Management of Midfoot Cavus

Grady, John F.; Schumann, Jaclyn; Cormier, Clare; LaViolette, Kathryn; Chinn, Austin B.

doi:10.1016/j.cpm.2021.02.004

Cited by 3 publications

(3 citation statements)

References 39 publications

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“…The findings demonstrate the positive influence and potential advantages of custom foot orthotics in enhancing gait characteristics and effectively distributing plantar pressure among pes cavus patients [40]. In addition, In a study published in 2021 by Grady et al [41], it was proposed that pes cavus could reduce foot pain by using custom foot orthotics, which was also related to the redistribution of plantar pressure by custom foot orthotics, resulting in a change in load bearing on each joint.…”

Section: Discussionmentioning

confidence: 74%

Mixed Comparison of Intervention with Assistive Devices for Plantar Pressure Distribution and Anatomical Characteristics in Adults with Pes Cavus: Systemic Review with Network Meta-Analysis

Zhang,

Xu,

et al. 2023

Applied Sciences

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Background: Pes cavus is a multiplanar foot deformity with an abnormal plantar pressure distribution and an overhigh medial longitudinal arch (MLA). Its causes are complex. In the past, people have usually focused on clinical surgery for pes cavus. However, this is not necessarily the best choice for some patients with non-ongoing or mild symptoms. In the 21st century, studies have just begun to focus on assistive devices intervention for pes cavus, which has been proven to be an effective non-surgical treatment. However, the effectiveness of assistive devices for patients with arched feet of any etiology has not been evaluated and evidence-based guidelines for clinical treatment options are lacking. Methods: A systematic review and network meta-analysis were performed, employing a comprehensive search across the databases of Web of Science, PubMed, as well as Scopus. The selected studies adhered to specific eligibility criteria, which included: (1) involving patients with pes cavus; (2) interventions with assistive devices; and (3) outcome measures of plantar pressure distribution and anatomical characteristics (MLA). Meanwhile, the standard mean difference was selected as the effect size. Results: A total of three studies were selected, and the authors achieved an agreement on the risk of bias with a kappa value equal to 0.74. According to the results of network meta-analysis, customized foot orthotics compared to other devices (lace-up ankle-support brace, semirigid brace) demonstrated the highest likelihood of being the most effective in optimizing plantar-pressure distribution among pes cavus patients. On the other hand, wearing hard custom foot orthotics compared to other devices (soft custom foot orthotics, off-the-shelf orthotics) showed the greatest potential in improving the medial longitudinal arch (MLA) of pes cavus patients. Discussion: Although becoming better than wearing regular footwear, wearing lace-up ankle-support braces or semirigid braces might not be optimal choices for treatments of pes cavus with the potential mechanism that the internal force created by the fixation of the proximal joint might be much less than the ground reaction force loaded on the distal segments that touch the ground. It could be concluded that foot orthotics show great potential in treating pes cavus under non-surgical conditions. This systematic review could provide valuable evidence for future research and clinical practice. Other: The PROSPERO Registration Number is CRD42022349687.

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Section: Discussionmentioning

confidence: 74%

Mixed Comparison of Intervention with Assistive Devices for Plantar Pressure Distribution and Anatomical Characteristics in Adults with Pes Cavus: Systemic Review with Network Meta-Analysis

Zhang,

Xu,

et al. 2023

Applied Sciences

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“…However, when the apex of the cavus foot deformity is located in the midfoot, the correction in the apex of the osteotomy is unavoidable. A variety of midfoot osteotomy methods have been described in detail in the previous section, among which the Cole, Japas, and Akron have been repeatedly reported for cavus foot correction [58,59,62,63,66,68]. The Cole is by far the most widely accepted all over the world [10].…”

Section: Discussionmentioning

confidence: 99%

“…Excessive removal of metatarsals or cuneiform will result in scaphoid foot deformity. In order to achieve a total correction at the apex of the deformity, it is necessary to consider the midfoot osteotomies, such as the Cole osteotomy, the Japas osteotomy, the Akron osteotomy, or the Myerson osteotomy [27,58,59].…”

Section: Forefoot Driven Cavus Footmentioning

confidence: 99%

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

Qin

Zhang

2022

JCM

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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.

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The Gradual Correction of Rigid Pes Cavus Using Midfoot Osteotomy Combined with Ilizarov Methods

Li,

Qin,

et al. 2024

Orthopaedic Surgery

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ObjectiveMidfoot osteotomy combined with Ilizarov methods of correction is a rarely reported treatment that is particularly well‐suited for severe rigid pes cavus. The study aimed to assess the radiological and clinical results of patients who had been treated for rigid pes cavus using this method.MethodsThe study retrospectively analyzed the clinical and radiological data of 15 pes cavus in 12 patients who were corrected by midfoot osteotomy with Ilizarov external frame in our department from March 2020 to September 2022. Radiologic outcomes were measured using the Meary angle (MA), talus‐first metatarsal angle (TM1A), calcaneal varus angle (CVA) and foot length with weight‐bearing radiographs. Functional assessments were evaluated in terms of pain, function, and quality of life by using the visual analogue scale (VAS), the American Orthopedic Foot and Ankle Society hindfoot scale score (AOFAS), and 36‐item Short Form Health Survey (SF‐36). Additionally, the postoperative satisfaction of patients was investigated by a questionnaire. The clinical and radiological results were evaluated by a paired t‐test.ResultsAll patients received plantigrade feet and pain relief. The mean follow‐up was 33.1 ± 5.0 months (range from 25 to 41 months). The etiology included poliomyelitis (4), idiopathic (3), trauma (2), spina bifida (2) and tethered cord syndrome (1). The duration of gradual correction was 30.4 ± 10.6 days, and the external fixation time was 116.3 ± 33.3 days. The bony union rate was 100%. The VAS, AOFAS, and SF‐36 scores significantly improved (p < 0.05). The MA, TM1A, and CVA were close to or reached the normal range postoperative (p < 0.01). The length of each foot was well preserved, which was increased more than 0.8 cm than preoperative. No major complications were reported except two cases of mildly hindfoot varus deformity. The results of the questionnaire showed that patients' satisfaction was 92% (11/12).ConclusionMidfoot osteotomy combined with Ilizarov external frame proved to be a reasonable procedure with satisfying mid‐term results for the gradual correction of rigid pes cavus.

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Management of Midfoot Cavus

Cited by 3 publications

References 39 publications

Mixed Comparison of Intervention with Assistive Devices for Plantar Pressure Distribution and Anatomical Characteristics in Adults with Pes Cavus: Systemic Review with Network Meta-Analysis

Mixed Comparison of Intervention with Assistive Devices for Plantar Pressure Distribution and Anatomical Characteristics in Adults with Pes Cavus: Systemic Review with Network Meta-Analysis

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

The Gradual Correction of Rigid Pes Cavus Using Midfoot Osteotomy Combined with Ilizarov Methods

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