Presentation
Work-up for septic arthritis/diabetic foot. There is a history of childhood poliomyelitis and permanent paralysis.
Patient Data
Features consistent with pes cavus, with forefoot plantar flexion especially the first metatarsal. There is forefoot valgus and adduction with mild hindfoot varus.
There is mild degenerative change.
In view of clinical suspicion, there is no septic arthritis or osteomyelitis appreciated on plain films.
Case Discussion
Pes cavus is also known as talipes cavus or pes cavovarus. It may present in both adults and children 1. it may be unilateral or bilateral 1. When unilateral, consider post-traumatic etiology. Bilateral pes cavus is often congenital, hereditary or due to a neuromuscular disorder 1.
The four causes of pes cavus include 1:
neuromuscular disorders including cerebral palsy, poliomyelitis, Parkinson disease, Huntington chorea, Friedreich ataxia, Amyotrophic lateral sclerosis, and Charcot-Marie-Tooth
post-traumatic
untreated or undertreated clubfoot
idiopathic including tarsal coalition, rheumatoid arthritis, osteoarthritis, plantar fibromatosis, and diabetic foot syndrome
In this instance, the patient was diabetic and had a history of childhood poliomyelitis with permanent paralysis.
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