Cavus feet. 7 keys to understand what this pathology means06 May 2021
El dig foot it is a foot that presents a plantar vault with more height than normal. They are normally shorter feet in terms of shoe size, due to the retraction that is generated in the entire musculature. We have to comment that, although they can cause pain, well treated they allow a normal life. Yes, it is necessary see a specialist to know what type of cavus foot it is and what is the best treatment.
Do you have high arches or do you think you may have them?
Next, we review what they are, causes y consecuencias, symptom, repercussions, Treatments and other issues you should know about this foot condition.
WHAT ARE CAVE FEET?
A pes cavus is characterized by a excess height of the plantar vault and it occurs when you have more bow than usual. It can be accompanied by a axis deviation towards internal and external, or stay neutral. They are usually more reactive and explosive feet, due to the amount of muscle retraction and power that characterizes them.
SIGNS AND SYMPTOMS
In addition to the appearance of a cavus foot, in which it can be seen that there is more arch than normal, there are other Signs and symptoms that may be indicating that we suffer from this condition:
- Pain in the muscles of the plantar area of the foot: when working with a lot of retraction, they can generate microtears of the musculo-ligamentous structures.
- Pain in the back of the foot and in the fingers, being too prominent. Famous ones are usually produced claw toes, due to deformity of the phalanges (bones) of the fingers caused by muscle retraction.
- Pain in the plantar pad of the forefoot. Due to a decrease in the contact surface of the foot, an excessive load is generated in the front support area, which can generate inflammatory pathologies.
- Formation of hyperkeratosis and plantar helomas (calluses). When they are caused by excess pressure, they are a defense mechanism of the skin itself, to withstand the increased load on the sole of the foot, caused by the decrease in the contact surface in cavus feet.
- Sensation of instability or appearance of sprains due to repetition. Due to the lack of support surface, in the second phase of contact of the foot with the ground, there is no good support of the external zone of the foot generating an excessive lateral movement and the possible loss of balance.
Cavus feet normally have a neurological component and muscular affection that characterizes them. This means that they are associated with problems in the development of the neuro-musculo-skeletal system, and may appear isolated or associated with other systemic diseases.
Normally babies are born with the foot completely opposite to what is a cavus foot, that is, are born with flat feet. As a child begins to take his first steps, The foot is one of the structures that develops more quickly due to the action of the muscles that make up the leg and foot..
It is very important that the plantar arch is generated to its anatomical and physiological position, and that it has a component of flexible bow. This flexibility It will be crucial for the arch of the foot to move and articulate through the bones that compose it, in order to perform its main function: absorb impacts. In high arches, over time, this movement is normally restricted, and more impact forces are generated on the foot itself, the rest of the lower extremity and the back.
To diagnose this pathology correctly, there are fingerprint analysis systems with pressure platform, in this way we see in the computer how is the footprint and with that we can determine the diagnosis.
There are different types of high arches, which can be classified according to the position of the heel and the position of the forefoot. To determine the amount of deviation existing in the heel, different measuring instruments are used, such as goniometers and video-analysis systems, in order to determine if pes cavus is:
- Neutral Stainless - Steel: the axis of the heel remains aligned with the axis of the leg
- I'm worth: the axis of the heel deviates inwards with respect to the axis of the leg, generating the tendency to step on the inside of the sole of the foot.
- Varo: the axis of the heel deviates outwards with respect to the axis of the leg, generating the tendency to step with the outer area of the sole of the foot.
On the other hand, pes cavus can also be classify based on the amount of tilt it generates in the rear or forefoot. For this, it is best to make measurements on an X-ray that provides the real position of the calcaneus and metatarsal bones:
- Pes cavus talus or posterior: These are feet in which the calcaneal bone is verticalized too much, generating a very marked increase in the beginning of the plantar arch.
- anterior pes cavus: These are feet in which the metatarsals have a very marked inclination and generate an increase in the plantar arch with an excessive load on the front plantar area of the foot.
For, classify them in terms of rigidity and functionwe use biomechanical tests that analyze the mobility of the first metatarsal, Tales como el Jack test, Hintermann's test, Coleman test. Each of them seeks to determine how the first metatarsal moves and how it will affect the biomechanics of the cavus foot. Normally, these are shorter feet in terms of length or shoe size, since they do not stretch as much as they should due to the muscular retraction generated by the inclination of the heel or forefoot area with the consequent height of the plantar arch.
In children, the most important thing is to establish a good diagnosis and a early treatment, because normally pes cavus comes "from the factory" and cannot be corrected, so it will cause problems with activity. However, we can act on the negative effects of pes cavus and on the progression factors that aggravate pes cavus: muscle shortening, spasticity and muscle rigidity, reduction of the support surface, instability of plantar support... The main objective is stop the development and evolution of pes cavus, because it is a type of foot that does not stop changing throughout life, worsening and aggravating the symptoms.
In both adults and children, the treatment of choice is to make a good custom template that will minimize the consequences of a cavus foot. Treatments should always be associated with exercises both Stretching such as improving balance. the possible operación pes cavus would be another treatment, always starting from a good biomechanical study of the tread and considering all the possibilities.
Most commonly this associated with neurological pathology (more or less serious) that generates the muscle retraction. It can affect men or women indistinctly and is not usually present at birth. It only occurs at birth associated with neurological diseases. Although it is suspected that there is a genetic component, it has not been scientifically proven that it is the cause that causes them. They can also occur idiopathically, that is, without being associated with any specific cause.
One of the main problems with pes cavus is that the support is based exclusively on two unique support points: the metatarsal area (under the toes) and the heel area. The correct support of a foot is to support the external lateral area of the foot, in addition to the two previous areas. It is common for pes cavus to have areas of calluses and metatarsalgia (pain in the area behind the toes) due to the increase in sustained load to which this area of the foot is subjected.
Due to this lack of support, pes cavus is often closely related to instability and frequently related to pathologies such as ankle sprains and injuries to the lateral structures of the knee.
At the level of the sole of the foot, in a cavus foot there is a significant increase in the tension generated in the plantar fascia (tissue that runs from the metatarsal heads to the heel). This sustained tension usually generates pathologies such as plantar fasciitis and heel spurs.
The tension generated in the sole of a cavus foot is transmitted through the Achilles-Plantar system to the Achilles tendon and the rest of the posterior muscles of the leg (calf, soleus and hamstrings), also generating an important lumbar overload.
For all of the above, it becomes evident that pes cavus has implications for health. So that it is essential that pes cavus be diagnosed and treated by a podiatrist in the first instance, combining physical and rehabilitative therapies through the physiotherapist to stop the associated muscular problems.
Dr. Antonio Gomez Bernal
Clinical Research Manager
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