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Pes Cavus Definition

KelliEubanks33398 2017.06.11 14:10 조회 수 : 7

Overview
f you stood on a big piece of paper with wet feet, would the impression leave only the heel and front of your foot? If so, then you have pes cavus, whose literal translation is ?hollow foot.? In everyday terms, pes cavus means your arch is much higher than normal. High arches don?t usually cause debilitating pain, though fatigue and foot aches are common. Your high arches might be a variation of what?s considered normal. The condition tends to run in families. But in many cases, a high arch, specially if it develops unexpectedly in one foot, ould highlight an underlying neurological problem.

Causes
There are different causes of a high-arched foot. In many cases, the cause is unknown. In other cases, the cause is a nerve disease, clubfoot or injury. Treatment ranges from changes in shoewear to surgeries, depending on the amount of deformity and related problems.High Instep

Symptoms
Symptoms may vary from a mild problem with shoe fitting to significant disability such as difficulty finding proper fitting footwear because the shoes are not deep enough due to high arch and the clawed toes. Shortened foot length. Foot pain with walking, standing, and running. Metatarsalgia with pain in the forefoot/ ball of the foot (usually 1st and 5th metatarsal heads), with or without calluses/corns. Pain and stiffness of the medial arch or anywhere along the mid-portion of the foot. Morton's neuroma with pain in the ball of the foot and lesser toes. Pain in the heel and sole of the foot from plantar fasciitis. Stress fractures of the metatarsals and other foot bones. Particularly in diabetics and those with compromised circulation, abnormal pressure may result in chromic ulcers of the heel and ball of the foot. Strain and early degenerative joint disease (osteoarthritis) of lower extremity joints. ?Pump bumps" (Haglund's deformity) on the back of the heel. Associated discomfort within and near the ankle joint. Ankle instability with frequent sprains. Tight Achilles tendons. The knees, hips, and lower back may be the primary source of discomfort. Chronic lower extremity pain my lead to inactivity and diminished well-being.

Diagnosis
Identifying the underlying reason for a high arch is important to help your doctor plan the right treatment. Some neurological conditions can cause high arches to worsen progressively. Your doctor will ask about family history of high arches and neurological conditions. In examining your foot, he?ll look at arch height and any calluses, hammer toes and claw toes. The doctor also will watch how you walk (your gait). To help discern bone conditions and see if degenerative arthritis is present, your doctor may refer you for foot and ankle X-rays. An X-ray of your spine also might be needed to determine if a tumor or other spinal problem exists. If clearer images of your spine are needed, your doctor may order an MRI (magnetic resonance imaging). In this diagnostic test, a magnetic field and radio waves are combined via computer to produce exceptionally detailed images. Electromyography determines the health of muscles and the nerves controlling those muscles. A needle-shaped electrode is inserted into the muscle and an oscilloscope displays the muscle?s electrical activity. Nerve-conduction studies measure the speed of signals traveling through nerves. Several electrodes are placed on the skin above a nerve. An electrode emits a mild electrical impulse to activate the nerve. The activity then continues down the length of the nerve. The distance between electrodes and the time it takes them to move from one electrode to the next determines how fast nerve signals travel.

Non Surgical Treatment
Treatment for cavus foot varies depending on the severity of your condition. Mild cases of cavus foot can often be remedied with foot and ankle bracing, custom-made orthotics or wearing more comfortable shoes. If your condition remains unresponsive to the aforementioned treatment methods, surgical treatment may be necessary. Surgery for cavus foot aims to relieve pain and improve stability.

Surgical Treatment
Soft-tissue surgery. Cavus foot is caused in part by an over-pull of one of the lateral ankle muscles. A release of this tendon can be performed on the outside of the ankle. Additionally, a transfer of this tendon can be performed to help in correcting deformity of the ankle joint. Often patients will have a tightness of their gastrocnemius muscle, one of the main muscles in the calf. This can increase the deformity or prevent a correction from working. It is addressed with a lengthening of a part of the calf muscle or Achilles tendon. This is often performed through one or more small cuts in the back of the leg/ankle. Finally, the plantar fascia may be tight. The plantar fascia is a cord-like structure that runs from the heel to the front part of the foot. Partial or complete plantar fascia release may be done. Tendon transfers. Too much pull of certain muscles and tendons is often the cause of the deformity related with a cavus foot. Moving one of these muscles or tendons may help the foot work better. In addition, patients with a cavus foot may have weakness in moving the foot up, which is sometimes called a foot drop. In these cases, a tendon from the back of the ankle may be moved to the top of the foot to help improve strength. Bony surgery. Correcting the deformity of the foot may not be possible with soft tissue procedures alone. In these instances, one or more bone cuts (osteotomies) may be needed. Instead of a bone cut, a fusion (arthrodesis) procedure may be used. A fusion removes the joint between two bones so they grow together over time. During a fusion the bones may be held in place with plates or screws. Dorsiflexion osteotomy of the first metatarsal. This procedure flattens out the arch. Calcaneal osteotomy. This procedure is performed to bring the heel bone back under the leg. This is needed if correction of the deformity in the front of the foot does not also correct the back of the foot or ankle. A calcaneal osteotomy can be performed several ways and is often held in place with one or more screws. Fusion. Sometimes patients have a deformity that has caused damage to the joints. In these cases, soft tissue procedures or bone cuts may not be enough, and it may be necessary to eliminate the joint. Toe surgery. Clawed toes are a common problem with cavus foot deformity. This can be treated with tendon surgery, fusion or removal of part of the toe bones. Following surgery the toes are often temporarily held in place with pins.Supinated Foot
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