Pes Planus and Pes Cavus

ALOYSIUS RODRIGUES
BPT YEAR III

ROLL NO: 06
PES PLANUS AND PES CAVUS
 CONTENTS:
 DEFINITION
 ETIOLOGY
 CLINICAL FEATURES
 SYMPTOMS AND SIGNS
 RADIOLOGICAL FEATURES
A) PES PLANUS:
a) DEFINITION: A POSTURAL DEFORMITY OF THE FOOT WHERE THE MEDIAL
LONGITUDINAL ARCH OF THE FOOT IS REDUCED, CAUSING THE MEDIAL BORDER OF THE
FOOT TO CONTACT THE GROUND WHEN A PERSON IS STANDING.
IT HAS TWO TYPES: CONGENITAL AND ACQUIRED.
b) ETIOLOGY:
i. HEREDITARY
ii. WEAK ARCHES OF THE FOOT
iii. PREVIOUS FOOT/ ANKLE INJURY
iv. EXCESSIVE FOOT STRESS
v. GENERAL MUSCLE HYPOTONIA
vi. UNSUITABLE FOOTWEAR
vii. HYPER-LAXITY SYNDROME (MARFAN'S SYNDROME)
viii. TARSAL COALITION (RIGID AND PAINFUL FLAT FOOT)
ix. TIBIAL POSTERIOR DYSFUNCTION
c) CLINICAL FEATURES:
MEDIAL ARCH IS OBLITERATED, NAVICULAR BONE IS PROMINENT AND FINGERS
CANNOT BE INSERTED UNDER THE ARCH AND SOLE OF FOOT. THE AREA OF WEIGHT
BEARING INCREASES AND MAY SHOW INCREASED CALLOSITY.
IT HAS THREE TYPES:
 FLEXIBLE: ON WEIGHT BEARING, NORMAL ARCH APPEARS.
 RIGID: COULD BE SEMI-RIGID OR FIXED. DURING NORMAL WEIGHT BEARING,
NORMAL ARCH DOESN’T APPEAR.
 STATIC: MOST COMMON ONE; DUE TO FAULTY POSTURE, EQUINUS DEFORMITY
OR VARUS DEFORMITY.
ALOYSIUS RODRIGUES
BPT YEAR III
ROLL NO: 06
d) SYMPTOMS AND SIGNS:
A) CHILDREN: GENETIC MUSCULOSKELETAL CONDITIONS LIKE DYSPREXIA,
LIGAMAENTOUS LAXITY OR HYPERMOBILITY, FOOT PAIN IN HEEL OR ARCH OF FOOT.
B) ADULT: DEVELOPS AS AN ACQUIRED FLATFOOT DUE TO INJURY, ILLNESS, UNUSUAL

OR PROLONGED STRESS TO FOOT, FOOT PAIN IN HEEL OR ARCH OF FOOT.
e) RADIOLOGICAL FEATURES:
A) CHILDREN: LATERAL X-RAY WITH C-SIGN WHICH IS A BONY BRIDGE BETWEEN TALAR
DOME AND SUSTENTACULUM TALI IN COMBINATION WITH A PROMINENT INFERIOR
BORDER OF THE SUSTENETACULUM TALI.
B) ADULTS: TALONAVICULAR COVERAGE ANGLE. CALCANEAL PITCH AND MEARY’S

ANGLE (TALAR-FIRST METATARSAL ANGLE).
B) PES CAVUS:
a) DEFINITION: A POSTURAL DEFORMITY CHARACTERIZED BY AN EXCESSIVELY HIGH

LONGITUDINAL ARCH THAT RESULTS FROM AN EQUINUS POSITION OF THE FOREFOOT
IN RELATION TO THE HINDFOOT.
IT HAS THREE TYPES:
 PES CAVOVARUS: IT PRESENTS WITH THE CALCANEUS IN VARUS, THE FIRST
METATARSAL PLANTAR FLEXED AND A CLAW TOE DEFORMITY. IT IS SEEN
PRIMARILY IN CHARCOT-MARIE-TOOTH DISEASE.
 PES CALCANEOVARUS: IT IS SEEN PRIMARILY FOLLOWING PARALYSIS OF THE
TRICEPS SURAE MUSCLE DUE TO POLIOMYELITIS AND PRESENTS WITH THE
CALCANEUS DORSI FLEXED AND FOREFOOT PLANTAR FLEXED.
 “PURE” PES CAVUS: IT PRESENTS AS THE CALCANEUS THAT IS NEITHER DORSI
FLEXED NOR IN VARUS AND IS HIGHLY ARCHED DUE TO A PLANTAR FLEXED
POSITION OF THE FOREFOOT ON THE REARFOOT
b) ETIOLOGY:
i. MUSCULAR DYSTROPHIES (DUCHENNE, BECKER)
ii. CORD LESIONS (POLIOMYELITIS, TETHERED CORD, SYRINGOMYELIA,
DIASTOMATOMYELIA)
iii. NEUROPATHIES (HMSN I, HMSN II)
iv. CEREBRAL DISORDERS (CEREBRAL PALSY, FRIEDREICH'S ATAXIA)
ALOYSIUS RODRIGUES
BPT YEAR III
ROLL NO: 06
v. VOLKMANN'S ISCHEMIC CONTRACTURE.
 CLASSIFICATION OF PES CAVUS:
 IDIOPATHIC
 SECONDARY
 TRAUMA
 OTHERS
c) CLINICAL FEATURES: THIS CONSISTS OF A HIGH MEDIAL LONGUITUDINAL ARCH, FIRST

METATARSAL DROP AND PRONATION, TIGHT PLANTAR FASCIA, COCK-UP DEFORMITIES
OF ALL TOES AT MTP JOINTS, VARUS HEEL AND CLAWING OF TOES.
d) SYMPTOMS AND SIGNS: PAIN FELT AT METATARSAL HEAD OR OVER TOES WHERE
SHOE PRESSURE IS MOST MARKED, CALLOSITIES APPEAR AT SAME SIGHT AND WALKING
TOLERANCE IS REDUCED, MUSCLE WEAKNESS AND JOINT INSTABILITY.
e) RADIOLOGICAL FEATURES: MEDIAL PERITALAR SUBLUXATION (MEDIALLY ROTATED BY

TALONAVICULAR COVERAGE ANGLE), CALCANEAL PITCH AND MEARY’S ANGLE.
 REFERENCES:
 TEXTBOOK OF ORTHOPEDICS BY JOHN EBNEZAR – 4 TH EDITION
 CAMPBELL’S OPERATIVE ORTHOPEDICS – 11TH EDITION
 BAILEY & LOVE’S SHORT PRACTICE OF SURGERY – 27 TH EDITION
 CLINICAL ORTHOPEDIC REHABILITATION – 4TH EDITION
 REVIEW OF ORTHOPEDICS BY MARK MILLER – 6 TH EDITION
 APLEY & SOLOMON’S SYSTEM OF ORTHOPAEDICS AND TRAUMA – 10 TH EDITION
_____________________________________________________________________________________

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ALOYSIUS RODRIGUES

BPT YEAR III

B) ADULT: DEVELOPS AS AN ACQUIRED FLATFOOT DUE TO INJURY, ILLNESS, UNUSUAL

B) ADULTS: TALONAVICULAR COVERAGE ANGLE. CALCANEAL PITCH AND MEARY’S

a) DEFINITION: A POSTURAL DEFORMITY CHARACTERIZED BY AN EXCESSIVELY HIGH

c) CLINICAL FEATURES: THIS CONSISTS OF A HIGH MEDIAL LONGUITUDINAL ARCH, FIRST

e) RADIOLOGICAL FEATURES: MEDIAL PERITALAR SUBLUXATION (MEDIALLY ROTATED BY

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