Cavus feet


Pes Cavus (high-arched) foot
 
Some questions answered


What is a cavus foot?

The inner edge of the foot is raised off the floor in the middle to form the arch of the foot. The height of the arch varies from person to person. When it is higher than normal the shape of the foot is called "cavus".
 
When a person with a cavus foot stands, the middle of the foot seems to be raised higher off the ground than normal. The heel may be drawn in towards the inner side, and the toes may also be drawn inwards. Some people with cavus feet also have curled-up "claw" toes.
 
Although the most obvious thing about a cavus foot is usually the high arch, this appearance is actually produced by other more basic deformities in the foot. In all cavus feet the front part of the foot is drawn downwards more than normal, and the part on the side of the big toe (first ray) is usually drawn down most of all. The result is to tip the arch upwards, and also to tip the foot onto its outer side. It is this combination that produces the appearance of a high arch and a large space under the foot.
 
In a few people with cavus feet who have weak calf muscles, the heel is also drawn down and this adds to the height of the arch. Other people, whose Achilles tendons become tight, have their heel drawn up. This tends to increase the pressure on the ankle and the ball of the foot. Other people's heels are neither drawn up or down. The heel of any cavus foot may also turn inwards because of the tilting of the rest of the foot. To start with, the heel tilting is flexible but with the passage of time the tissues and joints may become stiff and the heel tilt may become fixed.
 
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What causes a cavus foot?

In many people, we do not know the cause of their cavus foot. These people tend to have milder deformities and the foot appearance sometimes runs in the family.
 
Many medical conditions which cause weakness or lack of co-ordination of muscles can result in a cavus foot. Examples of such conditions include spina bifida, muscular dystrophy and conditions in which the small nerves in the legs do not work properly. It is thought that even when no definite medical condition can be found, cavus feet are probably due to very slight weakness of muscles in the legs and feet.
 
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I have high arches - should I be having tests for all these diseases?

This is an impossible question to answer in an information page such as this! If your arches appear to be getting higher, your feet are tilting over, your toes are curling up or your feet feel weak or numb, you should definitely consult your doctor. Otherwise it probably depends on how much trouble your feet are giving you.
 
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I have high arches - will my children have this too?

Possibly. Unless you know why you have high arches it is impossible to say how likely it is thst your children will have this too.
 
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What problems does pes cavus cause?

Many people with pes cavus have no problem at all. Sometimes it can be difficult to find shoes to fit, or the feet may ache, especially around the ankle, the outer edge of the foot or in the ball of the foot. Curled-up toes may rub on shoes.  
 
Cavus feet tend to be stiffer than normal and may not take pressure as well as normal feet, so they may ache if you have been on your feet for a while. Some people with mild cavus feet don't notice them until they take up running or other sports, when the cavus may limit their exercise tolerance.
 
Some people complain that their ankles feel weak and they get ankle sprains easily. A few people who have reduced feeling in their feet as part of the condition that caused the cavus, find that their skin rubs raw in areas of high pressure. This is a strong reason to consult your doctor.
 
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I go over on my ankle a lot - is this a sign of pes cavus?

Not necessarily. Most people who go over on the ankle a lot originally damaged the ankle in an injury and this has never fully healed. However, if you have a high arch as well, this could be contributing to the problem. There is a page on this site which gives further information about ankle ligament problems, including advice about when to consult a doctor or physiotherapist.
 
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I have pain in the ball of my foot - is this caused by pes cavus?

Not necessarily. There are many causes of pain in the ball of the foot, or "metatarsalgia". Sometimes no definite cause can be found. However, if you have a high arch, especially if you have curled-up toes too, this could be contributing to the problem. There is a page on this site which gives further information about metatarsalgia, including advice about when to consult a doctor or chiropodist
 
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My small toes are curled up - is this a sign of pes cavus?

Not necessarily. There are many causes of deformity of the small toes. However, if you have a high arch, they could be related. There is a page on this site which gives further information about problems with the small toes, including advice about when to consult a doctor or chiropodist.
 
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Can I do anything about it myself?

You won't be able to do anything about the underlying cause, if there is one. Exercising and stretching your foot may help to minimise the stiffness.
 
The most important thing is to take care of your feet well. Make sure there is plenty room in your shoes, with no rubbing on your toes. If you walk a lot or play sport, make sure you have plenty of shock-absorbing material in your shoes, as cavus feet are often a bit stiff and absorb shock poorly. If you don't have normal feeling in your feet, check them every day for raw, discoloured or broken areas of skin. A pad or insole in your shoe may help relieve aching in the arch of your foot.
 
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When should I take professional advice?

If your feet seem to be getting more deformed or troublesome in any of the ways outlined it is best to speak to your GP. Any child with cavus feet should be seen by a doctor.
 
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How will my doctor know what's wrong?

Your doctor will listen to your complaints about your cavus feet and examine you. Usually you will need a complete examination the first time you see your doctor, to see whether you have any medical condition that might cause cavus feet.
 
Your doctor may want you to see a specialist to discuss whether you should have any more tests. This may be a neurologist (a specialist in diseases of the nervous system) or an orthopaedic foot and ankle surgeon. If tests are felt necessary, you may have blood tests, Xrays of your feet or spine, scans of your spine or head or electrical tests to see if your nerves are working. Sometimes these tests come up with a definite medical condition, but sometimes they do not.
 
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What can be done about pes cavus?

The most important thing is basic foot care as outlined above (Can I do anything about it myself?). If you have difficulty getting shoes to fit, your GP or specialist can arrange for an orthotist to get you shoes with a bit more room. These usually look like ordinary shoes, just a bit bigger. The orthotist may also be able to help with insoles to relieve aching or to spread weight away from raw skin or calluses. If your foot tilts over a lot, especially if your heel tilts too, a splint, brace or caliper may make it more stable for walking.
If your ankle gives way a lot, it may be worth going through a course of exercises with a physiotherapist - it depends on how weak your muscles are to start with. Other things which help with a weak ankle include wearing a brace or splint or putting an extra bit on to your shoes to spread your weight out over a larger area of heel.
 
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Will I need an operation?

Most people with cavus feet do not need operations. However, if your cavus feet cause a lot of pain, rub badly on your shoes so that the skin breaks down, or your foot or ankle are very unstable, and simple treatment has not helped, it may be worth considering an operation to straighten your foot. Your GP can refer you to an orthopaedic foot and ankle surgeon to advise you about surgery.
 
The surgeon will listen to your problems, examine you carefully and analyse the exact nature of your deformity and the problems it causes. Surgery for cavus foot is often quite major, especially if the deformity is severe or very stiff.  
 
 
Possible operations include:
  • straightening your toes to stop them rubbing on your shoes and to take the pressure off the ball of your foot
  • breaking and re-shaping one or more bones in the front, middle or heel of your foot to straighten the deformity
  • re-shaping and stiffening one or more joints, usually in the middle or heel of your foot, to straighten the deformity and make your foot more stable
  • moving one or more of the tendons of your foot to another part of the foot to give more strength to a weak area
  • tightening the ligament of your ankle or strengthening it with another bit of tissue to stop your ankle going over
 
You might need more than one option from this list, and it may not be possible to do it all at once. Your surgeon will discuss the options fully with you, including the chances of success and failure, to help you make up your mind about what you want to do.
 
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