Interventions for the prevention and treatment of pes cavus

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Cochrane Database Syst Rev. 2007 Oct 17;(4):CD006154.

Interventions for the prevention and treatment of pes cavus.

Burns J, Landorf K, M, Crosbie J, Ouvrier R.

(NOTE: Pes cavus is a high arch that does not flatten with weightbearing)

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experts in the field to identify additional published or unpublished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.