Idiopathic pes calcaneocavus in a young adult: a rare developmental variant with radiographic confirmation

Abstract

Pes cavus refers to a spectrum of foot deformities characterized by an abnormally elevated medial longitudinal arch, with the calcaneocavus subtype defined by hindfoot dorsiflexion and a high arch being relatively uncommon and most often associated with underlying neuromuscular conditions such as Charcot–Marie–Tooth disease. Idiopathic presentations are rare, and potential developmental contributors remain poorly understood. We report a 19-year-old male with bilateral symptomatic calcaneocavus presenting with progressive forefoot and heel pain, clawing of toes, and functional limitation. Clinical examination revealed high medial arches, dorsiflexed hindfoot, and a rigid deformity as demonstrated by a positive Coleman block test. Weight-bearing radiographs confirmed calcaneocavus alignment, with Meary’s angle of >8°, calcaneal inclination of 34°28′, and increased talo–first metatarsal angle. Comprehensive neurological evaluation, including detailed clinical examination and electromyography/nerve conduction studies, was normal. The patient had a notable history of prematurity at 34 weeks of gestation without associated neurological sequelae. Conservative management with custom orthoses and targeted physiotherapy focusing on Achilles tendon stretching and intrinsic muscle strengthening resulted in significant symptomatic improvement at 3-month follow-up, with reduced pain and improved functional capacity. This case represents a rare example of radiographically confirmed idiopathic bilateral calcaneocavus in the absence of neurological or known genetic pathology and introduces prematurity as a potential developmental factor influencing foot morphology. While this association tries to associate prematurity as a factor, the report contributes to the limited literature on non-neuromuscular causes of cavus deformity and highlights the need for further studies to better understand this etiological spectrum.