OrthoNet

Cavus
Approach to Pes Cavus - Assessment

It may not be initially clear what the initial diagnosis is
Consider the differential:
Neuromuscular:
Muscular - muscular dystrophy
Long Tract and Central Disease - Friedrich’s, spinocerebellar degen’n, CP, syrinx, tumour,
tethered cord, dysraphism, diastematomyelia
Anterior Horn Cell - polio, SMA
Peripheral Nerves - CMT, tumour
Congenital: Arthrogryposis
Traumatic: Compartment syndrome, crush injury, burn.

Most commonly: CMT, polio, Friedrich’s, spinal cord tumour, dysraphism, diastematomyelia, tethered cord

Do a careful history
Do a full neurological examination
Do a careful physical examination of the lower extremity

Additional useful tests: CK, EMG, nerve conduction studies, nerve or muscle biopsy
Get a neurologist consult
Get a physiatrist consult
Get them hooked up with physio for strengthening and range of motion.

Questions to Ask:

Is the deformity bilateral or unilateral
- Bilateral: CMT, diabetic neuropathy, Friedrich’s ataxia, spinal cord tumour, spinal dysraphism, diastematomyelia, tethered cord
- Unilateral: polio, trauma, incomplete spinal cord injury, crush

Is the cavus deformity hindfoot or forefoot?
- a calcaneal pitch of >30 is more suggestive of gastrocs weakness secondary to polio, cauda equina, incomplete spinal cord injury, or meningomyelocele
- a calcaneal pitch of