From the Guidelines
Bilateral pes cavus is primarily caused by neurological conditions, with the most common causes including Charcot-Marie-Tooth disease, Friedrich's ataxia, and other spinal cord disorders such as spina bifida, poliomyelitis, cerebral palsy, and muscular dystrophy, as well as residual clubfoot deformity and idiopathic or genetic components 1. The causes of bilateral pes cavus can be categorized into several key groups, including:
- Neurological conditions: Charcot-Marie-Tooth disease, Friedrich's ataxia, and other spinal cord disorders such as spina bifida, poliomyelitis, cerebral palsy, and muscular dystrophy, which affect muscle balance in the feet 1.
- Residual clubfoot deformity: This can lead to pes cavus due to the altered biomechanics of the foot.
- Idiopathic or genetic components: In some cases, the condition may be idiopathic with no identifiable cause or may have a genetic component without an associated neurological disorder. The pathophysiology of bilateral pes cavus involves muscle imbalance, particularly between the stronger ankle dorsiflexors compared to the weaker plantar flexors, leading to forefoot equinus and compensatory hindfoot varus, which causes the characteristic high arch and often results in symptoms like lateral foot pain, ankle instability, metatarsalgia, and callus formation 1. Management of bilateral pes cavus typically begins with conservative measures such as orthotic devices, physical therapy, and appropriate footwear, with surgical intervention reserved for severe cases with significant pain or functional limitations. It is essential to note that the diagnosis of the underlying cause of bilateral pes cavus is crucial for effective management, and a thorough clinical evaluation, including a detailed medical history and physical examination, is necessary to determine the underlying cause and develop an appropriate treatment plan 1.
From the Research
Causes of Bilateral Pes Cavus
- Bilateral pes cavus can be caused by various factors, including neurological diseases, with Charcot-Marie-Tooth disease being a common underlying condition 2, 3.
- Direct pes cavus, which occurs only in the sagittal plane, may be related to a variety of causes, although neurological diseases predominate in posterior pes cavus 4.
- Pes cavovarus, a three-dimensional deformity, is often caused by palsy of the intrinsic foot muscles, usually related to Charcot-Marie-Tooth disease 4.
- Selective denervation of intrinsic foot musculature, particularly of the lumbricals, can lead to reduced ankle flexibility and forefoot cavus deformity 2.
- Other neuromuscular disorders, such as Duchenne Muscular Dystrophy, Spinal Muscular Atrophy, and Arthrogryposis Multiplex Congenita, can also contribute to the development of cavus foot deformity 5.
Neurological Conditions Associated with Cavus Foot Deformity
- Charcot-Marie-Tooth disease is a common underlying condition associated with cavus foot deformity, particularly in cases of pes cavovarus 4, 2, 3.
- Other neurological conditions, such as spinal muscular atrophy and arthrogryposis multiplex congenita, can also contribute to the development of cavus foot deformity 5.
- The evaluation of cavus foot deformity should involve a multidisciplinary approach to identify underlying neurological or neuromuscular disorders 3.