Approach to Pes Cavus – Assessment
It may not be initially clear what the initial diagnosis is
Consider the differential:
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
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