Pes Cavus

What is Cavus Foot?

Cavus foot is a condition in which

the foot has a very high arch.

Because of this high arch, an excessive

amount of weight is placed on the

ball and heel of the foot when

standing. Cavus foot can lead to a

variety of signs and symptoms, such

as pain and instability. It can develop

at any age, and can occur in one or

both feet.

Signs and Symptoms

The arch of a cavus foot will

appear high even when standing.

In addition, one or more of the

following signs and symptoms

may be present:

• Hammertoes (bent toes) or claw

toes (toes clenched like a fist)

• Calluses on the ball, side, or heel

of the foot

• Pain when standing or walking

• An unstable foot due to the heel

tilting inward, which can lead to

ankle sprains

Some people with cavus foot may

also experience foot drop, a

weakness of the muscles in the foot

and ankle that results in dragging

the foot when taking a step.

Foot drop is usually a sign of an

underlying neurologic condition.

What Causes Cavus Foot?

Cavus foot is often caused by a

neurologic disorder or other medical

condition—for example, cerebral

palsy, Charcot-Marie-Tooth disease,

spina bifida, polio, muscular

dystrophy, or stroke. In other cases of

cavus foot, the high arch may

represent an inherited structural

abnormality.

An accurate diagnosis is

important because the underlying

cause of cavus foot largely

determines its future course. If the

high arch is due to a neurologic

disorder or other medical condition,

it will probably worsen. On the other

hand, cases of cavus foot that do not

result from neurologic disorders

usually do not change in appearance.

Diagnosis

Diagnosis of cavus foot includes a

review of the patient’s family history.

The foot and ankle surgeon examines

the foot, looking for a high arch and

possible calluses, hammertoes, and

claw toes. The foot is tested for muscle

strength, and the patient’s walking

pattern and coordination are

observed. If a neurologic condition

appears to be present, the entire limb

may be examined. The surgeon may

also study the pattern of wear on the

patient's shoes.

X-rays are sometimes ordered to

further assess the condition. In

addition, the surgeon may refer the

patient to a neurologist for a

complete neurologic evaluation.

Treatment: Non-Surgical

Approaches

Non-surgical treatment of cavus foot

may include one or more of the

following options:

• Callus care. The surgeon often

trims the calluses and

recommends wearing small pads

around the calluses to reduce

pressure and pain. Patients

should never attempt to trim

calluses themselves, since this

could do more harm than good

and possibly result in an

infection.

• Orthotic devices. Custom orthotic

devices that fit into the shoe can

be beneficial because they

provide stability and cushioning

to the foot.

• Shoe modifications. High-topped

shoes support the ankle, and

shoes with heels a little wider on

the bottom add stability.

• Bracing. The surgeon may

recommend a brace to help keep

the foot and ankle stable. Bracing is

also useful in managing foot drop.

When is Surgery Needed?

If non-surgical treatment fails to

adequately relieve pain and improve

stability, surgery may be needed

to decrease pain, increase stability,

and compensate for weakness in

the foot. Surgery is also considered

for cases that are likely to get

worse—even if there is currently

no pain or instability. In these

instances, the goal of surgery is to

help reduce the severity of

future problems.

The surgeon will choose the best

surgical procedure or combination of

procedures based on the patient’s

individual case. In some cases where

an underlying neurologic problem

exists, surgery may be needed

again in the future due to the

progression of the disorder.