Evaluation and Management of Cavus Foot in Adults: A Narrative Review

Abstract

Objective: Cavus foot is a deformity defined by the abnormal elevation of the medial arch of the foot and is a common but challenging occurrence for foot and ankle surgeons. In this review, we mainly aim to provide a comprehensive evaluation of the treatment options available for cavus foot correction based on the current research and our experience and to highlight new technologies and future research directions. Methods: Searches on the PubMed and Scopus databases were conducted using the search terms cavus foot, CMT (Charcot–Marie–Tooth), tendon-transfer, osteotomy, and adult. The studies were screened according to the inclusion and exclusion criteria, and the correction of cavus foot was analyzed based on the current research and our own experience. At the same time, 3D models were used to simulate different surgical methods for cavus foot correction. Results: A total of 575 papers were identified and subsequently evaluated based on the title, abstract, and full text. A total of 84 articles were finally included in the review. The deformities involved in cavus foot are complex. Neuromuscular disorders are the main etiologies of cavus foot. Clinical evaluations including biomechanics, etiology, classification, pathophysiology and physical and radiological examinations should be conducted carefully in order to acquire a full understanding of cavus deformities. Soft-tissue release, tendon-transfer, and bony reconstruction are commonly used to correct cavus foot. Surgical plans need to be customized for different patients and usually involve a combination of multiple surgical procedures. A 3D simulation is helpful in that it allows us to gain a more intuitive understanding of various osteotomy methods. Conclusion: The treatment of cavus foot requires us to make personalized operation plans according to different patients based on the comprehensive evaluation of their deformities. A combination of soft-tissue and bony procedures is required. Bony procedures are indispensable for cavus correction. With the promotion of digital orthopedics around the world, we can use computer technology to design and implement cavus foot operations in the future.

Does the Sagittal Radiographic Morphology of Subtalar Joint Affect the Alignment of Foot?

“… 3 , 4 , 5 , 6 , 7 The cavus foot was considered a manifestation of a neuromuscular process. 8 , 9 , 10 , 11 Are there any common characteristics regarding flatfoot and cavus foot?…”

“…The causes of adult acquired flatfoot include dysfunction of the tibialis posterior tendon and ligament deficiency 3–7 . The cavus foot was considered a manifestation of a neuromuscular process 8–11 . Are there any common characteristics regarding flatfoot and cavus foot?…”

Análise do alinhamento clínico e ósseo do retropé de pacientes com pés cavovaros flexíveis em posição ortostática e ao teste do bloco de Coleman através da tomografia computadorizada com carga (WBCT)

“…Analisar a confiabilidade intra e interobservador dentro as mensurações realizadas. Qin et al 16 , em 2022, definem o pé cavo como uma deformidade complexa composta pela elevação anormal do arco plantar, retropé varo, aumento do pitch do calcâneo, médio pé elevado, antepé aduto, dedos em garra e equino.…”

“…Os autores descrevem esse sinal para auxiliar na avaliação clínica do retropé varo, podendo ser utilizado quando há dúvida no diagnóstico de retropé varo. Qin et al 16 , em 2022, descrevem aspectos a serem avaliados em pacientes com pé cavovaro. Para os autores, o exame físico do pé cavovaro deve incluir: avaliação da marcha, aparência e mobilidade articular, avaliação de desequilíbrios musculares, identificação da origem da deformidade na qual o teste do bloco de Coleman é o método mais popular, avaliação da deformidade do antepé, a mobilidade do primeiro raio e a presença de encurtamento da cadeia posterior.…”

“…Qin et al 16 , em 2022, publicam artigo de revisão sobre a avaliação e tratamento do pé cavovaro. Para os autores, o teste do bloco de Coleman é a maneira mais popular de se avaliar a flexibilidade do retropé dos pés cavovaros e determinar a origem da deformidade.…”