Cavus foot in CMT Children - New Research

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From the Journal of American Academic Orthopedic Surgery. 2003

May-Jun;11(3):201-11.

Cavus foot deformity in children.

Schwend RM, Drennan JC.

Associate Professor, Department of Orthopaedic Surgery, University of

New Mexico, Albuquerque, NM.

A cavus deformity of the foot is easily recognizable, but appropriate

neurologic assessment can help to determine the etiology. Cavovarus, the

most frequent type of cavus foot, presents with an elevated medial

longitudinal arch, first ray plantarflexion, and, if rigid, a fixed heel

varus. Common causes include progressive motor sensory conditions,

typically Charcot-Marie-Tooth disease, and nonprogressive conditions

such as cerebral palsy and poliomyelitis. A calcaneocavus foot may be

seen in poliomyelitis, spinal dysraphism, and peripheral neuropathy.

Initially, the cavus deformity is flexible, but if left untreated, it

becomes a fixed bony deformity. Physical examination should include the

cavovarus block test, which assesses flexibility of the hindfoot

deformity and can direct surgical treatment. Standing

radiographs of the feet and spine, magnetic resonance imaging, and

electrodiagnostic studies may be useful. Management goals are to obtain

a plantigrade, mobile, pain-free, stable, motor-balanced foot. Surgical

options include soft-tissue and plantar fascia releases for a flexible

deformity, osteotomy for a fixed deformity, and tendon transfers to

restore muscle balance. Triple arthrodesis has poor long-term results in

patients with progressive deformity and sensory impairment.