Pes Cavus                                                      

Patients with pes cavus frequently experience foot pain, which can lead to significant disability. Pes cavus has traditionally been viewed as a neuromuscular problem with a surgical solution. Burns et al. have done a series of clinical studies focusing on function and mechanical intervention for symptoms related to the cavus foot. Prior to this landmark study, there were no randomized trials examining mechanical interventions for the treatment of painful cavus feet, making this essential reading for practitioners.

Cherri Choate, DPM
Larry Huppin, DPM
Alona Kashanian, DPM
Paul R. Scherer, DPM
Effective Orthotic Therapy for the Painful Casvus Foot

Burns et al. evaluated 154 subjects with pes cavus and foot pain. Neutral suspension casts were taken for both the treatment group (custom foot orthoses) and control group (sham insoles) for treatment allocation blinding. Custom functional orthoses (polypropylene with a full length Poron cover) were made from the casts for the treatment group. The sham insoles were flat insoles made of latex foam. Foot pain, function, quality of life, and plantar pressure measurements were evaluated initially and after three months.  
The foot pain and foot function scores significantly improved and plantar pressures were significantly reduced with custom orthoses. Quality of life measures also favored the custom orthotic group.

Significance of the Article

The results of this study indicate that "custom foot orthoses are more effective than a control for reducing cavus foot pain and associated limitation in function." The custom orthoses significantly increased midfoot pressure and decreased rearfoot and forefoot pressures. The authors attribute this threefold improvement in pressure distribution with the custom foot orthoses to the shell being "molded to the exact morphological features of the participant's foot".

Significance for Orthotic Therapy

The dynamics of the pes cavus foot are complicated. This study provides evidence for the use of custom functional foot orthoses made from a neutral suspension cast to reduce foot pain, plantar pressures, and improve quality of life in patients with a painful cavus-type foot. The custom orthoses included a soft topcover; however, this study demonstrated that a soft insole alone is insufficient and does not provide the significant benefits of pain reduction and pressure redistribution achieved with the custom devices.