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The etiology of any cavus foot varies with the disease process, but all forms result from what?

muscle imbalance


What disease should you always suspect in every patient who presents with pes cavus?

Charcot-Marie-tooth disease


Which muscle groups are most often affected in CMT?

anterior and lateral compartment musculature


the foot deformities in CMT do not result from absolute weakness in teh motor units, but rather what?

relative imbalance of the failing foot intrinsics and preserved extrinsics


Which muscle in the lateral compartment is affected by CMT yet spared what other muscle?

PB is almost always affected but spares the PL


which muscle in the anterior compartment is affected by CMT yet spares a different anterior muscle?

EHL can be spared while the anterior tibialis is affected


explain the muscle imbalance behind equinus in CMT.

weak agonist: tibialis anterior
intact antagonist: triceps-surae


explain the muscle imbalance behind adduction and hindfood varus in CMT.

weak agonist: peroneus brevis
intact antagonist: tibialis posterior


explain the muscle imbalance behind plantarflexion of the first ray in CMT.

weak agonist: tibialis anterior
intact antagonist: peroneus longus


explain the muscle imbalance behind hallux claw toe in CMT.

weak agonist: foot intrinsics
intact antagonist: EHL and FHL


Which physical exam testing is used to see if a flatfoot is flexible or not?

Hubscher maneuver (toe test of jack)
if flexible- medial arch should reform when hallux is dorsiflexed
*can also have person stand on tiptoes to see if heel will go into varus


What is the Kidner procedure?

(for flatfoot tx- medial column procedure)
excise os tibiale externum and transpose TP to plantar aspect of navicular


Describe the Young procedure.

(for flatfoot tx- medial column procedure)
used to correct TN and/or NC fault in a flexible flatfoot with FF supinatus, wherein the TA is rerouted thru a keyhole slot in the navicular.


Describe the Lowman procedure.

TN arthrodesis combined with rerouting TA under the navicular and suturing it to teh spring ligament


Describe the Miller procedure.

navicular-medial cuneiform-1st met arthrodesis


Describe the hOke procedure.

navicular to 1st and 2nd cuneiform arthrodesis


Describe teh Cotton procedure.

dorsally-based opening wedge osteotomy of medial cuneiform, used to plantarflex the medial column


Describe the Evans procedure.

((for flatfoot tx- lateral column procedure)
opening osteotomy and insertion of bone graft about 1.5 cm proximal to CC joint


What physical exam testing can you use to test the flexibility of a cavus foot?

coleman block test


What soft tissue procedures can be useful for correction of a flexible pes cavus foot?

Steindler stripping
Hibbs suspension


What is the Hibbs suspension procedure?

the EDL tendon slips are detached from their insertion, combined, and reattached into into lateral cuneiform


What is the indication for HIbbs suspension procedure?

flexible cavus with claw toes secondary to extensor substitution phenomenon


what is the jones tenosuspension?

transfer of EHL to the 1st met head to treat a flexible plantarflexed 1st ray; must do a hallux IPJ joint fusion to prevent hallux cock up deformity


what is the STATT procedure?

(split Tibialis anterior tendon transfer)
TA is cut at its insertion proximally; then the lateral portion fo the TA is sutured to peroneus tertius


What is the Heyman procedure?

resecting the EDL from its distal insertion and reattaching the tendon to its respective met head
*digital fusion is required (similar to Jones tenosuspension)


what kind of symptoms may arise in the cavus foot due to poor shock absorption?

arch pain
intrinsic muscle fatigue
plantar fasciitis


what type of symptoms may arise in the cavus foot due to compensation for teh deformity by use of adjacent joint's ROM?

extensor substitution hammertoes
ankle joint instability/arthritis


what type of symptoms may arise in the cavus foot due to overuse syndromes?

Achilles tendonitis/enthesopathy
plantar fasciitis
tarsal tunnel syndrome


What is the normal calcaneal inclination angle?

18-21 deg


What is the Cole procedure ?

(cavus correction- apex of deformity at midfoot )
dorsiflexory closing wedge osteotomy thru the entire midfoot