Pes Cavus

Goal Of Examination


1.  Identify possible aetiology

- NM axis

- RA

- trauma

- clubfoot / arthrogryposis


2.  Define the deformity & its flexibility

- fixed / flexible forefoot

- fixed / flexible hind foot

- fixed / flexible lesser toes




Aids / shoes




Stork Legs

Lesser toes clawing


Hands (dorsal wasting intrinsics (CMT 1), rheumatoid hands)


Medial Side


High Medial arch

Plantar flexed first ray

Claw first toe




Hindfoot varus

Calf muscle bulk



- scoliosis

- cutaneous manifestations spinal dysraphism


Double heel raise 

- Heel swings into varus or remains in valgus

- does the medial arch restore

- bilateral suggests neurological


Single heel raise

- Must put patient close to wall

- otherwise will cheat by pushing up or leaning forward against wall 


Coleman Block Test

- block under lateral foot

- allow first ray to touch ground

- Assess hindfoot

- If hindfoot varus flexible, heel corrects

- Elimination of forefoot deformity will correct hindfoot deformity if hindfoot flexible


Lateral side


Exclude calcaneo-cavus




Stiff ankle 


Marionette Gait / High stepping

- Fixed equinus (weak Tib ant)(back knee gait)


Tip toe & heel walk




Examine Sole

- callosities over metatarsal head



- tenderness

- thickening CPN



- range AKJ

- range STJ

- Silverskiold

- active v passive


Motor examination

- T. Ach strong / plantarflexion

- T. Ant weak / dorsiflexion and inversion

- T. Post strong / plantarflexion and inversion

- PB weak / eversion


First MT

- is plantar flexion correctable


Claw toes 

- correctible


Neurological Exam


Abdominal Reflexes


Decreased or absent DTR

- CMT 1


Sensory decrease in 25%