Cavus Foot: Causes, Diagnosis, and Treatment Options
Cavus foot, also known as pes cavus, is a condition in which the arch of the foot is higher than normal. This abnormal arch places excessive pressure on the ball and heel of the foot, often leading to pain, instability, and deformity. The condition can affect one or both feet and may develop at any age. In some individuals, cavus foot is stable, while in others, especially when caused by neurologic disorders, it can worsen over time.
How Common It Is and Who Gets It? (Epidemiology)
Cavus foot affects approximately 10% of adults and is more common in individuals with underlying neurologic disorders such as Charcot-Marie-Tooth disease, cerebral palsy, or spina bifida. It can also occur in healthy individuals with inherited foot structure abnormalities. The condition is seen equally in men and women and may present during childhood or early adulthood.
Why It Happens – Causes (Etiology and Pathophysiology)
Cavus foot can be caused by a variety of conditions, broadly grouped into neurologic and structural causes.
Neurologic disorders such as Charcot-Marie-Tooth disease, cerebral palsy, poliomyelitis, spina bifida, or stroke affect the communication between nerves and muscles, leading to muscle imbalance.
Congenital or inherited structural abnormalities may cause a naturally high arch without any underlying disease.
Trauma or surgery involving the foot or leg can alter the balance of muscles and tendons.
Idiopathic cases have no identifiable cause.
In neurologic cases, progressive muscle weakness or imbalance pulls the foot into an excessively arched and inward-tilted position, creating instability and pain.
How the Body Part Normally Works? (Relevant Anatomy)
The arch of the foot absorbs shock and distributes body weight during movement. The calcaneus (heel bone), metatarsals, plantar fascia, and tendons maintain the arch’s structure and function. In cavus foot, these structures become misaligned. The heel tilts inward (varus), the forefoot points downward (plantarflexed first ray), and the toes may curl (claw toes). This leads to uneven pressure on the ankle and foot, causing instability and discomfort.
What You Might Feel – Symptoms (Clinical Presentation)
Symptoms of cavus foot include a visibly high arch, pain under the ball and heel of the foot, calluses, and recurrent ankle sprains. The toes may form claw or hammer shapes, and the heel may tilt inward, causing instability. Some people experience foot drop, a condition that makes it difficult to lift the front of the foot while walking. Symptoms can worsen with activity and may become more pronounced over time.
How Doctors Find the Problem? (Diagnosis and Imaging)
Diagnosis begins with a physical examination and medical history. The specialist evaluates gait, alignment, muscle strength, and foot flexibility. The Coleman block test helps determine whether the deformity originates in the forefoot or hindfoot. Standing X-rays reveal bone alignment, calcaneal pitch, and the apex of the deformity. Advanced imaging such as MRI or CT scans may be ordered in complex cases, while electromyography (EMG) tests help identify neurological causes.
Classification
Cavus foot is classified by cause, location, and flexibility.
By cause: neurologic, congenital, acquired, or idiopathic.
By location: forefoot-driven (originating from the front of the foot), hindfoot-driven (from the heel), or mixed (involving both).
By flexibility: flexible deformities can be corrected conservatively or with tendon transfers, while rigid deformities often require bone realignment surgery.
Other Problems That Can Feel Similar (Differential Diagnosis)
Conditions that mimic cavus foot include chronic ankle instability, plantar fasciitis, flatfoot (pes planus), Achilles tendon contracture, and peripheral neuropathy. A thorough physical exam and imaging help differentiate these conditions.
Treatment Options
Non-Surgical Care
Conservative treatment aims to relieve pain, improve stability, and prevent progression. Orthotics support the arch and redistribute pressure. High-topped shoes improve ankle stability. Bracing can correct mild deformities and help control foot drop. Physical therapy focuses on stretching tight muscles and strengthening weak ones. Anti-inflammatory medications help reduce discomfort.
Surgical Care
Surgery is reserved for rigid or progressive cases where non-surgical treatments fail. The goal is to create a stable, plantigrade (flat, weight-bearing) foot. Procedures may include soft tissue releases, tendon transfers (such as transferring peroneus longus to brevis), osteotomies to realign bones, or arthrodesis (fusion) for severe deformities or arthritis. Modern 3D planning and customized guides can improve surgical precision and recovery.
Recovery and What to Expect After Treatment
Non-surgical recovery focuses on gradual improvement through physical therapy, bracing, and orthotic use. Most patients experience relief within several months. After surgery, recovery may take 8 to 12 weeks of non-weightbearing immobilization, followed by physical therapy. Full recovery can take several months depending on the type of procedure and severity of deformity.
Possible Risks or Side Effects (Complications)
Potential complications include wound healing issues, infection, nerve injury, nonunion of bone, and residual deformity. Progressive neurologic disease may cause recurrence even after correction. Patients using braces or casts should watch for skin irritation or pressure sores.
Long-Term Outlook (Prognosis)
The prognosis depends on the underlying cause. Patients without neurologic involvement generally recover well with proper treatment. Those with progressive neurologic disease may require ongoing management. Most achieve long-term pain relief, improved function, and greater stability after surgical correction or consistent use of orthotics.
Out-of-Pocket Costs
Medicare
CPT Code 28300 – Calcaneal Osteotomy (for Cavus Foot Deformity Correction): $153.01
Medicare Part B typically covers 80% of the approved cost for this procedure once your annual deductible has been met, leaving you responsible for the remaining 20%. Supplemental Insurance plans such as Medigap, AARP, or Blue Cross Blue Shield usually cover that 20%, minimizing or eliminating out-of-pocket expenses for Medicare-approved procedures. These plans work alongside Medicare to fill the coverage gap and reduce patient costs.
If you have Secondary Insurance, such as TRICARE, an Employer-Based Plan, or Veterans Health Administration coverage, it acts as a secondary payer. These plans often cover any remaining balance, including coinsurance or small deductibles, which typically range from $100 to $300 depending on your plan and provider network.
Workers’ Compensation
If your cavus foot deformity correction is required due to a work-related condition or injury, Workers’ Compensation will cover all associated medical expenses, including surgery, rehabilitation, and follow-up care. You will not have any out-of-pocket expenses, as the employer’s insurance carrier directly pays for all approved services.
No-Fault Insurance
If your cavus foot deformity or related condition was caused or aggravated by an automobile accident, No-Fault Insurance will typically cover the full cost of your treatment, including surgery and postoperative care. The only possible out-of-pocket cost may be a small deductible or co-payment depending on your policy.
Example
Olivia Martinez underwent a calcaneal osteotomy (CPT 28300) to correct her cavus foot deformity. Her estimated Medicare out-of-pocket cost was $153.01. Since Olivia had supplemental coverage through AARP Medigap, her remaining balance was fully covered, leaving her with no out-of-pocket expenses for the procedure.
Frequently Asked Questions (FAQ)
Q. What is a cavus foot?
A. A cavus foot is a condition where the arch of the foot is higher than normal.
Q. What are the symptoms of cavus feet?
A. Symptoms of cavus feet can include pain, calluses, ankle instability, and difficulty fitting into shoes.
Q. What causes cavus feet?
A. Cavus feet can be caused by neurological disorders, inherited structural abnormalities, or trauma.
Q. Which neurological conditions are associated with cavus feet?
A. Neurological conditions associated with cavus feet include Charcot-Marie-Tooth disease, spina bifida, and cerebral palsy.
Q. How is cavus foot diagnosed?
A. Cavus foot is diagnosed through a physical examination and imaging studies like X-rays.
Q. What are the non-surgical treatments for cavus feet?
A. Non-surgical treatments for cavus feet include orthotic devices, bracing, and physical therapy.
Q. When is surgery recommended for cavus feet?
A. Surgery is recommended when non-surgical treatments fail to relieve symptoms or when deformities worsen.
Q. What types of surgeries are performed for cavus feet?
A. Surgeries for cavus feet can include tendon transfers, osteotomies, and fusion procedures.
Q. How do orthotic devices help with cavus feet?
A. Orthotic devices help by providing support, cushioning, and distributing pressure more evenly across the foot.
Q. What is the goal of surgery for cavus feet?
A. The goal of surgery for cavus feet is to create a more balanced and stable foot.
Q. How important is early diagnosis of cavus foot?
A. Early diagnosis of cavus foot is important to prevent progression of deformity and worsening symptoms.
Q. Can cavus feet lead to other problems?
A. Yes, cavus feet can lead to problems such as ankle sprains, foot ulcers, and chronic pain.
Q. Is cavus foot always caused by a neurological condition?
A. No, cavus foot can also be caused by non-neurological factors such as inherited foot structure.
Q. What symptoms might indicate that cavus foot is worsening?
A. Symptoms like increasing instability, pain, and difficulty walking may indicate that cavus foot is worsening.
Q. How can bracing help patients with cavus feet?
A. Bracing can provide stability, prevent ankle sprains, and improve walking ability in patients with cavus feet.
Q. What is an osteotomy in the context of cavus foot surgery?
A. An osteotomy involves cutting and realigning bones to correct deformities associated with cavus foot.
Q. What is a tendon transfer for cavus feet?
A. A tendon transfer involves moving tendons to a new location to balance the muscles around the foot.
Q. How can physical therapy help patients with cavus feet?
A. Physical therapy can strengthen muscles, improve balance, and increase flexibility for patients with cavus feet.
Q. Are custom shoes beneficial for people with cavus feet?
A. Yes, custom shoes can accommodate foot deformities and provide better support and comfort.
Q. Can children develop cavus feet?
A. Yes, cavus feet can develop in children, especially if they have underlying neurological conditions.
Q. What are the long-term outcomes for patients with cavus feet after treatment?
A. Long-term outcomes are generally positive when cavus feet are properly diagnosed and treated.
Summary and Takeaway
Cavus foot is a high-arched foot deformity that can cause pain, instability, and secondary problems such as hammertoes or ankle sprains. Early recognition and conservative management can prevent worsening symptoms. For more severe or progressive deformities, surgical correction restores alignment and function, leading to a more stable and comfortable gait.
Clinical Insight & Recent Findings
A recent study examined the outcomes of surgical correction of cavus foot in patients with Charcot-Marie-Tooth (CMT) disease, one of the most common neurological causes of this deformity. The researchers reviewed 45 patients (57 feet) who underwent reconstructive surgery and followed them for two years.
The results showed significant improvements in both function and quality of life—patients reported higher scores on the Foot and Ankle Disability Index (FADI) and the SF-12 physical component scale, while X-ray measurements confirmed better alignment of the foot structure.
These findings highlight that, when conservative treatments are not enough, surgery can meaningfully reduce pain, improve gait, and enhance daily function for individuals with CMT-related cavus foot. (“Study on surgical outcomes for cavus foot in Charcot-Marie-Tooth disease – see PubMed.”)
Who Performs This Treatment? (Specialists and Team Involved)
Cavus foot is managed by orthopedic foot and ankle surgeons or podiatric surgeons. Neurologists, physiatrists, and physical therapists are often part of the multidisciplinary care team.
When to See a Specialist?
You should see a specialist if you have persistent foot pain, frequent ankle sprains, or a visible high arch that causes difficulty walking or fitting shoes.
When to Go to the Emergency Room?
Seek emergency care for severe ankle pain after an injury, open wounds, or signs of infection such as redness, fever, or drainage near surgical sites.
What Recovery Really Looks Like?
Recovery depends on the treatment plan. With proper orthotics and therapy, patients can return to normal activity. After surgery, most patients regain full function after several months with structured rehabilitation.
What Happens If You Ignore It?
Ignoring cavus foot can lead to chronic pain, callus formation, ankle instability, and joint degeneration. Long-term neglect can cause arthritis or fixed deformities that are more difficult to treat.
How to Prevent It?
Maintain healthy foot mechanics, wear supportive footwear, and manage neurologic or musculoskeletal conditions early. Stretching and strengthening exercises for the calves and ankles can also help maintain balance and stability.
Nutrition and Bone or Joint Health
A diet rich in calcium, vitamin D, protein, and omega-3 fatty acids promotes bone strength and supports joint health. Staying hydrated and avoiding smoking also improve healing after surgery.
Activity and Lifestyle Modifications
After recovery, engage in low-impact exercises like swimming or cycling. Avoid high-impact activities that stress the ankle. Use orthotics or braces if recommended to maintain alignment and prevent recurrence
Dr. Mo Athar
