Introduction
Pes cavus, commonly known as high arches. These deformities of the ankle and foot present in various degrees, from mild to severe. Mild deformities are easily stretchable needing rigid immobilization in a corrected position. Severe ones are rigid. Many a times, these deformities are present in combination. In about 50% of the cases, they are bilateral; when unilateral, involvement of the right foot is more common.
Definition
There is marked exaggeration of the longitudinal arch of the foot with dropping of the tarsus. It may be associated with equinovarus or calcaneal deformities. It is also known as contracted foot.
Etiology
The causes of pes cavus are varied, but it’s most frequently neurological in origin.
- Idiopathic: Sometimes, no specific cause is found, and it’s termed idiopathic
- Neurological Conditions: Conditions like Charcot-Marie-Tooth disease, spina bifida, cerebral palsy and poliomyelitis are common culprits. These conditions can cause muscle imbalances, leading to the characteristic high arch.
- Genetics: In some cases, it can be inherited, even without an identifiable neurological cause.
- Muscle weakness: Weakness of the intrinsic foot muscles, lumbricals and interossei could be the cause
Signs & Symptoms
Individuals with pes cavus often experience a range of symptoms:
- Foot Pain: Particularly in the ball of the foot (metatarsalgia) and heel.
- Calluses: Development of thick calluses under the ball and heel of the foot due to increased pressure.
- Ankle Instability: Frequent ankle sprains.
- Hammer Toes or Claw Toes: clawing of the toes.
- Difficulty Finding Shoes: Due to the unusual foot shape.
- Stiffness: Reduced flexibility in the foot.
Investigation
Diagnosing pes cavus typically involves:
- Physical Examination: A thorough assessment of the foot’s structure, gait, and flexibility.
- X-rays: To visualize the bony alignment and measure arch height.
- Neurological Evaluation: To rule out or identify underlying neurological conditions.
- Gait Analysis: To observe how the foot functions during walking.
Physiotherapy Management
Physiotherapy plays a vital role in managing pes cavus symptoms and improving function:
- Pain Management: Faradic foot bath and exercises under warm water can be given.
- Strengthening Exercises: active exercises to the metacarpophalangeal joints, ankle and foot.
- Stretching:. Stretching sessions to flatten the longitudinal arch by weight bearing and weight transfers to it.
- Footwear Advice: Corrective shoes with soft padding are given to encourage weight bearing over the arch.
- Gait Retraining: To improve walking mechanics and reduce stress on the foot.
- Orthotics: Custom-made shoe inserts to provide support, distribute pressure, and improve shock absorption
- Balance Training: To enhance stability and reduce the risk of ankle sprains.
Conclusion
This elevated arch causes the heel and forefoot to bear excessive weight, often leading to pain and instability. Early intervention can significantly reduce pain, improve foot function, and enhance the overall quality of life for those affected.