High Arch Feet (Pes Cavus)

What is pes cavus (high arch feet)?

Pes cavus is having high arch feet. Your arches are the flexible part of your soles, between your heel and the ball of your foot. They usually arch a little when your feet are at rest, and they flex when you walk.

Some people have higher arches than usual. High arches never flatten or touch the ground, even when you’re putting your weight on them. If you make a footprint, there will be no middle part of your foot.

You may have high arches naturally or because of a medical condition. If it’s mild, pes cavus (cavus foot) may not cause any issues. But it can cause issues for some people, and it can also be progressive.

Walking with a high instep puts more stress on other parts of your foot. This can cause discomfort, and sometimes injury. Some people develop bone and muscle changes from walking on high arch feet.

What symptoms can pes cavus (cavus foot) cause?

If high arch feet cause you symptoms, the first ones you’re likely to notice are:

• Foot pain, especially in the ball or heel
• Ankle pain and swelling
• Arch pain

Over time, you may develop:

• Corns and calluses on the parts of your foot that take more pressure
• Ankle joint instability, causing it to frequently roll or even sprain
• Inward-curling toes (claw toes or hammertoes)

Some people develop chronic pain from repetitive strain injuries, like:

• Metatarsalgia (inflammation in the ball of your foot)
• Plantar fasciitis (inflammation in a ligament in your heel)
• Peroneal tendonitis (inflammation in a tendon in your outer ankle)

How does pes cavus affect walking?

Walking on high arch feet causes supination (under pronation). This means you tend to walk on the outsides of your feet, putting more pressure on less flexible parts: the ball, the heel and the outer toes.

A normal foot rolls from the outside of the foot toward the inside (pronates) when you step on it. This helps it absorb shock and adapt to uneven surfaces. But high arches don’t roll very well, so your feet stay on the outer edge instead.

How does pes cavus change your foot?

When pes cavus (cavus foot) progresses and causes further musculoskeletal changes to your foot, these changes take one of two forms. Healthcare providers call them pes cavovarus and pes calcaneocavus:

• Pes cavovarus (cavovarus foot). Cavovarus foot is the most common variation of pes cavus. It combines high arches (cavus) with an inward-tilting heel (varus). The big toe is flexed to point down (plantarflexed,) making the whole foot arch. It’s also called hollow foot or claw foot.
• Pes calcaneocavus (calcaneocavus foot). Calcaneocavus foot is a less common variation. In this version, your heel (calcaneus) is flexed upward (dorsiflexed), while your forefoot is flexed downward, making your arches highest in the back. It’s sometimes called posterior pes cavus.

What are the complications of high arch feet?

High arches can cause progressive deformity of your foot, making walking increasingly painful and unstable. Besides repetitive strain on your foot itself, this may also cause secondary problems, like:

• Knee pain
• Back pain
• Foot and ankle arthritis

What causes pes cavus?

Many people are born with high arches, so genetics are certainly a factor. However, in other cases, high arch feet can be a symptom of another condition, such as spina bifida or muscular dystrophy.

Muscle imbalances in your lower body can cause anatomical changes leading to high arch feet. When some muscles are abnormally weak, others become abnormally tight and pull your foot out of shape.

Neuromuscular disorders are the most common reason for these muscle imbalances. These disorders affect how your nerves communicate with your muscles, often leaving some muscles inactivated.

Many of these are genetic disorders that children inherit at birth. But they progress very slowly, so they may not be diagnosed right away. High arch feet in children may be one of the first symptoms.

Examples of hereditary causes include:

• Charcot-Marie-Tooth disease
• Muscular dystrophy
• Spina bifida occulta

Neuromuscular disorders can also happen during your life, due to things like:

• Diabetes-related neuropathy
• Spinal tumors
• Stroke

Injuries and contractures can also cause cavus foot. For example, misaligned bones may cause muscle imbalances. Not moving enough after an injury can cause your tissues to tighten and contract.

Sometimes, babies are born with muscle contractures, not because of a neurological disorder or injury, but because it happened in the womb. Clubfoot is a congenital contracture that can cause pes cavus.

How are high arch feet diagnosed?

An orthopaedist can diagnose cavus foot during a physical exam. They’ll observe how you stand and walk. They might ask you to move your foot in different ways to learn where it’s flexible and where it’s rigid.

To learn more about your condition, they might follow up with imaging tests, like a foot X-ray or MRI. If they suspect a neuromuscular disorder, they might suggest an EMG test or a nerve conduction study.

How do healthcare providers treat pes cavus?

Treatment depends on how severe your condition is and whether it’s likely to get worse. If your condition and your symptoms are mild, treatment focuses on physical therapy and pain relief.

Possible treatments include:

• Orthotics. Special shoes or shoe inserts can help place your foot in a more favorable position for walking. You can get orthotics over the counter, or an orthotist can design you custom ones.
• Braces, splints or casts. Wearing a brace, splint or cast on your feet is one way to gently stretch the tight tissues over time. Some people wear one at night, and others all the time for several weeks.
• Physical therapy. A physical therapist can prescribe exercises to do at home or with their assistance. This can help improve the strength and flexibility of the muscles involved.
• Pain relievers. Over-the-counter medications, like nonsteroidal anti-inflammatory drugs (NSAIDs), can help ease pain and swelling after walking. Simple icing can also help.

Can you fix pes cavus?

If your feet are severely deformed, or your provider expects them to keep getting worse, you might need surgery. The goal of surgery is to relieve pain by making your feet bear your weight more evenly.

Surgery for pes cavus may include:

• Osteotomy: Realigning and reshaping your bones
• Soft tissue release: Making small cuts in soft tissues to relieve tension
• Tendon transfer: Replacing a nonfunctional tendon with a functional one
• Joint fusion: Fusing two bones in a joint together

How can I reduce my risk for high arch feet?

Because high arch feet are either genetic or caused by an underlying condition, there really isn’t a way to prevent the problem from occurring. However, high arch pain can be successfully managed with proper monitoring and treatment.

Do high arch feet get worse without treatment?

In general, high arch feet related to neuromuscular disorders do tend to worsen over time. If you have this type of pes cavus, you can expect to need treatment sooner or later — and sooner might be better.

High arch feet that run in your family without any related disorder probably won’t worsen. Cavus foot due to an injury tends to be stable. Your orthopaedist can tell you what to expect from your condition.

What is the prognosis after pes cavus treatment?

If you have a progressive condition that’s likely to get worse over time, you’ll have the best results from treating it sooner. This is especially true for children, whose bodies are still forming and flexible.

Timely surgery can help prevent pes cavus from causing increasing deformity and becoming rigid. Once the condition has advanced, you’ll need more significant surgery to fix it, and it might not fix everything.

Rehabilitation after surgery is important to its long-term success. That means following your provider’s advice on how and when to start using your foot again and keeping up with your physical therapy.

Depending on your condition, you may need to continue with physical therapy or home exercises indefinitely. Those with progressive disorders may need additional treatment down the road.