Lower Limb Wasting, Pes Cavus and Clawing of Toes

In this photo, there is apparent leg-length discrepancy and wasting of the lower limb muscles – the left side relatively more severe. Typical pes cavus (high-arched foot) are seen on both sides. Clawing of the toes can also be seen. This sign is postulated to be due to a different degree of wasting – the peroneus brevis and tibialis anterior muscles are affected more, whilst the peroneus longus and tibialis posterior muscles are relatively spared. These signs are often seen in chronic neuropathies, such as Charcot-Marie Tooth disease (Hereditary Motor and Sensory Neuropathy Type I) and Friedreich’s Ataxia.