Subtle Cavovarus Foot: A Missed Risk Factor for Chronic Foot and Ankle Pathologies

Abstract

This literature review investigated the subtle cavovarus foot with a search in Pubmed and Google Scholar using the following keywords: Subtle cavovarus foot, cavovarus foot or cavus foot and one or more of the following: Associations, injuries, ankle sprains, ankle instability, sports, plantar pressure, dynamic pedobarography, Tekscan and footprint, from January 1980 to February 2019. Subtle cavovarus foot can alter foot and ankle biomechanics but reference values are lacking for dynamic pedobarography assessment. Subtle cavovarus foot is associated with peroneal tendinopathy, metatarsal stress fractures, and recurrent lateral ankle sprains, potentially leading to chronic ankle instability due to altered walking central control patterns. Treatment includes flexible/semi-rigid orthotics to laterally offload the foot, or surgery in rigid cases. Subtle cavovarus foot is associated with chronic foot and ankle pathologies. Unfortunately, diagnosis is often difficult or delayed. Early conservative management, with appropriate foot orthotics, favors a safer return to sports.

The effect of personalized orthopedic insoles on plantar pressure during running in subtle cavus foot

“…The calcaneal pitch angle is the angle between the line connecting the lowest two points on the lower surface of the heel bone and the horizontal plane. The sagittal plane angle of inclination of the heel bone is 10°–25° in people with normal arches and greater than 30° in people with cavus feet ( Benjamin et al, 2020 ). It has been shown that calcaneal pitch is positively correlated with peak heel pressure and negatively correlated with arch pressure.…”

“…Although the cavus foot is commonly caused by neurological disorders, SCF is considered to be a variant of normal as common as flatfoot deformities ( Monoli and Graham, 2005 ). The Coleman block test detects if the heel varus for SCF is of primary origin or is secondarily caused by the plantarflexion of the first metatarsal ( Deben and Pomeroy, 2014 ; Benjamin et al, 2020 ). A one-inch block is placed under the heel and lateral border of the foot.…”

“…Adjusting the foot to a neutral position can improve the biomechanical function of the foot, providing support and stability, and reducing discomfort or pain ( Pascual et al, 2009 ). As a result, podiatrists recommend the use of a forefoot wedge pad and lowering the support under the arch to help correct SCF ( Manoli and Graham, 2018 ; Benjamin et al, 2020 ). A study personalized full-length orthoses for SCF with ankle instability and pain.…”

Jones type fifth metatarsal fracture fixation in athletes: A review and current concept

“…In the case of athletes, it could be due to continuous pressure when a player jumps, runs, or tackles an opponent. Notably, according to a recent study by Benjamin et al [ 13 ], athletes with cavovarus feet are prone to repetitive trauma, which results in Zone 3 injuries. This study proposes the theory that the physical structure of an athlete’s foot could be one of the significant determinants of Jones-type fracture prevalence.…”

Reliability and correlation of weight-bearing cone beam CT and Foot Posture Index (FPI) for measurements of foot posture: a test-retest study

“…The medial longitudinal foot arch is flexible and flattens during impact acting as an important shock absorber [ 1 ]. This ability is limited by a flat foot arch (pes planovalgus) or high foot arch (pes cavovarus) increasing the risk of injuries [ 2 – 5 ]. Several clinical measurements are described for assessing foot posture [ 6 , 7 ], but Foot Posture Index (FPI) is the recommended assessment tool as it evaluates the posture of the whole foot [ 8 ].…”