Pes Cavus Vs Pes Planus In Children

Overview
Cavus foot is a condition in which the foot has an arch that is much higher than normal. As a result of this high arch, a large amount of weight is placed on the ball and heel of the foot when children walk or stand. Their feet become sore at the top and middle, and they have trouble finding shoes that fit properly. In addition, the high arches cause children?s ankles to roll outward slightly. This instability can lead to frequent ankle sprains.

Causes
The cause and deforming mechanism underlying pes cavus is complex and not well understood. Factors considered influential in the development of pes cavus include muscle weakness and imbalance in neuromuscular disease, residual effects of congenital clubfoot, post-traumatic bone malformation, contracture of the plantar fascia and shortening of the Achilles tendon.

Symptoms
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 great running shoe. 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
Your podiatrist will likely observe your feet as you walk, and will examine your foot up close, checking for the above symptoms, such as a visibly high arch, hammertoes or claw toes, or calluses on your heel or on the ball of your foot. He or she may also take a peek at your shoes to see where they?ve become worn. X-rays may also be ordered to give your podiatrist an inside look at what?s going on with your bone structure.

Non Surgical Treatment
If a considerable part of the deformity is flexible, a corrective orthosis should be used. For example, in forefoot-driven cavovarus, the hindfoot is flexible, and so an orthotic shoe insert incorporating lateral forefoot posting (support) and recessing under the first metatarsal will allow the hindfoot to correct. For ankle instability, the lateral side of the hindfoot post can be built up as well as the lateral forefoot post, creating a pronatory moment on the forefoot that counteracts the excessive supinatory moment in the hindfoot.

Surgical Treatment
Surgery is a last resort if the above conservative measures fail to control symptoms. Surgery is only justified when deformity is so pronounced or progressive that symptoms are intrusive and unresponsive to conservative treatments. On the other hand, surgery should not be delayed so long that severe ulceration develops or the patient cannot ambulate. A timely, limited surgical intervention, while the foot is still flexible, can re-balance the foot and prevent the need for a larger, more technically demanding procedure later on.