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INDEX
OBJECTIVE ........................................................................ 3
PES CAVUS ....................................................................... 4
BIBLIOGRAPHY ................................................................. 22
OBJECTIVE
The main goals to be attained by the student during this work session are summarized
in the following points:
Know the most relevant quantitative methods for the assessment of Pes Cavus.
Biomechanical assessment of foot pathologies, and design and manufacture of orthotic solutions
PES CAVUS
Pes cavus is the general term used to describe a high-arched foot. The deformity
consists of several different components, including varying degrees of rearfoot varus,
forefoot equinus, metatarsus adductus and digital deformities.
Pes Cavus is often caused by a neurologic disorder or other medical condition like
cerebral palsy, Charcot Marie Tooth disease, spinal bifida, polio, muscular dystrophy or
stroke. In other cases of Pes Cavus, the high arch may represent an inherited
structural abnormality. (Figure 1)
In one third of cases Pes Cavus is congenital. Acquired Pes Cavus often occurs due to
neurological abnormalities (Figure 2. Pes Cavus ).
In less serious forms of Pes Cavus there are usually no symptoms and treatment is
put on hold.
In growing children (in the case of rectifiable Pes Cavus) a foot bed is sometimes
prescribed, which should cause the longitudinal arches to collapse, by means of
pressure on the underside of the heel bone and behind (proximal) the heads of the
metatarsals, in combination with pressure on the instep by the shoe (a three-point
pressure).
If a varus tilt of the heel bone occurs in the Pes Cavus, this should be corrected where
possible (Figure 2).
In extreme cases the Pes Cavus is operated on.
ONLINE TRAINING
BIOMECHANICAL ASSESSMENT
CLINICAL EXPLORATION
Subtalar joint formed in such a way that the calcaneus is excessively inverted
when the foot is maintained at its neutral position.
The rearfoot varus deformity represents the combined degrees of the tibiofibular
varus and the subtalar varus. A deformity greater than the ideal value of 4 (2 of
the subtalar varum and 2 of the tibiofibular varum) is extremely common on
cavus feet.
Pes Cavus is also represented by a valgus deformity on the forefoot. This deformity
is caused by an osseous abnormality in the talonavicular and calcaneocuboid
joints.
Seriousness of pathology can be decreased when it is a flexible foot (if the intern
longitudinal arch deforms by pushing the 1st metatarsal head upwards,
maintaining the ankle in right angle and the knee in flexion).
Biomechanical assessment of foot pathologies, and design and manufacture of orthotic solutions
Varus position of the heel on loaded foot without neutralized subtalar joint:
Bisector of calcaneus
Obtained from:
Tools:
Definition:
Bisector of calcaneus.
Methodology:
Proximal point.
Distal point.
Image:
ONLINE TRAINING
Bisector of calcaneus
Calcaneus varus
>
of
varus:
Gait analysis
Initial contact produced on the metatarsal zone instead of on the heel zone.
1st phase
During the second and third gait phases, support is produced on the metatarsal
heads and heel zones.
If the cavus foot is associated to a claw toes (neurologic cavus foot) the take
off is done without the help of toes because they are dorsally subluxated, and
thus metatarsal heads are overloaded. During the take off there is a strong
contraction of the extensor muscles (not counteracted by the action of the
interbone muscles, as it occurs on a normal foot). Toes lift like claw toes
rubbing the upper part of the toes with the shoe. This causes helomas and
hyperqueratosis that can be very painful.
Biomechanical assessment of foot pathologies, and design and manufacture of orthotic solutions
o
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ONLINE TRAINING
QUANTITATIVE EVALUATION:
Chippaux Index
Obtained from:
Footprint.
Tools:
Definition:
Methodology:
Criteria:
Chippaux criteria:
o
Image:
Biomechanical assessment of foot pathologies, and design and manufacture of orthotic solutions
Staheli Index
Obtained from:
Footprint.
Tools:
Definition:
Methodology:
Criteria:
Image:
ONLINE TRAINING
Clarke Index
Obtained from:
Footprint.
Tools:
Definition:
Methodology:
Criteria:
Image:
Biomechanical assessment of foot pathologies, and design and manufacture of orthotic solutions
Footprint.
Tools:
Definition:
Methodology:
ONLINE TRAINING
Image:
Biomechanical assessment of foot pathologies, and design and manufacture of orthotic solutions
X-RAY
LATERAL VIEW ON LOADED FOOT:
Tools:
X-ray.
Definition:
Criteria:
Image:
ONLINE TRAINING
Calcaneal axis.
Tools:
X-ray.
Definition:
Criteria:
ormal foot: when the projection of the MearyTomeno line or Shade line passes through the axis
of the Navicular, 1st Cuneiform and 1st Metatarsal.
Image:
Biomechanical assessment of foot pathologies, and design and manufacture of orthotic solutions
Tools:
X-ray.
Definition:
Criteria:
Image:
ONLINE TRAINING
Tools:
X-ray.
Definition:
Angle formed by the Talus axis and the axis of the 1st
Metatarsal.
Criteria:
Image:
Biomechanical assessment of foot pathologies, and design and manufacture of orthotic solutions
Hibbs angle
Obtained from:
Tools:
X-ray.
Definition:
Criteria:
Image:
ONLINE TRAINING
Calcaneal axis.
Tools:
X-ray.
Definition:
Criteria:
Image:
Biomechanical assessment of foot pathologies, and design and manufacture of orthotic solutions
Kite Angle
Obtained from:
Tools:
X-ray.
Definition:
Criteria:
Image:
ONLINE TRAINING
VALIDATION
The use of the proper orthotic solution should relax structures (like plantar fascia and
muscles), reduce overpressures in metatarsal heads and heel area, provide comfort,
and in consequence, reduce foot pain and normalize gait.
Biomechanical assessment of foot pathologies, and design and manufacture of orthotic solutions
BIBLIOGRAPHY
1. J.L. Moreno de la Fuente; Podologa general y biomecnica, Masson (2003)
Barcelona, Spain.
2. Thomas C. Michaud D.C. Newton, Massachusetts. Foot Orthoses, and other
formas of conservative foot care. Williams & Wilkins (1993). Baltimore, USA.
3. A.Chevrot; Diagnstico por imagen de las afecciones del pie, Masson, 2000
Barcelona, Spain.
4. M. Nez-Samper, L.F. Llanos; Biomecnica, medicina y ciruga del pie. Masson
(2007), 2ed Barcelona, Spain
5. R. Viladot, O.Cohi, S. Clavell; Ortesis y prtesis del aparato locomotor. 2.1.
Extremidad inferior; Masson (1987) Barcelona, Spain.
6. American Academy of Orthopaedic Surgeons. Atlas of orthotics. Biomechanical
principles and application. The C.V. Mosby Company (1985). ST. Louis,
Toronto, Princeton.
7. Enrique Viosca, MFrancisca Peydro, Antonio Puchol, Carlos Soler, Jaime Prat,
Aleixandre Corts, Javier Snchez, Juan M. Belda, Rubn Lafuente, Raquel
Poveda. Gua de uso y prescripcin de productos ortoprotsicos a medida
Instituto de Biomecnica de Valncia (1993). Valencia, Spain.
8. Ronald L. Valmassy, DPM, MS. Clinical biomechanics of the lower extremities.
Mosby- Year Book, Inc. (1996)
9. Andr-R. Baehler. Tcnica ortopdica: indicaciones. Tomo I: Biomecnica
Extremidad inferior. Masson (1999). Barcelona, Spain.
10. Donald Lorimer, Gwen French, Maureen ODonnell, J. Gordon Burrow. Neales
Disorders of the foot. Diagnosis and Management sixth edition. Churchill
Livingstone (2002).
11. Gerald F. Harris, Peter A. Smith, Richard M. Marks. Foot and ankle motion
analysis. Clinical treatment and technology. Taylor &Francis Group (2008).
12. A. I. Kapandji. Fisiologa articular. Tomo 2: Miebro inferior. 5th edition. Editorial
medica Panamericana (1998).
13. NVOS-Orthobanda. ORTHOPEDISCHE SCHOENTECHNIEK. Boek 2 Orthopedie.
Uitgeverij De Dienst (2002)
ONLINE TRAINING