What is Pes Cavus?

Pes cavus is a condition where the arch of the foot is abnormally high. Unlike a normal arch that flattens slightly when standing or walking, a cavus foot remains rigidly arched, placing excessive pressure on the ball and heel of the foot. This can cause pain, instability, and progressive deformities such as hammertoes or claw toes.

Pes cavus can affect one or both feet, may be inherited, or may develop due to underlying neurologic or muscular conditions.

Causes

Pes cavus may be:

  • Genetic / idiopathic – some people are simply born with high arches

  • Neurologic – the most common cause, due to muscle imbalance from conditions such as:

    • Charcot‑Marie‑Tooth disease

    • Muscular dystrophy

    • Spina bifida

    • Stroke or spinal cord tumors

  • Post‑traumatic – after fractures or injuries that alter foot mechanics

  • Other factors – contractures of the plantar fascia, residual clubfoot, or diabetes‑related neuropathy

Symptoms

Not all high arches cause problems, but when symptomatic, patients may notice:

  • Pain in the ball or heel of the foot

  • Frequent ankle sprains or instability (foot tends to roll outward)

  • Corns and calluses under the metatarsal heads or heel

  • Claw toes or hammertoes from muscle imbalance

  • Difficulty finding comfortable shoes

  • In severe cases: stress fractures, plantar fasciitis, or peroneal tendonitis

  • Secondary issues: knee, hip, or back pain due to altered gait

Diagnosis

Diagnosis involves:

  • Physical exam – assessing arch height, flexibility, and gait

  • Footprint test – cavus feet leave little or no midfoot impression

  • Coleman block test – determines if the deformity is flexible or rigid

  • Imaging – X‑rays to measure arch angles; MRI or EMG if neurologic disease is suspected

  • Neurologic evaluation – often recommended, since two‑thirds of adults with symptomatic pes cavus have an underlying neurologic condition

Nonsurgical Treatment

Conservative care is often effective, especially in mild or flexible cases:

  • Orthotics – custom insoles to redistribute pressure and support the arch

  • Shoe modifications – wide toe boxes, cushioned soles, rocker‑bottom shoes

  • Bracing – ankle‑foot orthoses for instability or foot drop

  • Physical therapy – stretching tight muscles, strengthening weak ones, balance training

  • Pain management – NSAIDs, icing, and activity modification

  • Callus care – padding or trimming to reduce pressure points

When is Surgery Needed?

Surgery may be considered when:

  • Pain persists despite conservative care

  • The deformity is rigid and progressive

  • There is severe instability, recurrent sprains, or tendon damage

Surgical options include:

  • Soft tissue release – lengthening tight fascia or tendons

  • Tendon transfers – balancing weak and strong muscles

  • Osteotomy – cutting and realigning bones to lower the arch

  • Arthrodesis (fusion) – fusing joints in severe or arthritic cases

The goal is to create a plantigrade foot (flat, stable, and pain‑free for walking), not necessarily to restore a “normal” arch.