Cavus Foot

Question 1

pes cavus is primarily a deformity of which plane?

Answer 1

sagittal

Question 2

how is pes cavus deformity classified?

Answer 2

anterior cavus
posterior cavus
combination
(as well as flexible/rigid)

Question 3

what does anterior cavus mean?

Answer 3

forefoot is plantarflexed on the rearfoot

Question 4

what does posterior cavus mean?

Answer 4

rearfoot is excessively dorsiflexed on the forefoot

Question 5

what are the etiologies of pes cavus deformity?

Answer 5

congenital
acquired
idiopathic

Question 6

when examining a patient with a pes cavus deformity, which part of the exam deserves special attention? why?

Answer 6

the neurological exam bc of the high correlation btwn neuromuscular disorders and pes cavus

Question 7

what are some congenital etiologies of cavus deformity?

Answer 7

CMT 
spina bifida
Friedrich's ataxia
cerebral palsy 
Roussy-Levy syndrome
muscular dytrophy 
clubfoot
syphilis

Question 8

what are some acquired etiologies of pes cavus?

Answer 8

poliomyelitis 
spinal cord tumors
trauma, infection 
Lederhose diease 
hysteria
stroke

Question 9

what is pseudo equinus?

Answer 9

not a true limitation of AJ dorsiflexion but is ratehr a condition that exists when available ankle dorsiflexion potential is used up in order to compensate for an anterior equinus (i.e. the talus is maximally dorsiflexed)

Question 10

what surgical procedure addresses the frontal plane component of a rearfoot varus?

Answer 10

Dwyer calcaneal osteotomy (lateral closing wedge)

Question 11

what is the role of plantar fasciotomies in cavus foot sx?

Answer 11

used to reduce the contracture of the plantar aponeurosis that is typical of a cavus foot

Question 12

what are the effects of transferring the long extensor tendons to the metatarsal heads?

Answer 12

• eliminates deforming forces on teh digits
• helps compensate for muscle imbalance responsible for creating flexible cavus
• increases or maintains ankle dorsiflexory power

Question 13

what is a jones suspension?

Answer 13

an isolated transfer of EHL to the neck of the 1st met

*additionally, hallux IPJ is fused

Question 14

what is a prerequisite of a jones suspension?

Answer 14

flexible plantarflexed 1st ray (with adequate dorsiflexory ROM)

Question 15

what are the consequences of over-correction following a jones suspension?

Answer 15

hallux limitus

Question 16

what is a heyman procedure?

Answer 16

transfer of all 5 long extensor tendons to their respective met heads. this helps to reduce flexible atnerior cavus.

Question 17

what is the hibbs procedure?

Answer 17

transfering the EDL to 3rd cueniform to reduce a flexible anterior cavus

Question 18

what is a STATT procedure?

Answer 18

lateral 1/2 of TA tendon is anatomosed to the peroneus tertius tendon near its insertion at the base of 5th met. this is used when EHL and EDL muscles are weak but the anterio tibial is full strength

Question 19

what is the purpose of PL tendon transfer ot the lesser tarsus?

Answer 19

help incerase ankle dorsiflexory power and to reduce drop foot component seenw ith pes cavus. also helps reduce plantarflexory force of teh first ray

Question 20

how is the tibialis posterior tendon transfer done?

Answer 20

PT tendon is sectioned at the navicular tuberosity, the tendon is rerouted thru the IO mb from posterior to anterior and transfered down teh EDL tendon sheath and inserted into the lesser tarsus

Question 21

what is Engle’s angle?

Answer 21

(quick and dirty measurement of met adductus angle)
angle formed btwn teh longitudinal bisection of the intermediate cuneiform and the longitudinal bisection of the 2nd met
(normal is 24 deg)