Pressure characteristics in painful pes cavus feet resulting from CMT

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Gait & Posture

Volume 28, Issue 4, November 2008, Pages 545-551

Pressure characteristics in painful pes cavus feet resulting from

Charcot–Marie–Tooth disease

Jack Crosbie a, Burns a, b and A. Ouvrier b

a Physiotherapy, Faculty of Health Sciences, The University of

Sydney, Australia bInstitute for Neuromuscular Research, Discipline

of Paediatrics and Child Health, Faculty of Medicine, The University

of Sydney, Australia

Abstract

Charcot–Marie–Tooth (CMT) disease often presents with peripheral

muscle imbalance associated with a painful cavus (medial high-arched)

foot deformity which becomes increasingly severe and rigid as the

disease progresses. The purpose of this study was to investigate the

effect of pes cavus on foot pain and dynamic plantar pressure in CMT,

and to explore the relationships between plantar pressure and pain.

Sixteen participants diagnosed with CMT and painful pes cavus were

assessed for foot posture, ankle dorsiflexion range of motion, levels

of foot pain, functional impairment, health-related quality of life

and plantar pressure distribution while walking. Plantar pressure

parameters (mean pressure, peak pressure, pressure–time integral) and

contact duration were measured using the Novel Pedar® in-shoe

capacitance transducer system and the foot was divided into rearfoot,

midfoot and forefoot regions for analysis.

Increasing cavus foot deformity was associated with more widespread

foot pain and increased pressure under the forefoot and midfoot

regions. In contrast, peak pressure decreased under the rearfoot.

Neither relationship was found between foot pain intensity and any of

the pressure variables, nor was ankle dorsiflexion range of motion

correlated with pain location, intensity or degree of pes cavus.

Although pes cavus in CMT is associated with substantial pain and

dysfunction, there is no clear link between foot pain and plantar

pressure. The more severe the degree of pes cavus, however, the more

pressure develops under the lateral margin of the foot; probably as a

result of the changed foot–ground contact seen during gait.