SN7 SHORT NOTE 5M

Describe Pes Cavus in detail.

General Surgery · Final Professional

Definition

Pes cavus is a foot with an abnormally high medial longitudinal arch that does not flatten on weight-bearing — the opposite of flat foot (pes planus). It is often accompanied by clawing of the toes and a varus heel, and concentrates load on the heel and metatarsal heads.

Causes

While some cases are idiopathic or familial, a cavus foot — especially if progressive, unilateral or associated with clawing — is frequently neurological in origin. Important causes include Charcot–Marie–Tooth disease (hereditary motor and sensory neuropathy), spinal dysraphism, poliomyelitis, cerebral palsy and Friedreich’s ataxia. Muscle imbalance across the foot produces the deformity.

DANGER / REMEMBER

A newly developing or progressive pes cavus, particularly if unilateral or with clawing, should prompt a search for an underlying neurological cause (e.g. Charcot–Marie–Tooth disease or a spinal cord lesion) — the foot deformity may be the presenting sign.

Clinical Features & Management

Symptoms include pain under the metatarsal heads and heel (from abnormal loading), callosities, lateral ankle instability and difficulty with footwear. Management: treat any underlying neurological cause; conservative measures (cushioned/moulded insoles and orthoses, appropriate footwear, physiotherapy) for milder cases; and surgery (soft-tissue release, tendon transfers to rebalance the foot, corrective osteotomy, or arthrodesis) for fixed or progressive deformity.

Clinical Note

Because a cavus foot is so often the outward sign of a hidden neurological disorder, the assessment of any patient with a high-arched foot includes a focused neurological examination and a family history, looking in particular for the peroneal wasting and areflexia of Charcot–Marie–Tooth disease; identifying the cause not only guides foot treatment but may uncover a condition with wider implications for the patient and family.

CLINICAL PEARL

A high-arched foot is a clue, not just a mechanical problem: progressive or unilateral cavus, especially with clawed toes, should send you looking for a neurological cause such as Charcot–Marie–Tooth disease.

Always look for an underlying neurological disorder.

KEY POINT

Key points TO remember

High medial arch that doesn’t flatten on standing (opposite of flat foot), often with clawed toes.
Frequently neurological — esp. Charcot–Marie–Tooth; also spinal dysraphism, polio, CP.
Progressive/unilateral cavus with clawing → seek a neurological cause.
Pain under metatarsal heads/heel; treat cause + orthoses; surgery (release/transfer/osteotomy) for fixed deformity.

EXAM TIP

Sources: Maheshwari's Essential Orthopaedics; Apley & Solomon's System of Orthopaedics and Trauma; AO Principles of Fracture Management.

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