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Interventions for the prevention and treatment of pes cavusBurns J, Landorf KB, Ryan MM, Crosbie J, Ouvrier RA
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SummaryInterventions 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 (e.g. 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 (e.g. metatarsalgia, sesamoiditis) or heel (e.g. 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 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 review of one 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%. More research is needed to determine the effectiveness of other interventions for people with painful high-arched feet.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 1, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This version first published online:
October 17. 2007 AbstractBackgroundPeople 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. ObjectivesTo assess the effects of interventions for the prevention and treatment of pes cavus. Search strategyWe searched the Cochrane Neuromuscular Disease Group Trials Register (April 2007), MEDLINE (January 1966 to April 2007), EMBASE (January 1980 to April 2007), CINAHL (January 1982 to April 2007), AMED (January 1985 to April 2007), all EBM Reviews (January 1991 to April 2007), SPORTdiscuss (January 1830 to April 2007) and reference lists of articles. We also contacted known experts in the field to identify additional published or unpublished data. Selection criteriaWe included all randomised and quasi-randomised controlled trials of interventions for the treatment of pes cavus. We also included trials aimed at preventing or correcting the cavus foot deformity. Data collection and analysisTwo authors independently selected papers, assessed trial quality and extracted data. Main resultsOnly one trial (custom-made foot orthoses) fully met the inclusion criteria. Two additional cross-over trials (off-the-shelf foot orthoses and footwear) were also included. Both studies assessed secondary biomechanical outcomes less than three-months after randomisation. Data used in the three studies could not be pooled due to heterogeneity of diagnostic groups and outcome measures. The one trial that fully met the inclusion criteria investigated the treatment of cavus foot pain in 154 adults over a three month period. The trial showed a significant reduction in the level of foot pain, measured using the validated 100-point Foot Health Status Questionnaire, with custom-made foot orthoses versus sham orthoses (WMD 10.90; 95% CI 3.21 to 18.59). Furthermore, a significant improvement in foot function measured with the same questionnaire was reported with custom-made foot orthoses (WMD 11.00; 95% CI 3.35 to 18.65). There was also an increase in physical functioning of the Medical Outcomes Short Form - 36 (WMD 9.50; 95% CI 4.07 to 14.93). There was no difference in reported adverse events following the allocation of custom-made (9%) or sham foot orthoses (15%) (RR 0.61; 95% CI 0.26 to 1.48). Authors' conclusionsIn one randomised controlled trial, custom-made foot orthoses were significantly more beneficial than sham orthoses for treating chronic musculoskeletal foot pain associated with pes cavus in a variety of clinical populations. There is no evidence for any other type of intervention for the treatment or prevention of foot pain in people with a cavus foot type. |