjad Moiffak Moreden, M.D. The General Assembly of Damascus Hospital Ministry of Health Damascus, Syria Jan. 30, 2007 Definition Pes cavus is a high arch that does not flatten with weightbearing. No specific radiographic definition of cavus foot exists. The deformity can be located in the forefoot, midfoot, or hindfoot or in a combination of these sites. What’s the problem? clawing of the toes, posterior hindfoot deformity (described as an increased calcaneal angle), contracture of the plantar fascia, and cock-up deformity of the great toe. This can cause increased weightbearing for the metatarsal heads and associated metatarsalgia and callus. Etiology 80% of the time caused from malunion of calcaneal or talar fractures, burns, sequelae of compartment syndrome, residual clubfoot, and neuromuscular disease. 20% of cases are idiopathic and nonprogressive . Residual clubfoot Etiology Cont… Neuromuscular diseases cause muscle imbalance that leads to an elevated arch. These diseases include muscular dystrophy, Charcot-Marie-Tooth (CMT) disease, spinal dysraphism, polyneuritis, intraspinal tumors, poliomyelitis, syringomyelia, Friedreich ataxia, cerebral palsy, and spinal cord tumors. A patient with new onset of a unilateral deformity but without history of trauma must be evaluated for spinal tumor. Etiology Cont… Multiple theories : Etiology Cont…Charcot-Marie-Tooth (CMT) The anterior tibialis muscle and the peroneus muscle develop weakness. Antagonist muscles, posterior tibialis and peroneus longus, pull harder than the other muscles, causing deformity. Specifically, the peroneus longus pulls harder than the weak anterior tibials, causing plantarflexion of the first ray and forefoot valgus. The posterior tibialis pulls harder than the weak peroneus brevis, causing forefoot adduction. Intrinsic muscle develops contractures while the long extensor to the toes, recruited to assist in ankle dorsiflexion, causes cock-up or clawtoe deformity. With the fore