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. 2007 Oct 17;2007(4):CD006154.
doi: 10.1002/14651858.CD006154.pub2.

Interventions for the prevention and treatment of pes cavus

J Burns  1 , K B Landorf, M M Ryan, J Crosbie, R A Ouvrier
Affiliations

Interventions for the prevention and treatment of pes cavus

J Burns et al. Cochrane Database Syst Rev. .

Abstract

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 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 We also contacted known experts in the field to identify additional published or unpublished data.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 criteria: We 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 analysis: Two authors independently selected papers, assessed trial quality and extracted data.

Main results: Only 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' conclusions: In 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.

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Conflict of interest statement

J. Burns, J. Crosbie and R. Ouvrier have been involved in studies that may be eligible for consideration in this review.

Figures

1
1
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Custom‐made foot orthoses versus sham, Outcome 1 Change in foot pain at three months.
2.1
2.1. Analysis
Comparison 2 Botulinum toxin type‐A versus control (note number of participants refers to legs not people ‐ see text), Outcome 1 Change of calcaneal‐first metatarsal angle.
2.2
2.2. Analysis
Comparison 2 Botulinum toxin type‐A versus control (note number of participants refers to legs not people ‐ see text), Outcome 2 Change of tibia‐calcaneal angle.
2.3
2.3. Analysis
Comparison 2 Botulinum toxin type‐A versus control (note number of participants refers to legs not people ‐ see text), Outcome 3 Change of Foot Posture Index.
2.4
2.4. Analysis
Comparison 2 Botulinum toxin type‐A versus control (note number of participants refers to legs not people ‐ see text), Outcome 4 Change of ankle dorsiflexion range of motion.
2.5
2.5. Analysis
Comparison 2 Botulinum toxin type‐A versus control (note number of participants refers to legs not people ‐ see text), Outcome 5 Change of dorsiflexion foot strength.
2.6
2.6. Analysis
Comparison 2 Botulinum toxin type‐A versus control (note number of participants refers to legs not people ‐ see text), Outcome 6 Change of plantarflexion foot strength.
2.7
2.7. Analysis
Comparison 2 Botulinum toxin type‐A versus control (note number of participants refers to legs not people ‐ see text), Outcome 7 Change of inversion foot strength.
2.8
2.8. Analysis
Comparison 2 Botulinum toxin type‐A versus control (note number of participants refers to legs not people ‐ see text), Outcome 8 Change of eversion foot strength.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Burns 2006 {published data only}
    1. Burns J, Crosbie J, Ouvrier R, Hunt A. Effective orthotic therapy for the painful cavus foot: a randomized controlled trial. Journal of the American Podiatric Medical Association 2006;96(3):205‐11. - PubMed
Burns 2010 {published and unpublished data}
    1. Burns J, Scheinberg A, Ryan MM, Rose KJ, Ouvrier RA. Randomized trial of botulinum toxin to prevent pes cavus progression in pediatric CMT1A. Muscle & Nerve 2010;42(2):262‐7. - PubMed
Hertel 2005 {published and unpublished data}
    1. Hertel J, Sloss BR, Earl JE. Effect of foot orthotics on quadriceps and gluteus medius electromyographic activity during selected exercises. Archives of Physical Medicine and Rehabilitation 2005;86(1):26‐30. - PubMed
Wegener 2008 {published and unpublished data}
    1. Wegener C, Burns J, Penkala S. Effect of neutral‐cushioned running shoes on plantar pressure loading and comfort in athletes with cavus feet: a crossover randomized controlled trial. American Journal of Sports Medicine 2008;36(11):2139‐46. - PubMed

References to studies excluded from this review

Bellomo 1982 {published data only}
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Bus 2004 {published data only}
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Butler 2005 {unpublished data only}
    1. Butler RJ. Interaction of arch type and footwear on running mechanics. Interaction of arch type and footwear on running mechanics PhD Thesis. Delaware: University of Delaware, 2005.
Butler 2006 {published data only}
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Butler 2007 {published data only}
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Kavros 2005 {published data only}
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Knapik 2010 {published data only}
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Molloy 2009 {published data only}
    1. Molloy JM, Christie DS, Teyhen DS, Yeykal NS, Tragord BS, Neal MS, et al. Effect of running shoe type on the distribution and magnitude of plantar pressures in individuals with low‐ or high‐arched feet. Journal of the American Podiatric Medical Association 2009;99(4):330‐8. - PubMed
Mubarak 2009 {published data only}
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Olmsted 2004 {published data only}
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Simkin 1989 {published data only}
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