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

 

Look

 

Aids / shoes

 

Front

 

Stork Legs

Lesser toes clawing

Scars

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

 

Medial Side

 

High Medial arch

Plantar flexed first ray

Claw first toe

 

Behind

 

Hindfoot varus

Calf muscle bulk

 

Back 

- 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

 

Gait

 

Stiff ankle 

 

Marionette Gait / High stepping

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

 

Tip toe & heel walk

 

Sit

 

Examine Sole

- callosities over metatarsal head

 

Feel

- tenderness

- thickening CPN

 

Move

- 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%