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Pes Cavus Pes cavus clawfoot refers to a foot with an abnormally high arch and a fixed equinus deformity of the forefoot see Fig 626 The shortening of the foot and increased pressure produce calluses on the metatarsal area and on the dorsum bottom of the foot CharcotMarieTooth disease a peripheral neuromuscular disorder associated with a familial degenerative disorder diabetes mellitus and tertiary syphilis are common causes of pes cavus Exercises are prescribed to manipulate the forefoot into dorsiflexion and relax the toes Bracing to protect the foot may be used In severe cases arthrodesis fusion is performed to reshape and stabilize the foot Mortons Neuroma Mortons neuroma plantar digital neuroma neurofibroma is a swelling of the third lateral branch of the median plantar nerve see Fig 626 The third digital nerve which is located in the third intermetatarsal web space is most commonly involved Microscopically digital artery changes cause an ischemia of the nerve The result is a throbbing burning pain in the foot that is usually relieved when the patient rests Conservative treatment consists of inserting innersoles and metatarsal pads designed to spread the metatarsal heads and balance the foot posture Local injections of hydrocortisone and a local anesthetic may provide relief If these fail surgical excision of the neuroma is necessary Pain relief and loss of sensation are immediate and permanent Flatfoot Flatfoot pes plamis is a common disorder in which the longitudinal arch of the foot is diminished It may be due to congenital abnormalities or associated with bone or ligament injury muscle and posture imbalances excessive weight muscle fatigue poorly fitting shoes or arthritis Symptoms include a burning sensation fatigue clumsy gait edema and pain Exercises to strengthen the muscles and to improve posture and walking habits are helpful A number of foot orthoses are available to give the foot additional support Severe flatfoot problems are usually treated by an orthopedic surgeon or a
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