Pes Cavus Foot Research Articles

Cadaveric Simulation of a Pes Cavus Foot

The pes cavus deformity has been well described in the literature; relative bony positions have been determined and specific muscle imbalances have been summarized. However, we are unaware of a cadaveric model that has been used to generate this foot pathology. The purpose of this study was to create such a model for future work on surgical and conservative treatment simulation. We used a custom designed, pneumatically actuated loading frame to apply forces to otherwise normal cadaveric feet while measuring bony motion as well as force beneath the foot. The dorsal tarsometatarsal and the dorsal intercuneiform ligaments were attenuated and three muscle imbalances, each similar to imbalances believed to cause the pes cavus deformity, were applied while bony motion and plantar forces were measured. Only one of the muscle imbalances (overpull of the Achilles tendon, tibialis anterior, tibialis posterior, flexor hallucis longus and flexor digitorum longus) was successful at consistently generating the changes seen in pes cavus feet. This imbalance led to statistically significant changes including hindfoot inversion, talar dorsiflexion, medial midfoot plantar flexion and inversion, forefoot plantar flexion and adduction and an increase in force on the lateral mid- and forefoot. We have created a cadaveric model that approximates the general changes of the pes cavus deformity compared to normal feet. These changes mirror the general patterns of deformity produced by several disease mechanisms. Future work will entail increasing the severity of the model and exploring various pes cavus treatment strategies.

Influence of running shoe type on distribution and magnitude of plantar pressures among those with pes planus or pes cavus feet

Influence of running shoe type on distribution and magnitude of plantar pressures among those with pes planus or pes cavus feet

Pressure characteristics in painful pes cavus feet resulting from Charcot–Marie–Tooth disease

Charcot–Marie–Tooth (CMT) disease often presents with peripheral muscle imbalance associated with a painful cavus (medial high-arched) foot deformity which becomes increasingly severe and rigid as the disease progresses. The purpose of this study was to investigate the effect of pes cavus on foot pain and dynamic plantar pressure in CMT, and to explore the relationships between plantar pressure and pain. Sixteen participants diagnosed with CMT and painful pes cavus were assessed for foot posture, ankle dorsiflexion range of motion, levels of foot pain, functional impairment, health-related quality of life and plantar pressure distribution while walking. Plantar pressure parameters (mean pressure, peak pressure, pressure–time integral) and contact duration were measured using the Novel Pedar ® in-shoe capacitance transducer system and the foot was divided into rearfoot, midfoot and forefoot regions for analysis. Increasing cavus foot deformity was associated with more widespread foot pain and increased pressure under the forefoot and midfoot regions. In contrast, peak pressure decreased under the rearfoot. Neither relationship was found between foot pain intensity and any of the pressure variables, nor was ankle dorsiflexion range of motion correlated with pain location, intensity or degree of pes cavus. Although pes cavus in CMT is associated with substantial pain and dysfunction, there is no clear link between foot pain and plantar pressure. The more severe the degree of pes cavus, however, the more pressure develops under the lateral margin of the foot; probably as a result of the changed foot–ground contact seen during gait.

Quantification of Muscle Strength and Imbalance in Neurogenic Pes Cavus, Compared to Health Controls, Using Hand-Held Dynamometry

Pes cavus foot deformity in neuromuscular disease is thought to be related to an imbalance of musculature around the foot and ankle. The most common cause of neurogenic pes cavus is Charcot-Marie-Tooth (CMT) disease. The aim of this investigation was to objectively quantify muscle strength and imbalance using hand-held dynamometry in patients diagnosed with CMT and pes cavus, compared to healthy controls. Muscles responsible for inversion, eversion, plantarflexion, and dorsiflexion of the foot and ankle were measured in 55 subjects (11 CMT patients with a frank pes cavus, and 44 healthy controls with normal feet) using the Nicholas hand-held dynamometer (HHD). Test-retest reliability of the HHD procedure also was determined for each of the four muscle groups in the healthy controls. Test-retest reliability of the HHD procedure was excellent (ICC3,1 = 0.88 to 0.95) and the measurement error was low (SEM = 0.3 to 0.7 kg). Patients with CMT were significantly weaker than normal for all foot and ankle muscle groups tested (p < 0.001). Strength ratios of inversion-to-eversion and plantarflexion-to-dorsiflexion were significantly higher in the patients with CMT and pes cavus compared to individuals with normal foot types (p > 0.01). Hand-held dynamometry is an objective and reliable instrument to measure muscle strength and imbalance in patients with CMT and a pes cavus foot deformity.

Weight bearing ankle dorsiflexion range of motion in idiopathic pes cavus compared to normal and pes planus feet

Background: Various factors are considered influential in the development of pes cavus. Short tendo-Achilles is one factor that has been hypothesised as a deforming mechanism of ‘idiopathic’ pes cavus. Objective: To measure tendo-Achilles length in subjects with idiopathic pes cavus, compared to normal and pes planus feet, and to examine the relationship between tendo-Achilles length and foot type. Method: Fifty-three healthy volunteers (34 female, 19 male) were recruited to encompass a wide range of foot types, varying in degree of cavoid, normal and planus features. Foot type was measured weight bearing using the Foot Posture Index (FPI). The length of the tendo-Achilles was also measured weight bearing using the lunge test. Results: Twenty-four subjects with pes cavus, 24 subjects with a normal foot type and five subjects with pes planus completed the study. Lunge angle in the pes cavus group was significantly less than the normal and pes planus groups ( P < 0.001). A strong, positive correlation was identified between tendo-Achilles length and foot type ( r = 0.757, P < 0.001; r 2 = 57.3%). Conclusion: Distinct differences exist in tendo-Achilles length in individuals with a pes cavus foot type, compared to normal and pes planus feet. A strong positive relationship between tendo-Achilles shortness and pes cavus severity has been identified.

The effect of pes cavus on foot pain and plantar pressure

Clinical management of patients with painful pes cavus is challenging because the mechanism of foot pain is poorly understood. The purpose of this study was to explore the influence of various pes cavus aetiologies on foot pain and plantar pressure characteristics, and to identify the relationship between foot pain and plantar pressure. Seventy subjects were recruited for this study. They included 30 subjects with pes cavus of unknown aetiology (idiopathic), 10 subjects with pes cavus of neurological aetiology (neurogenic) and 30 subjects with a normal foot type. The presence and location of foot pain was recorded and barefoot plantar pressures were measured using the EMED-SF platform for the whole foot, rearfoot, midfoot and forefoot regions. Subjects with pes cavus of either idiopathic or neurogenic aetiology reported a higher proportion of foot pain (60%) compared to subjects with a normal foot type (23%) (P=0.009). Pressure-time integrals under the whole foot, rearfoot and forefoot regions in pes cavus, of both idiopathic and neurogenic origin, were higher than in the normal foot type (P<0.01). Pressure-time integrals in subjects reporting foot pain were higher than for pain free subjects (P<0.001). There was a significant correlation between pressure-time integral and foot pain (r=0.49, P<0.001). Foot pain is a common finding among individuals with pes cavus. Regardless of aetiology, pes cavus is characterized by abnormally high pressure-time integrals which are significantly related to foot pain. An understanding of the relationship between pes cavus pressure patterns and foot pain will improve the clinical management of these patients.

Relationship between foot type, foot deformity, and ulcer occurrence in the high-risk diabetic foot

We hypothesized an association between foot type, foot deformity, and foot ulceration and conducted an analysis of a well-characterized, high-risk diabetic population of 398 subjects. The average age was 62 years of age and 74% of the study population were males. Foot-type distributions were 19.5% pes cavus (high arch), 51.5% neutrally aligned (normal arch), and 29.0% pes planus (low arch). We quantified the presence of hallux valgus (23.9%), hammer/claw toes (46.7%), and hallux limitus (24.4%). A significant association was found between foot type and hallux valgus (p = 0.003); pes planus feet had the highest prevalence as compared with neutrally aligned feet (odds ratio [OR] = 2.43, p = 0.0006). Foot type was also significantly associated with fixed hammer/claw toes (p = 0.01); pes cavus feet had the highest prevalence as compared with neutrally aligned feet (OR = 3.89, p = 0.001). Foot type was also significantly associated with hallux limitus (p = 0.006) with pes planus feet having the highest prevalence as compared with neutrally aligned feet (OR = 2.19, p = 0.003). However, foot type was not significantly related to any ulcer outcome (p = 0.7). Fixed hammer/claw toes (OR = 3.91, p = 0.003) and hallux limitus (OR = 3.02, p = 0.006) were associated with increased risk of any ulcer occurrence. This study affirms that foot type and foot deformity are related and that foot deformities are associated with ulcer occurrence.

A new SBF2 mutation in a family with recessive demyelinating Charcot-Marie-Tooth (CMT4B2).

Charcot-Marie-Tooth (CMT) 1type 4 is a group of autosomal recessive progressive motor and sensory neuropathies characterized by distal muscle weakness and atrophy associated with sensory loss and, frequently, pes cavus foot deformity. CMT4 includes clinically and genetically heterogeneous disorders. Seven genes responsible for the different CMT4 subtypes (CMT4A, B1, B2, C, D, E, and F) have been identified so far.1 CMT4B, characterized by focally folded myelin sheaths on sural nerve biopsy, was first described in an Italian family2 and then in several other families of different ancestry. CMT4B is genetically heterogeneous. One form of CMT4B is caused by homozygous loss of function mutations in the myotubularin-related 2 gene (MTMR2) on chromosome 11q23 (CMT4B1).3 A second locus responsible for CMT4B has been mapped …

The geometric architecture of the subtalar and midtarsal joints in rheumatoid arthritis based on magnetic resonance imaging.

To compare in vivo the 3-dimensional (3-D) geometric architecture of the subtalar and midtarsal joints in normal and rheumatoid arthritic (RA) feet, using magnetic resonance imaging (MRI) analysis. MRI was performed on 23 patients with RA, all of whom had disease activity in the subtalar and/or midtarsal joints. Image processing techniques were used to create 3-D reconstructions of the calcaneus (C), cuboid (c), navicular (N), and talus (T) bones. Twenty-four standard architectural parameters were measured from the reconstructions and were compared with data from 10 normal subjects. These parameters defined both 3-D distance and angular relationships among the 4 bones studied. Pattern classification techniques were used to establish a geometric architecture foot profile for the RA patients. The degree of individual patient fit to the new RA foot profile and to profiles for normal, pes planus, and pes cavus foot types was derived. Logistic regression was used to examine the relationship of foot architecture to inflammatory disease characteristics and physical examination variables. Subtalar or midtarsal pain was reported by all 23 patients, and 22 of the 23 patients presented with >/=1 clinical feature of pes planovalgus deformity. In 21 patients, ultrasonography revealed synovitis at >/=1 tarsal joint or surrounding tendon. In the RA group, the normalized distances between the geometric centroids were significantly closer for bone pairs Cc and cT and significantly distracted for bone pair CN compared with the distances in normal subjects. In RA patients (versus normal subjects), the angles subtended at the bone centroids were significantly decreased in 3 bone groups (CNc, TCN, and TNc) and significantly increased in 3 bone groups (CcN, CcT, NTc). The angles formed between the major principal axes of bone pairs CT and cT were significantly increased in RA patients compared with those in normal subjects. Pattern classification defined 11 RA feet as having normal structure and 12 as having abnormal structure. However, the abnormal feet did not fit consistently with structures defined for RA, pes planus, or pes cavus foot types. Logistic regression demonstrated that subtalar joint synovitis was the only predictive factor for abnormal subtalar and midtarsal architecture (odds ratio 19.2, 95% confidence interval 1.77-200.0). This unique 3-D MRI-based technique successfully quantified the effects of RA on the geometric architecture of the foot and the patient-specific nature of these changes. This technique can be used to provide logical therapy for correction.

Unique X‐linked mental retardation syndrome with fingertip arches and contractures linked to Xq21.31

We studied 10 members of a 4 generation Missouri kindred with a dominant mental retardation syndrome with increasing severity in males. The 21 year-old propositus presented with severe mental retardation, microcephaly, asymmetric face, exotropia, hypogonadism, joint hypermobility, rocker bottom feet, and 10 low digital arches. Two brothers and a male cousin had similar features. The mother, sister, niece, maternal aunt, female cousin, and grandmother were examined and each had 8 to 10 low digital arches. Five of the women had exotropia and one had pes cavus feet. Chromosome analysis for fragile X in multiple relatives was normal. To determine the likelihood that this was an X-linked syndrome. DNA from relatives was hybridized to probes which detect 13 different loci spanning the X-chromosome. A peak LOD score of 2.78 at theta equal to 0.0 was calculated for the syndrome locus and DXYS1 (pDP34). The more distal Xq loci showed increasing recombination with the syndrome locus. These results are consistent with location for this syndrome near Xq21.31, the chromosomal locus for DXYSI.