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78 Cards in this Set
- Front
- Back
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pes cavus
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ecessively high plantar longitudinal arch
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what are the etiologies for cavus foot
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idiopathic
neurologic iatrogenic |
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what are some iatrogenic causes of cavus foot
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surgery
peroneal nerve injury weak anterior muscle group overpowering posterior tibial tendon |
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there is no what with cavus foot
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demonsterable underlying pathology
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what are the diagnostic studies done with cavus foot
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CBC with diff
serum enzymes motor NCVs EMG muscle/nerve biopsy |
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what are some neurological causes of cavus feet
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HSMNs
spinocerebellar degeration cord tumor polyneuritis polio syphylis cerebelar palsy arthrogryph spastic or mono parapalegia trauma homocystinuria distal muscular dystrophy |
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what is charcot marie tooth disease
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progressive peroneal musculare atrophy
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who is more likely to get CMT
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males
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clinical signs of CMT
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stork legs
monkey fist steppage gait-drop foot decreased DTR decreased epicritic sensation decreased NCV - abnormal EMG |
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differentials for CMT
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friedreichs ataxia
rousey-levy syndrome dejerine-sotas disease poliomyelitis |
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where is the muscle weakness with CMT
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peroneus tertius
EHL, EDL, Tibialis anterior, peroneus brevis |
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what are signs of friedrichs ataxia
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onset<20
dysarthria decreased position and vibratory sensation muscle weakness areflexic nystagmus partial deafness |
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what are the three classifications of cavus foot
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anteior
posterior combined |
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anterior cavus is primarily deformed in what plane
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sagittal
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what is the deformity of anterior cavus
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excessive plantarflexion of forefoot on rearfoot
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local anterior cavus
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first ray
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global anterior cavus
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entire forefoot
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compensation deformities for cavus foot
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contracted digits
reverse buckling at MTP reverse buckling at ankle joint tarsal sagittal plane flexibility |
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posterior cavus is primarily a deformity of what
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STJ
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what angle is increased in posterior cavus
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calcaneal inclination
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where is deformity in a cavoadductus foot
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transverse plane at the midtarsal or lisfrancs joint
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posteior equinus is the lack of what
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lack of adequate dorsiflexion at the ankle joint
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signs of cavus foot
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abnormal shoe wear
digital contracture muscle weakness/atrophy |
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neurologic exam for cavus foot
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cranial nerves
vestibular auditory testing visual exam balance(rhombergs sensory examination motor examination spinal examination |
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0 muscle strength
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no muscle activity
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1 muscle strength
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muscle contracts no motion
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2 muscle strength
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motion with gravity eliminated
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4 muscle strength
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motion with mild resistance
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5 muscle strength
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motion with resistance
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where do you place muscle to test it
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in contracted position
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what does coleman block test tell us
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about relationship of varus heel and plantarflexed 1st ray
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what does gait look like with cavus feet
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wide base
short steps high steps footslap footdrop |
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what is the ankle sign of cavus foot
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lateral ankle instability
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what views do you get with cavus foot
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AP
lateral calcaneal axial AP ankle ankle charger |
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what is ankle charger view used for
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to evaluate osseous ankle block
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what do you evaluate on AP with cavus
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met adductus
forefoot adductus forefoot abductus |
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what do you evaluate on lateral radiograph in cavus foot
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calcaneal inclination angle
mearys angle hibbs angle metatarsal declination sinus tarsi |
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mearys angle
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bisection of talus with bisection of 1st met
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hibbs angle
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long axis of calcaneus
bisection of 1st met |
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what will you see on lateral radiograph with cavus
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increased CIA
Increased met declination hammertoe deformities |
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where does mearys angle intersect with anterior cavus
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lisfrancs joint
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what is measurement of mearys angle and CIA with anterior cavus
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mearys > 10 degrees
CIA < 30 degrees |
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where does mearys angle intersect with posterior cavus
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proximal to choparts joint
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what is measurement of mearys and CIA in posterior cavus
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mearys < 10
CIA > 30 |
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where does mearys angle intersect in combined cavus
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at choparts joint
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where does mearys angle intersect in combined cavus primarily anterior
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at NC joint
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what is CIA in combined cavus primarily anterior
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about 30 degrees
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what is the position of the talus in combined cavus primary posterior
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talar varus
short talar neck adducted and plantarflexed |
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what is CIA with combined cavus primary posterior
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> 30
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where does mearys angle intersect with combined cavus primary posterior
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at choparts joint
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where does mearys angle intersect with midfoot cavus
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at NC joint
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what is dynamic cause of midfoot cavus
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extensor substitution
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what are goals of treatment with cavus foot
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decrease deformity
prevent progression restore muscle balance enhance function decrease disability decrease symptoms |
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what are the non-surgical treatments for cavus foot
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stretching
debridement orthoses patient education |
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soft tissue procedures for cavus foot
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steindler stripping
plantar fasciotomy garceau and brahms hibbs jones heyman peroneal stop PL transfer/lngth/resc TP transfer/rls STATT TAL/gastroc recession |
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what is rlsd in steindler stripping
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abductor digiti quinti
abductor hallucis FDB plantar fascia quadratus plantae |
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what are functional reasons for steindler stripping
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allows FF to PF on RF
rls the windlass mechanism decreases calcaneal incl angle |
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steindler stripping is not a what
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primary procedure
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what types of cavus in steindler stripping used for
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anterior
posterior combined |
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jones suspension
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EHL to 1st met
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reasons for jones suspension in cavus
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remove retrograde forces
reduces hallus malleus decreases met declination angle |
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indications for jones
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flexible pf 1st met
weak tibialis anterior improves EHL as dorsi of ankle |
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hibbs
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EDL to midfoot
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reasons for hibbs in cavus
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removes retrograde forces
reduces claw toes decreases met declination angle |
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indications for hibbs
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flexible anterior cavus
flexible clawtoes extensor substitution weak tib ant/EDL/EHL |
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heyman
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EDL to met necks
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peroneal stop
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tenodesis of PL and PB
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functional reasons for peroneal stop
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increases power of PB and decreases PF of 1st ray by PL
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indication for peroneal stop
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flexible/semiflexible PF 1st ray
flexible heel varus |
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peroneal stop is rarely used when
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alone
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rationale for peroneal longus lengthening
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decrease PF of 1st ray
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indications for peroneal longus lengthening
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flexible/semiflexible 1st ray
weak tibialis anterior |
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peroneal longus tendon transfer in cavus
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PL to dorsal lesser tarsus in EDL tendon sheath or split tib anterior and peroneus tertius sheaths
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functional outcomes of peroneus longus tendong transfer
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aids in dorsiflexion of ankle
decreases PF on 1st ray |
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indications for peroneus longus tendon transfer
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weak tibialis anterior
drop foot deformity |
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tibialis posterior tendon transfer
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TP tendon transferred to dorsum of lesser tarsus in EDL sheath or split tib ant and peroneus tert
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fucntion of TP transfer
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aids in DF of ankle
decreases supination |
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indications for TP tendon transfer
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weak anterior muscle group
drop foot |
