The Anatomy of Cavus Foot Deformity - NUCRE

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194 AMINIAN & SANGEORZAN Fig. 4. Forefoot-driven hindfoot varus mechanics. (A) Plantarflexed first ray leading to an inversion thrust of the hindfoot. (B) Normal forefoot with hindfoot in neutral position. a neutral or flat foot, the foot rotates around the talus. The cuboid follows the calcaneus. In a neuromuscular cavus foot, the calcaneus is rotated internally beneath the talus resulting in a narrow anterior-posterior talocalcaneal angle. Since the cuboid follows the calcaneus, the cuboid is plantar Fig. 5. Pressure data from the right foot of three individuals with different types of cavus foot. Light blue areas are low pressure; red areas are the highest pressure. The foot on the far left is a subtle cavus foot with forefoot-driven cavus. The first ray is hyper-plantarflexed resulting in high pressure under the first metatarsal head with little under the fourth and fifth. The middle foot shows a foot with a lot of hindfoot rotation and pitch and midfoot rotation resulting in increased pressure under the heel and the lateral border of the foot. The foot on the right is so severe that only the lateral border bears significant weight.
to the navicular, not beside it. This locks the midfoot and overloads the lateral side of the foot (Fig. 2). Another way to look at Chopart function is to view the foot from the front with the forefoot removed (Fig. 3). If an axis drawn through the two joints is parallel to the ground, there will be relatively free flexion. The more the axis approaches a vertical orientation, the less flexion will be possible (see Fig. 3). Pathologic mechanics THE ANATOMY OF CAVUS FOOT DEFORMITY Cavus foot deformity rarely presents in the young child (younger than 3 years) but may develop as the child grows. The etiology can be attributed to the brain, spinal cord, peripheral nerves, or to structural problems of the foot. When motor imbalance begins before maturation of the skeleton, there can be substantial change in healthy bone morphology. When cavus is acquired after skeletal maturity, there may be little or no change in the morphology. Two thirds of adults with symptomatic cavus foot have an underlying neurologic condition, most commonly Charcot-Marie-Tooth (CMT) disease [3,4]. Mechanically, cavus deformity can be a result of a plantarflexed first ray. Studies suggest that patients with CMT have early degeneration of the Fig. 6. Plantar footprint of a cavus midfoot. This is a black-and-white image of a cavus foot viewed from below through plexiglass. The part of the foot in contact with the glass is represented by red. The midfoot is rotated into varus so that the first and second metatarsals are not in contact with the ground during standing. 195
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The Anatomy of Cavus Foot Deformity - NUCRE

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