Subtle cavus foot

Abstract

Objective: To identify the prevalence of ankle and foot disorders in patients with subtle cavus foot (SCF). Methods: This was a retrospective case series. Patients with lower limb disorders who upon clinical examination were also diagnosed with SCF were evaluated. Patients diagnosed with disorders that could lead to this deformity, such as trauma sequelae and neurological disorders, and those with the presence of cavovarus foot with severe deformity were excluded. Correlations between ankle and foot disorders and the presence of SCF were evaluated. Results: A total of 119 patients (67 males/52 females) were evaluated, totalling 238 feet. One hundred forty-one feet had subtle cavus, and 97 feet had physiological alignment. Of the 141 SCF, 76 feet were right feet, and 65 were left feet. Twenty-two patients had bilateral SCF. One undred forty complaints were identified, which led to 18 diagnoses: ankle instability (37 cases/26.2%), peroneal tendon tendinopathy (31 cases/22.0%), plantar fasciitis (18 cases/12.8%), Achilles tendon tendinopathy (10 cases/7.1%), osteochondral talar lesion (7 cases/5.0%), mechanical metatarsalgia (6 cases/4.3%), hallux sesamoid disorders (5 cases/3.5%), Morton’s neuroma (5 cases/3.5%), hallux valgus (5 cases/3.5%), pain in the lateral side of the foot (4 cases/2.8%), anterior impact (3 cases/2.1%), pain in the medial side of the tibia (2 cases/1.4%), plantar plate injury (2 cases/1.4%) and other disorders with a prevalence <1%. Conclusion: We found a clear correlation between SCF and acute and chronic ankle instability, peroneal and Achilles tendon tendinopathy and plantar fasciitis. 
 Level of Evidence IV; Therapeutic Studies; Case Series.

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“…Lateral soft-tissue structures of the ankle are stretched out, [4] putting the subject at risk for lateral ankle sprains caused by excessive plantarflexion, inversion, and internal rotation of the ankle [6]. As a result, there is an increased risk of developing chronic ankle instability, and patients will tend to report feeling their ankle "giving way" [2,7,8]. The aim of this report is to review the subtle cavovarus foot, including its clinical evaluation, radiological findings and plantar pressure measurements.…”

“…A normal, neutral arch has the least possibility of injury because of its even plantar pressure distribution. Any deviation from normal increases overall plantar [8,14], hallux valgus [8], and pain on the lateral aspect of the foot [6,10,11,13]. The Achilles tendon, which becomes a secondary inverter, is commonly pathologic as well [8,13,14].…”

“…The pathologies associated with subtle cavovarus foot ( Figure 7) include ankle instability [3,4,6,8,13,21,30], peroneal tendon pathologies [2,3,8,13,14], stress fractures [6,13] especially at the 5 th metatarsal head [3,4], plantar fasciitis [3,8,10], ankle arthritis [11], forefoot equines [3,6], osteochondral talar lesion [8], mechanical metatarsalgia [8,10,11], hallux sesamoid disorders of their center of pressure and a more lateral gait. As a result, they hesitate when loading their forefoot and toes at the end of the stance phase, as they are unstable in plantarflexion [7,32].…”

“…The subtle cavovarus foot condition causes lateral soft-tissue structures, such as the anterior talo-fibular ligament and the peroneal tendons, to be stretched during gait. This results in peroneal tendon hyperactivity and is associated with peroneal tendinopathy and tear [2,3,8,14].…”

“…With normal foot alignment, the heel pad cannot be viewed. This should be followed by a posterior view of the hindfoot for confirmation, although it will only be positive in more severe cavovarus deformities [3,8]. [2,4,6,9] detects if the hindfoot varus is of primary origin or is secondarily caused by the plantarflexion of the first metatarsal [11,13].…”