What is pes cavus (high arches)?
Pes cavus also known as high arches or cavus foot is a condition in which the arch of the foot is significantly greater than a normal foot arch. The extent of the raised arch causes a greater proportion of the sole of the foot to lift from the floor. The foot consists of three arches a transverse, longitudinal and medial arch. The arches are formed by the main bones of the foot mostly the tarsal and metatarsal bones and are reinforced by the surrounding soft tissues including ligaments, tendons, and muscles. The arches are designed to absorb any impact, acting as shock absorbers and are responsible for distribute body weight evenly, limiting the amount of pressure through the joints of the foot. High arches interfere with the normal weight distribution through the foot as an increased amount of pressure is placed upon the ball and heel of the foot.
Cavus foot can lead to a variety of signs and symptoms, such as pain and instability
Why & when does pes cavus occur?
Pes cavus can develop in children and adulthood and can affect either one or both feet.Most cases of high arches come from an inherited foot posture and in these cases there will be a degree of high arches from adolescence. Pes cavus can also be the result of an underlying neurological or medical condition such as cerebral palsy, spina bifida, muscular dystrophy, stroke and charcot-marie-tooth disease.
What does pes cavus feel like?
Pes cavus presents as a notably elevated arch when standing, the mid foot will be stiff and inflexible and pain and discomfort will be felt when weight-bearing. Calluses often develop around the heel and the ball of the foot due to an increased pressure through these areas. Hammertoes and clench toes are both contraction deformities of the toes which can also occur due to the change in weight distribution from high arches. Many cases report ankle sprains and shin pain, this is usually linked to ankle instability caused by the heel tilting inwards.
When there is an underlying neurological or medical condition the symptoms may be from the condition rather than the high arches. Muscular weakness resulting in a dragging foot or foot drop can be a sign of an underlying condition.
How is pes cavus diagnosed?
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 is likely to progressively worsen. On the other hand, cases of cavus foot that do not result from neurologic disorders usually do not change in appearance.
What treatments are available for pes cavus?
Your GP or podiatrist/chiropodist should be able to diagnose you by listening to your symptom history and thoroughly examining the foot and ankle including the foot posture when standing and walking and testing the foot and ankle muscles. Additionally they will also check the tread on the bottom of your shoes to assess to pattern of wear on the foot. If an underlying neurological or medical condition is suspected then the doctor may elect to refer for further investigations. Your doctor will most likely order an X-ray of the foot to determine the extent of the deformity.
Conservative treatment options for pes cavus include shoe modifications including opting for high topped shoes that support and reinforce the weakened, instable ankles. Orthotics and arch inserts can be used to support and cushion the arch posture and biomechanics. The doctor will most likely prescribe anti-inflammatory medication and painkillers for pain relief and to reduce any swelling there is also the option of corticosteroid injections to reduce persistent inflammation and pain. Occasionally a brace will be used to stabilise the foot and ankle and prevent further injury. Your doctor may also refer you to a podiatrist/chiropodist or physiotherapist who may use ultrasound or manual therapy to reduce pain levels.
Doctors will normally only recommend surgical intervention for more severe, progressed cases or when conservative treatment fails. You will be referred to a specialist ankle and foot orthopaedic surgeon who will recommend the type of surgery based on your health, activity level and the severity and extent of your condition. The recovery and results you see after surgery will vary, depending on the type of procedure performed.