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Biomechanics exam 3 ( Armi) > Pes Cavus > Flashcards

Pes Cavus Flashcards

1
Q

Pes cavus

A

high arched foot

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2
Q

Pes cavus is a ——–plane deformity

A

Sagittal

usually with other type of planal deformities

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3
Q

Pes cavus might be

A

congenital or structural abnormalities

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4
Q

deformities with an inverted calcaneus ( frontal plane deformity) may present with a

A

high arched foot

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5
Q

A rigid FF valgus is compensating by

A

STJ supination

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6
Q

A compensated FF valgus might appear as

A

a pes cavus foot type

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7
Q

Is pes cavus fixed or a functional deformity?

A

can be both

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8
Q

Is pes cavus foot pronated or supinated?

A

can be either supinated or pronated

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9
Q

A FF varus with a cavus foot deformity is likely to compensate with

A

pronation

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10
Q

What are some radiographic findings for supinated foot?

A 
-Increased calcaneal inclination angle
Decreased talar declination angle
-posteriorly displaces cyma line
-Plantar deviation of Meary's line
-Increased stair-step effect on metatarsals 
-Bullet hole sinus tarsi
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11
Q

Meary’s line

A

A line that is bisecting talus

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12
Q

What is stair-step effect?

A

when you look at met you can see them individually when the foot is supinated

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13
Q

what do you see on DP radiograph for supinated foot

A
  • decreased talocalcaneal angle
  • FF adducted on RF
  • Increasead FF /metatarsal overlap
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14
Q

What do you see on high arched foot w/o supination radiograph

A
  • increased calcaneal inclination angle
  • Decreased Talar declination angle
  • Normal Meary’s line
  • Normal cyma line
  • Normal realtionship of the metatarsals
  • No FF or metatarsal adduction
  • Normal talocalcaneal angle
  • Normal relationship of the metatarsals
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15
Q

pes cavus deformities categorization

A
  • location of deformity
  • co-existing deformities
  • method of compensation
  • etiology
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16
Q

What does etiology mean?

A

cause

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17
Q

Types of Pes Cavus based on location type

A
  • Anterior cavus
  • Posterior Cavus
  • Combined/global cavus
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18
Q

what type of Pes Cavus is the most common

A

Anterior Cavus

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19
Q

What are some Anterior cavus

A
  • Metatarsus Cavus
  • Lesser tarsus cavus
  • FF cavus
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20
Q

Where does the apex of deformity located in metatrsus cavus?

A

at Lis Franc’s joint

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21
Q

In metatrsus cavus deformity what can you palpate at the area of 1st metatrsocuneiform joint?

A

Dorsal prominence

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22
Q

in metatrsus cavus , the talus, navicular and cuneiform will be all

A

collinear

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23
Q

What are some clinical appearance of metatrsus cavus?

A
  • High instep
  • 1st metatarsocuneiform exostosis
  • shoe fitting is difficult
  • Normal cuboid angulation
  • pseudoequnius may lead to pronation
  • claw toes with anterior displacement of the fat pad plantar to the met heads
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24
Q

With pes cavus what kind of hammer toe etiology you might see?

A

Extensor substitution

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25
Q

Lesser tarsus Cavus

A
  • The lesser tarsal bones are in a plantarflexed attitude
  • A generalized dorsal prominence may be noted in the lesser tarsal area
  • you might see planatarflexed 1st ray
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26
Q

In FF cavus , the FF is plantarflexed at?

A

Chopart’s joint

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27
Q

in FF cavus , RF appears to be in what position?

A

dorsiflexed

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28
Q

in FF cavus where would you see dorsal prominence of the talar head

A

immediately anterior to the medial malleolus noted on an off weight bearing exam

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29
Q

In FF cavus , navicular, cuboid, 4th and 5th metatrsals are in what position

A

plantarflexed to the RF as compared to normal

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30
Q

what are some FF cavus findings on radiograph

A
  • An increased calcaneal inclination angle but no FF adduction
  • Anterioly displaced cyma line
  • increased plantar declination of the cuboid
  • WIder talo-calcaneal angle
  • Plantarflexed and adducted talus
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31
Q

What are some symptoms of FF cavus ?

A
  • Sagittal linear crease may be found between the 3rd and 4th metatarsals
  • Keratoma sub 2nd, 4th and /or 5th met heads
  • Adductovarus contractures 3rd, 4th and 5th digits
  • tailor’s bunion
  • postural fatigue
  • HAV
32
Q

Why do we have HAV in FF cavus?

A

because the 1st ray may be hypermobile

33
Q

FF cavus variants

A
  • Plantarflexed cuboid with dorsiflexed 4th and 5th metatrsals is more common that pf cuboid w/ df 5th and 5th metatrsals
  • No pronation is required for compensation
34
Q

clinical findings fo FF cavus variants?

A
  • Plantar prominence of the styloid process of 5th metatarsal
  • increased arch/ increased calcaneal inclination angle but no adduction of the FF
  • May cause apophysitis at the 5th met base
  • Tailor’s bunion/splay foot appearance (secondary to dorsiflexed 5th ray)
35
Q

posterior cavus may happen due to

A

as a result of pseudoequinus
intrinsic muscle spasticity
maybe a congenital deformity

36
Q

Combined /global cavus

A
  • both anterior and posterior cavus are present
  • rarest type
  • often used interchangeably anterior pes cavus
37
Q

Structural deformities of Pes Cavus are

A

NOT associated with MTJ supination compensation

38
Q

Acquired and Congenital forms of Pes Cavus are

A

Associated with MTJ supination ( particularly adduction of the FF )

39
Q

What are some Infectious etiologies of Pes Cavus?

A
  • poliomyelitis (viral)

- Syphylis ( bacterial)

40
Q

What kind of gait to people with syphilis have?

A

Tebes dorsalis

41
Q

What are some neoplastic etiologies for Pes cavus?

A
  • Benign tumor pressing on the lumbar-sacral nerve roots

- malignant tumors ( rare) pressing on the lumbar-sacral nerve roots

42
Q

What are some Neurogenic etiologies ?

A

Non congenital neurological diseases

43
Q

What are some traumatic etiologies for Pes cavus ?

A
  • head injuries

- Isolated nerve injuries

44
Q

What are some biomechanical etiologies for Pes Cavus?

A
  • plantarflexed 1st ray
  • uncompensated RF varus
  • Rigid FF valgus
45
Q

What are some iatrogenic etiologies for Pes cavus ?

A

Prolonged bed rest

overcorrected flatfoot surgery

46
Q

Endocrine Etiologies

A

-diabtetes mellitus -intrinsic muscle weakness

47
Q

Pes cavus deformities are associated with

A

muscle imbalance

48
Q

spasticity

A

Tonic spasticity

clonic spasticity

49
Q

tonic spasticity-

A

Increased tone in the muscle belly

50
Q

tonic spasticit is usually associated with

A

guarding due to pain

51
Q

people who have tarsal coalition usually have

A

tonic spasticity

52
Q

tonic spasticity may exhibit

A

cogwheel release

53
Q

clonic spasticity usually associated with

A

Upper motor neuron deficit

54
Q

Posterior weakness

A
  • Tricep weakness
  • Tricep spasticity
  • Tibialis Posteiro Spasticity
55
Q

in Tricep weakness, decreased pull on the calcaneus may lead to

A

increased calcaneal inclination angle

56
Q

with Tricep weakness , deep posterior muscle groups have to work harder and that leads to

A

STJ supination and digital deformities

57
Q

Tricep spasticity may lead to

A

toe-walking

58
Q

tibialis posterior spastisity may lead to

A

constant and increased supination at the STJ

BC constant pull of arch

59
Q

Anterior weakness

A
  • Global anterior weakness

- Isolated muscle weakness

60
Q

Global anterior weakness may lead to

A
  • overpowering of the superficial and deep flexors

- equinus of both the ankle and the FF

61
Q

Isolated muscle weakness may lead to

A

the result depends on which muscles were involved

62
Q

PL and TA are

A

antagonists

63
Q

If TA is weak

A

the PL will have to work harder at pull harder at the 1st ray causing a stronger plantarflexory pull

64
Q

Lateral (PL ) spasticity may lead to

A

increase plantarflexory pull on the 1st ray

65
Q

What is the function of intrinsic muscles

A

stabilize the digits

66
Q

what happens if intrinsic muscles become weakened ?

A
  • The digits will become dorsally contracted ( diabetic pt)

- The metatarsals then become increasingly plantarflexed, contributing to a cavus deformity

67
Q

Compensation for the Pes cavus is dependent upon

A

the location of the deformity
other associated pathology
rigidity of the deformity

68
Q

In general 4 changes will occur in Pes Cavus deformity

A
  1. dosral contraction of the digits
  2. plantarflexion of the metatarsals
  3. relatibe df of the FF on the RF (with flexible deformity only)
  4. pseudoequinus
69
Q

What is the purpose of paulos-coleman block test

A

used to determine whether or not an inverted RF is as a result of a plantarflexed 1st ray

70
Q

what is one rule for paulos-coleman block test

A

the first ray should be hanging off a block

71
Q

Treatment for Pes Cavus

A
  • determine if progressive
  • Take any associated muscle imbalance into considerations
  • treatment may range from orthoses and shoe modifications to bracing to surgical procesures -fusions , osteotomies
  • muscle, tendon surgeries to transfer or realign the muscle pull
72
Q

When you do tendon transfer you have to take some things into considerations

A
  • at least 1/2 to 1 full musle grade will be lost ( you are going to lose some muscle strength)
  • the tendon may or may not be transferred in phase
73
Q

orthotic modifications with the claw toe deformity and plantarflexed metatarsals

A

FF extension to pad met head because fat pad is likely to be anteriorly displaced

74
Q

What other deformities are associated with Pes cavus

A

lateral ankle stability

75
Q

what do you do to fix lateral ankle stability

A
  • Lateral flange on an orthosis may help prevent excessive inversion
  • lateral heel and or sole flare on the shoe may prevent lateral instability at heel strike and midstance
76
Q

with pes cavus excessive weight might be on the

A

heel, 1st and 4th and /or 5th met heads

77
Q

what do you do with the weight issue?

A

orthoses may need to be made to increase weight bearing on the remainder of the foot

Biomechanics exam 3 ( Armi) (10 decks)

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