Interventions for the prevention and treatment of pes cavus (high-arched foot deformity)

Pes cavus is characterised by an excessively high medial longitudinal arch (the arch on the inside of the foot) and is typically defined as a high-arched or supinated foot type. Population based studies suggest the prevalence of pes cavus is approximately 10%, and its cause is primarily neuromuscular (for example Charcot-Marie-Tooth disease) or idiopathic (unknown) in nature. It has been estimated that 60% of people with cavus feet will experience chronic foot pain at some time in their life, most commonly beneath the forefoot (for example metatarsalgia, sesamoiditis) or heel (for example plantar fasciitis). Conditions such as these are thought to be the result of abnormal pressure distribution across the sole of the foot during walking. Many conservative therapies and surgical procedures have been recommended for cavus-related foot pain. In particular, foot orthoses (aids applied and worn on the outside of the body to support the bony structures) customised to an individual's foot shape are increasingly prescribed by podiatrists, physiotherapists, orthopaedic surgeons and rehabilitation specialists for people with pes cavus pain. This updated review analysed four relevant trials, but only one fully met the inclusion criteria. This trial with 154 adults showed that custom-made foot orthoses can reduce and redistribute plantar foot pressure and subsequently decrease foot pain by approximately 75%. Some biomechanical outcomes, such as pressure distribution, improve with custom-made foot orthoses and footwear, but many other biomechanical outcomes, such as foot alignment or muscle activity, do not improve with botulinum toxin or off-the-shelf foot orthoses, respectively. More research is needed to determine the effectiveness of other interventions for people with painful high-arched feet.

Authors' conclusions: 

This updated review shows that custom-made foot orthoses are significantly more beneficial than sham orthoses for treating foot pain associated with pes cavus in a variety of clinical populations. We also show that some secondary biomechanical outcomes improve with custom-made foot orthoses and footwear, but not with botulinum toxin or off-the-shelf foot orthoses. There is an absence of evidence for any other type of intervention for the treatment or prevention of pes cavus.

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Background: 

People with pes cavus frequently suffer foot pain, which can lead to significant disability. Despite anecdotal reports, rigorous scientific investigation of this condition and how best to manage it is lacking.

Objectives: 

To assess the effects of interventions for the prevention and treatment of pes cavus.

Search strategy: 

We searched the Cochrane Neuromuscular Disease Group Specialized Register (17 August 2010), MEDLINE (January 1966 to August 2010), EMBASE (January 1980 to August 2010), CINAHL (January 1982 to August 2010), AMED (January 1985 to August 2010) and reference lists of articles. We contacted experts in the field to identify additional published or unpublished data.

Selection criteria: 

We included all randomized and quasi-randomised controlled trials of interventions for the treatment of pes cavus. We included trials aimed at preventing or correcting the pes cavus deformity.

Data collection and analysis: 

Two authors independently selected papers, assessed trial quality and extracted data.

Main results: 

Four trials were included in the review. One new trial of botulinum toxin was identified in the updated search. Only one trial of custom-made foot orthoses fully met the inclusion criteria. Three additional studies (botulinum toxin, footwear and off-the-shelf foot orthoses), all assessing secondary outcomes were included. We could not pool data used in the four studies due to heterogeneity of diagnostic groups and outcome measures. The one trial that fully met the inclusion criteria investigated the treatment of pes cavus pain in 154 adults over three months. The trial showed a significant reduction in the level of foot pain with custom-made foot orthoses versus sham orthoses (WMD 10.90; 95% CI 3.21 to 18.59). Furthermore, a significant improvement in self-reported foot function and physical functioning was reported with custom-made foot orthoses. There was no difference in reported adverse events following the allocation of custom-made or sham orthoses. Secondary biomechanical outcomes improved with the use of custom-made foot orthoses and footwear (pedobarography), but not with intramuscular injections of botulinum toxin (radiographic) or off-the-shelf foot orthoses (electromyography).

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