Jeffrey Roehl

Overview

Cavus foot refers to an abnormally high arch and because of this high arch structure, 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, particularly pain and instability and it can develop at any age, and can occur in one or both feet. People with high arches are often times vulnerable to overuse injuries during sports and exercise because their feet aren?t good shock absorbers, due to less surface contact with the ground.

Causes

Pes Cavus is typically a result of a fixed plantar flexion of the foot. Plantar Flexion is the movement of the ankle, pointing the toes away from the shin (think pressing a gas pedal in your car). However, a fixed plantar flexion does not guarantee that a person has pes cavus.

Symptoms

The foot serves as an organ of load distribution, shock absorption, balance and propulsion. Pes cavus interferes with all of these functions. Supination of the hindfoot normally results in a change of the foot from a loosely packed, flexible, energy absorbing structure to a tightly packed, stiffer lever. This change occurs naturally during the gait cycle. When the hindfoot remains supinated throughout the gait cycle, however, the reduced flexibility lessens the foot?s capability as a shock absorber and diminishes its ability to balance on uneven ground. Hindfoot varus also leads to an increased moment on the ankle, making ankle inversion injuries common. Eventually there may be dramatic varus tilting of the ankle and secondary osteoarthritis.

Diagnosis

Examination of the muscle groups and muscle strength is important. Furthermore, pain along the peroneal tendons may be a sign of a peroneal tendon tear. This may result in a cavus foot much like a posterior tibial tendon dysfunction may result in flatfoot. Instability of the lateral ankle may also lead to a cavus foot position as the talus deviates into a varus position due to the laxity of the lateral ankle ligaments.

Non Surgical Treatment

Initially a careful investigation is needed to rule out any neurological condition that is causing the high arched foot. This will depend on what is causing the pain, if anything. For instance, flexible high arches may not need any treatment. Wear shoes with a good cushioning, depth and arch support which may help relieve pain and improve walking. Debridement of corns and calluses. Various pads made from silicone or felt can be used to get pressure off the painful areas. Control body weight to decrease load on the feet. Physical therapy modalities such as laser therapy for associated tendonitis. Foot and ankle joint manipulations to help increase joint range of motion. Foot orthotic devices can provide support for stressed joints and soft tissues.

Surgical Treatment

Surgery is a last resort if the above conservative measures fail to control symptoms. Surgery is only justified when deformity is so pronounced or progressive that symptoms are intrusive and unresponsive to conservative treatments. On the other hand, surgery should not be delayed so long that severe ulceration develops or the patient cannot ambulate. A timely, limited surgical intervention, while the foot is still flexible, can re-balance the foot and prevent the need for a larger, more technically demanding procedure later on.