Pes Cavus (High-Arch)

Pes Cavus (high arch foot type), This deformity is described by elevated longitudinal arch, plantarflexion of the 1st ray, hindfoot varus and adduction of the forefoot. Can be an acquired or congenital deformity (present at birth).  Around 50-60 % of the patients have a neurological component. This type of deformity leads to a very stiff midfoot and rearfoot. This can cause callus and arthritic changes at joints and bony exostosis at insertion of tendon.

High Arch

Cause:

  • Present at birth
  • Muscle imbalance: weak Tibialis Anterior tendon, and strong Posterior Tibial tendon
  • Neuromuscular conditions: CMT (charcot Marie-tooth), Polio, Spina bifida, Spinal impingement/Spinal cord tumor
  • Traumatic: Compartment syndrome/Crush injuries

Symptoms:

  • High arch foot type
  • Callus present sub 1st metatarsal, 5th metatarsal, base of the 5th metatarsal and calcaneus
  • Stiff midfoot and rearfoot
  • Tight achilles tendon
  • Plantar fasciitis is a common complaint in this foot type
  • Recurrent ankle sprains due to the imablace and adducted foot type
  • Sesamoiditis
  • Claw and hammertoes

Treatment:

X Rays: initially taken to visualize the bony deformity along with physical exam. 

Due to the high rate of neuromuscular condition, EMG/NCV are performed to find the root cause of the deformity.

Conservative Therapy :

This is usually done with orthotics, The goal of the orthotics is fore pressure redistribution and to prevent overloading of the joint of the foot and ankle. Ankle bracing may be used to prevent recurrent ankle sprains. 

Surgical intervention:

For those that have failed conserveatvie therapy. Surgical intervention may be warranted. Multiple surgical procedures exist such as tendon transfer, soft tissue release, calcaneal osteotomy, forefoot reconstruction, Lateral ligament reconstruction and even supramalleolar osteotomy. The surgeon will pick the right procedure of choice based on physical, radiographic and neuromuscular findings. 

This condition is an abnormally high arch of the foot that results in an excessive amount of bodyweight being directed to the ball and heel of the foot. Cavus foot can be congenital or acquired, may develop at any age, and can affect one or both feet.