pes cavus

凹足

WordNet

1. the 17th letter of the Hebrew alphabet

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/08/14 14:02:18」(JST)

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Pes cavus
Classification and external resources
High arch in foot of a person with a hereditary neuropathy
ICD-10	Q66.7
ICD-9	754.71
DiseasesDB	24563
MedlinePlus	001261
eMedicine	orthoped/539

Pes cavus (in medical terminology, also high instep, high arch, talipes cavus, cavoid foot, and supinated foot type) is a human foot type in which the sole of the foot is distinctly hollow when bearing weight. That is, there is a fixed plantar flexion of the foot. A high arch is the opposite of a flat foot, and somewhat less common.

History

The term pes cavus is Latin for "hollow foot" and is synonymous with the terms talipes cavus, cavoid foot, high-arched foot, and supinated foot type. Pes cavus is a multiplanar foot deformity characterised by an abnormally high medial longitudinal arch. It also commonly features a varus (inverted) hindfoot, a plantarflexed position of the first metatarsal, an adducted forefoot, and dorsal contracture of the toes. Despite numerous anecdotal reports and hypothetical descriptions, very little rigorous scientific data exist on the assessment or treatment of pes cavus.

Types

The term pes cavus encompasses a broad spectrum of foot deformities. Three main types of pes cavus are regularly described in the literature: pes cavovarus, pes calcaneocavus and ‘pure’ pes cavus. The three types of pes cavus can be distinguished by their aetiology, clinical signs and radiological appearance.

Pes cavovarus, the most common type of pes cavus, is seen primarily in neuromuscular disorders such as Charcot-Marie-Tooth disease, and in cases of unknown aetiology, conventionally termed as ‘idiopathic’. Pes cavovarus presents with the calcaneus in varus, the first metatarsal plantarflexed and a claw-toe deformity. Radiological analysis of pes cavus in Charcot-Marie-Tooth disease shows the forefoot is typically plantarflexed in relation to the rearfoot.

In the pes calcaneocavus foot, which is seen primarily following paralysis of the triceps surae due to poliomyelitis, the calcaneus is dorsiflexed and the forefoot is plantarflexed. Radiological analysis of pes calcaneocavus reveals a large talo-calcaneal angle.

In ‘pure’ pes cavus, the calcaneus is neither dorsiflexed nor in varus, and is highly arched due to a plantarflexed position of the forefoot on the rearfoot.

A combination of any or all of these elements can also be seen in a ‘combined’ type of pes cavus that may be further categorized as flexible or rigid.

Despite various presentations and descriptions of pes cavus, all are characterised by an abnormally high medial longitudinal arch, gait disturbances and resultant foot pathology.

Epidemiology

There are few good estimates of prevalence for pes cavus in the general community. While pes cavus has been reported in between 2 and 29% of the adult population, there are several limitations of the prevalence data reported in these studies. Population-based studies suggest the prevalence of the cavus foot is approximately 10%.

Cause

Pes cavus may be hereditary or acquired, and the underlying cause may be neurological, orthopedic or neuromuscular. Pes cavus is sometimes—but not always—connected through Hereditary Motor and Sensory Neuropathy Type 1 (Charcot-Marie-Tooth disease) and Friedreich's Ataxia; many other cases of pes cavus are natural.

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.

Among the cases of neuromuscular pes cavus, 50% have been attributed to Charcot-Marie-Tooth disease, which is the most common type of inherited neuropathy with an incidence of 1 per 2,500 persons affected. Also known as Hereditary Motor and Sensory Neuropathy (HMSN), it is genetically heterogeneous and usually presents in the first decade of life with delayed motor milestones, distal muscle weakness, clumsiness and frequent falls. By adulthood, Charcot-Marie-Tooth disease can cause painful foot deformities such as pes cavus. Although it is a relatively common disorder affecting the foot and ankle, little is known about the distribution of muscle weakness, severity of orthopaedic deformities, or types of foot pain experienced. There are no cures or effective treatment to halt the progression of any form of Charcot-Marie-Tooth disease.

The development of the cavus foot structure seen in Charcot-Marie-Tooth disease has been previously linked to an imbalance of muscle strength around the foot and ankle. A hypothetical model proposed by various authors describes a relationship whereby weak evertor muscles are overpowered by stronger invertor muscles, causing an adducted forefoot and inverted rearfoot. Similarly, weak dorsiflexors are overpowered by stronger plantarflexors, causing a plantarflexed first metatarsal and anterior pes cavus.

Pes cavus is also evident in people without neuropathy or other neurological deficit. In the absence of neurological, congenital or traumatic causes of pes cavus, the remaining cases are classified as being ‘idiopathic’, because their aetiology is unknown.

Pain and disability

As with certain cases of flat feet, high arches may be painful due to metatarsal compression; however, high arches— particularly if they are flexible or properly cared-for—may be an asymptomatic condition.

People with pes cavus sometimes—though not always—have difficulty finding shoes that fit and may require support in their shoes. Children with high arches who have difficulty walking may wear specially designed insoles, which are available in various sizes and can be made to order.

Individuals with pes cavus frequently report foot pain, which can lead to a significant limitation in function. The range of complaints reported in the literature include metatarsalgia, pain under the first metatarsal, plantar fasciitis, painful callosities, ankle arthritis and Achilles tendonitis.

There are many other symptoms believed to be related to the cavus foot. These include shoe-fitting problems, lateral ankle instability, lower limb stress fractures, knee pain, iliotibial band friction syndrome, back pain and tripping.

Foot pain in people with pes cavus may result from abnormal plantar pressure loading because, structurally, the cavoid foot is regarded as being rigid and non-shock absorbent and having reduced ground contact area. There have previously been reports of an association between excessive plantar pressure and foot pathology in people with pes cavus.

Treatment

Surgical treatment is only initiated if there is severe pain, as the available operations can be difficult. Otherwise, high arches may be handled with care and proper treatment.

Suggested conservative management of patients with painful pes cavus typically involves strategies to reduce and redistribute plantar pressure loading with the use of foot orthoses and specialised cushioned footwear. Other non-surgical rehabilitation approaches include stretching and strengthening of tight and weak muscles, debridement of plantar callosities, osseous mobilization, massage, chiropractic manipulation of the foot and ankle and strategies to improve balance. There are also numerous surgical approaches described in the literature aimed at correcting the deformity and rebalancing the foot. Surgical procedures fall into three main groups:

1. soft-tissue procedures (e.g. plantar fascia release, Achilles tendon lengthening, tendon transfer);
2. osteotomy (e.g. metatarsal, midfoot or calcaneal);
3. bone-stabilising procedures (e.g. triple arthrodesis).

See also

• Arches of the foot
• Foot type
• En pointe
• Foot binding
• Rocker bottom foot

References

External links

• International Foot and Ankle Biomechanics Community (i-FAB)

UpToDate Contents

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• 1. 若年アスリートにおける足部痛の臨床的特徴およびマネージメント clinical features and management of foot pain in the young athlete
• 2. シャルコーマリートゥース病などの一次性の遺伝性運動感覚性ニューロパチー hereditary primary motor sensory neuropathies including charcot marie tooth disease
• 3. 足底筋膜炎および踵痛を呈するその他の原因 plantar fasciitis and other causes of heel pain
• 4. 若年アスリートにおける足部および足関節の疼痛評価 evaluation of foot and ankle pain in the young athlete
• 5. フリードライヒ失調症 friedreich ataxia

English Journal

• Stress fractures of the lateral rays in the cavovarus foot: indication for surgical intervention.

• Bluth B, Eagan M, Otsuka NY.AbstractLateral ray stress fractures are a known complication of the cavovarus foot deformity. Malpositioning of the forefoot and hindfoot leads to increased pressure on the heel and lateral rays, resulting in significant morbidity. Patients with nonprogressive deformities can be managed surgically or nonsurgically in an attempt to decrease adverse events. It is often difficult to predict which patients will benefit most from a surgical intervention. This article describes 2 model cases of stress fractures in patients with nonprogressive cavovarus foot deformities. Patient 1 was an active patient with a minor, flexible cavovarus deformity, and patient 2 was a relatively inactive patient with a severe, fixed deformity.These cases serve to illustrate a spectrum of the 2 major risk factors for the development of a stress fracture of the lateral rays: severity of deformity and activity level of the patient. We believe the relationship between these 2 risk factors constitutes a threshold that allows the development of a stress fracture to serve as an adequate marker for surgical intervention. Within this patient population, a stress fracture indicates that given a patient's lifestyle, his or her deformity is sufficient enough to cause significant and repeated morbidity. Surgical restoration of the foot to plantigrade will eliminate the increased forces to the lateral metatarsals and decrease the incidence of further injury. Thus, stress fractures of the lateral rays in patients with nonprogressive cavovarus deformities should be considered an indication for surgical intervention.
• Orthopedics.Orthopedics.2011 Oct 5;34(10):e696-9. doi: 10.3928/01477447-20110826-28.
• Lateral ray stress fractures are a known complication of the cavovarus foot deformity. Malpositioning of the forefoot and hindfoot leads to increased pressure on the heel and lateral rays, resulting in significant morbidity. Patients with nonprogressive deformities can be managed surgically or nonsu
• PMID 21956071

• Free flap reconstruction of extensive defects following resection of large neurofibromatosis.

• Uygur F, Chang DW, Crosby MA, Skoracki RJ, Robb GL.SourceFrom the Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
• Annals of plastic surgery.Ann Plast Surg.2011 Oct;67(4):376-81.
• BACKGROUND: : Neurofibromatosis type 1 (NF-1) is a locally invasive tumor that can grow extensively with diffuse infiltration into surrounding tissue. Resecting a large neurofibroma can result in an extensive defect that is difficult to reconstruct and can cause both aesthetic and functional deformi
• PMID 21587052

Japanese Journal

• 臨床室 中足部痛を主訴とした特発性凹足変形に対して踵骨骨切り術を行った1例

• 倉 知彦,伊東 勝也,大島 学 [他]
• 整形外科 59(4), 401-404, 2008-04
• NAID 40015923328

• 凹足変形を有し慢性進行性経過をとった慢性炎症性脱髄性多発神経炎の1例

• 喜多 也寸志,岡 伸幸,清水 洋孝
• 末梢神経 = Peripheral nerve 17(2), 264-266, 2006-12-01
• NAID 10027578102

Related Links

• Pes cavus - Wikipedia, the free encyclopedia

High arch (also high instep, pes cavus in medical terminology) is a human foot type in which the sole of the foot is distinctly hollow when bearing weight. That is, there is a fixed plantar flexion of the foot. A high arch is the opposite of a flat foot, ...

Related Pictures

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★リンクテーブル★

リンク元	「凹足」「foot deformity」
関連記事	「PES」「pe」「p」

「凹足」

　　[★]

英

hollow foot

ラ

pes cavus, talipes cavus

関

足部変形 pes cavus deformity、鉤爪足/鉤爪様足

• シャルコー・マリー・トゥース病

参考

• 1.

http://www.umm.edu/graphics/images/en/9195.jpg

「foot deformity」

　　[★]

足変形、足部変形

関

pes cavus

「PES」

　　[★] 喉頭蓋前間隙 preepiglottic space

「pe」

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• n.

• 体育。ペルーのドメイン名

「p」

　　[★]

• ピコ

10の-12乗

関

pico