Cavus foot, also known as pes cavus, is a condition characterized by an abnormally high arch of the foot. This excessive arch causes increased pressure on the ball and heel of the foot during standing and walking, often resulting in pain, instability, and difficulty with balance. The condition can affect one or both feet and may develop at any age. Understanding its causes, biomechanics, and treatment options is essential for effective management and long-term comfort.
Causes of Cavus Foot (High-Arched Foot)
Cavus foot may develop from a variety of underlying factors. In many cases, it results from neurologic disorders or systemic conditions that affect muscle balance and nerve function, such as Charcot-Marie-Tooth (CMT) disease, cerebral palsy, spina bifida, polio, or stroke. In other patients, the deformity may be congenital or inherited, without a neurologic cause. In these idiopathic cases, the arch often remains stable over time and may not worsen. Proper diagnosis is crucial since the underlying cause determines whether the condition is progressive or stable.
Biomechanics of Cavus Foot
Cavus foot is more than just a “high arch.” It is a complex structural deformity that alters normal foot mechanics. Typical features include a varus hindfoot (heel tilts inward), plantarflexed first ray (the first metatarsal points downward), high calcaneal pitch, and claw or hammertoes. During walking, the foot’s normal shock absorption and windlass mechanism are disrupted. Pressure becomes concentrated along the lateral border of the foot, causing pain, calluses, instability, and recurrent ankle sprains.
Symptoms of Cavus Foot
Common symptoms include pain in the heel or ball of the foot, hammertoes or claw toes, calluses under the metatarsal heads or heel, and ankle instability or frequent sprains. Some individuals experience foot drop, a weakness in the muscles that lift the foot, especially when the cause is neurologic. These symptoms may worsen with prolonged standing or physical activity.
Diagnosis
Diagnosis begins with a thorough medical and family history, followed by a physical examination to assess arch height, flexibility, and muscle strength. The Coleman Block Test helps determine whether the deformity is forefoot- or hindfoot-driven. Gait analysis and a neurologic assessment may also be performed. Weight-bearing X-rays identify the apex and severity of the deformity, while CT or MRI may be used for complex cases. Electromyography (EMG) and nerve conduction studies are helpful in diagnosing neuromuscular causes.
Nonsurgical Treatment Options
For mild or moderate deformities, conservative measures can help reduce pain and improve function. These include custom orthotic devices that provide cushioning and stability, high-topped or supportive footwear, and bracing for patients with weakness or foot drop. Stretching and strengthening exercises can improve flexibility and balance, while activity modification and anti-inflammatory medications may help relieve pain and inflammation.
Surgical Treatment Options
When conservative management fails, surgery may be needed to create a plantigrade foot—a foot that makes full, balanced contact with the ground. Surgical goals include achieving a stable, pain-free foot and correcting muscle imbalance and bone deformity. Common procedures include plantar fascia release, tendon transfers (such as peroneus longus to brevis or extensor hallucis longus transfer), osteotomies (bone realignment procedures like Cole, Japas, or Dwyer), and arthrodesis (fusion) in cases of stiffness or arthritis. Surgeons increasingly use 3D imaging, computer-assisted planning, and printed cutting guides to enhance precision and outcomes.
Postoperative Care and Rehabilitation
After surgery, the foot is typically placed in a non-weightbearing cast for several weeks. As healing progresses, gradual weight-bearing and physical therapy are introduced to restore strength, motion, and balance. Rehabilitation includes stretching, strengthening, proprioceptive exercises, and gait training to help prevent recurrence and improve function.
Prevention and Long-Term Management
While cavus foot cannot always be prevented, early diagnosis and intervention can minimize complications. Supportive footwear, regular physical therapy, and the use of orthotics or braces can improve stability and reduce symptoms. Patients with neurologic causes should have ongoing follow-up to monitor for progression.
Summary and Key Takeaways
Cavus foot is a complex condition that often results from neurologic or congenital factors. It alters the natural balance and biomechanics of the foot, leading to pain, instability, and deformity. Diagnosis relies on careful clinical and radiographic evaluation, and while nonsurgical options may provide relief, surgery is often required in severe or progressive cases. Advances in 3D surgical planning and personalized care have significantly improved patient outcomes, helping individuals regain comfort and mobility.
Research Spotlight
A 2022 review in the Journal of Clinical Medicine highlights that cavus foot—a deformity marked by a high medial arch—is most often linked to neuromuscular causes such as Charcot-Marie-Tooth disease. The article emphasizes the importance of individualized assessment using physical exams, radiologic imaging, and gait analysis to determine the precise source of deformity.
Treatment typically combines soft-tissue releases, tendon transfers, and osteotomies tailored to each patient’s unique biomechanics. Modern 3D modeling now allows surgeons to simulate different correction methods before operating, improving accuracy and reducing complications.
The authors conclude that computer-aided and 3D-printed surgical guides are transforming how cavus foot is corrected, offering safer and more precise outcomes for patients. (“Study on new 3D-guided approaches for cavus foot surgery – see PubMed.“)
References / Citations (Optional)
“Cavus Foot (High-Arched Foot).” FootHealthFacts.org – American College of Foot and Ankle Surgeons.
Orthobullets Team. “Surgical Treatment of Cavus Foot.” Orthobullets. Updated October 9, 2025.
Do you have more questions?
Q. What is cavus foot?
A. Cavus foot is a condition where the arch of the foot is higher than normal, causing an uneven distribution of weight on the foot.
Q. What causes cavus foot?
A. Cavus foot can be caused by neurological conditions such as cerebral palsy, spina bifida, polio, muscular dystrophy, or may be inherited without any underlying condition.
Q. What are the symptoms of cavus foot?
A. Symptoms can include pain, instability, calluses, hammertoes, claw toes, and frequent ankle sprains due to an unstable foot position.
Q. How is cavus foot diagnosed?
A. Diagnosis involves a clinical exam, patient history, and imaging studies such as X-rays to assess the foot structure.
Q. What are the non-surgical treatment options for cavus foot?
A. Non-surgical treatments include custom orthotics, bracing, shoe modifications, and physical therapy to relieve symptoms and improve stability.
Q. When is surgery recommended for cavus foot?
A. Surgery is recommended when non-surgical treatments fail to provide relief or if the deformity is severe and causing significant pain or instability.
Q. What types of surgery are available for cavus foot?
A. Surgical options may include tendon transfers, osteotomies to realign bones, and fusion procedures to stabilize the foot.
Q. What is the recovery time after cavus foot surgery?
A. Recovery time varies but generally involves several weeks of non-weight bearing followed by rehabilitation and physical therapy.
Q. Can cavus foot lead to other foot problems?
A. Yes, cavus foot can lead to problems such as hammertoes, calluses, instability, and increased risk of ankle sprains.
Q. Is cavus foot more common in one gender?
A. Cavus foot affects both males and females and can occur at any age.
Q. Can children have cavus foot?
A. Yes, cavus foot can be present in children, and early diagnosis and treatment can help prevent complications.
Q. Will cavus foot get worse over time?
A. It can worsen over time, especially if associated with progressive neurological conditions. Regular monitoring and treatment are important.
Q. Can orthotics help with cavus foot pain?
A. Yes, custom orthotics can help redistribute pressure, provide arch support, and reduce pain associated with cavus foot.
Dr. Mo Athar
