Cavus Foot: High Arch Causes, Symptoms & Treatment

What Is Cavus Foot and What Causes It?

Cavus foot (pes cavus) is a condition where the arch of the foot is abnormally high, causing excess pressure on the ball and heel. It affects 10-25% of the population and in 50-80% of cases is caused by an underlying neurological condition such as Charcot-Marie-Tooth disease, cerebral palsy, or spina bifida.

The foot normally has a curved arch that helps distribute body weight evenly and absorb shock when walking. In cavus foot, this arch is excessively high, which changes how weight is distributed across the foot. Instead of the weight being spread evenly, it concentrates on the ball of the foot (under the toes) and the heel, while the middle part of the foot bears almost no weight at all. This abnormal weight distribution is what causes many of the symptoms associated with cavus foot.

The condition can affect one or both feet and ranges from mild to severe. In mild cases, the high arch may be barely noticeable and cause no problems. In severe cases, the foot may be significantly deformed, with the toes curling into a claw-like position and the heel turning inward, making walking difficult and painful.

Understanding the underlying cause of cavus foot is crucial because treatment approaches differ significantly depending on whether the condition is progressive (getting worse over time) or stable. Progressive cavus foot is usually associated with neurological conditions and may require more aggressive treatment to prevent deterioration.

Neurological causes of cavus foot

The most important thing to understand about cavus foot is that it's often a sign of an underlying neurological condition. In fact, studies show that 50-80% of people with cavus foot have an identifiable neurological cause. This is why a thorough medical evaluation is essential when cavus foot is diagnosed, especially if it develops gradually in childhood or adolescence.

Charcot-Marie-Tooth disease (CMT) is the most common neurological cause of cavus foot, accounting for approximately 50% of all cases with an identified cause. CMT is an inherited condition that affects the peripheral nerves, causing progressive muscle weakness in the feet and legs. The muscle imbalance that results from this nerve damage leads to the characteristic high arch. Importantly, CMT often runs in families, so a family history of high arches or foot problems may indicate this condition.

Other neurological conditions that can cause cavus foot include:

• Cerebral palsy: Brain damage occurring before, during, or shortly after birth that affects muscle control
• Spina bifida: A birth defect where the spine doesn't close properly, affecting nerve function
• Muscular dystrophy: A group of genetic diseases causing progressive muscle weakness
• Polio and post-polio syndrome: Viral infection affecting motor neurons
• Spinal cord tumors: Tumors that compress nerves in the spinal cord
• Stroke: Brain damage that can affect muscle control on one side of the body
• Friedreich's ataxia: A genetic condition causing progressive nervous system damage

How muscle imbalance creates a high arch

To understand why neurological conditions cause cavus foot, it helps to know how foot muscles work together. The foot has two main groups of muscles that pull in opposite directions - some pull the arch up (like the tibialis posterior) while others pull it down (like the peroneus longus). Normally, these muscles balance each other perfectly.

When certain nerves are damaged, some muscles become weaker than others. If the muscles that pull the arch down become weak while those that pull it up remain strong, the arch gradually rises higher and higher. The toes also become affected - as the small muscles in the foot weaken, the toes begin to curl into a claw-like position because the long muscles in the leg overpower them.

This muscle imbalance also explains why the heel often turns inward in cavus foot. The muscles on the inside of the ankle become relatively stronger than those on the outside, pulling the heel into an abnormal position called "hindfoot varus." This makes ankle sprains much more common because the foot is constantly tilted to one side.

Idiopathic (unknown cause) cavus foot

In about 20-50% of cases, no underlying neurological condition can be found despite thorough testing. This is called idiopathic cavus foot. These cases are typically inherited - if one or both parents have high arches, their children are more likely to have them too. Idiopathic cavus foot is generally more stable than neurological cavus foot, meaning it doesn't usually get progressively worse over time.

Some researchers believe that idiopathic cavus foot may actually represent a very mild form of CMT or other hereditary neuropathies that aren't severe enough to cause other symptoms. However, for practical purposes, if a person has high arches without any neurological symptoms and no family history of neurological disease, their condition is likely to remain stable and can be managed conservatively.

What Are the Symptoms of Cavus Foot?

Common symptoms of cavus foot include foot pain (especially in the ball and heel), ankle instability and frequent sprains, claw toes or hammer toes, calluses, difficulty finding comfortable shoes, and tired legs after walking. Symptoms often develop gradually and worsen over time if untreated.

The symptoms of cavus foot vary greatly depending on the severity of the condition and whether there's an underlying neurological cause. Some people with mild cavus foot have no symptoms at all - they simply have noticeably high arches. Others experience significant pain and functional limitations that affect their daily activities.

It's important to understand that symptoms typically develop gradually over months or years rather than appearing suddenly. This gradual onset means people often don't realize their foot shape is causing their problems, especially if they've had high arches their whole life. Many people assume foot pain is normal or attribute it to other causes like aging or being on their feet too much.

Pain patterns in cavus foot

Pain is the most common reason people with cavus foot seek medical attention. The abnormal weight distribution caused by the high arch concentrates pressure on specific areas of the foot, leading to characteristic pain patterns.

Ball of the foot pain (metatarsalgia) is extremely common because the high arch forces the front of the foot to bear more weight than it should. People often describe this as feeling like they're walking on rocks or having a permanent bruise under their toes. The pain is usually worse when walking, standing for long periods, or wearing shoes with thin soles.

Heel pain develops because the heel absorbs more impact than normal. This can lead to plantar fasciitis (inflammation of the tissue connecting the heel to the toes), heel bruising, or even stress fractures in severe cases. The pain is often worse first thing in the morning or after periods of rest.

Ankle pain results from the abnormal position of the heel and the resulting strain on the ankle joint and surrounding ligaments. Many people with cavus foot also develop chronic ankle instability, leading to recurrent sprains that can become a frustrating cycle of injury and re-injury.

Toe deformities

As cavus foot progresses, the toes often become deformed. Claw toes develop when both joints of the toe bend abnormally - the toe bends up at the joint where it meets the foot, then curls down at the middle and end joints, creating a claw-like appearance. Hammer toes are similar but affect only one joint. These toe deformities can make wearing shoes extremely difficult and painful, as the tops of the bent toes rub against the shoe.

Toe deformities also affect balance and walking ability. The toes play an important role in pushing off during walking, and when they're locked in an abnormal position, this function is impaired. Many people with cavus foot feel unstable when walking, especially on uneven surfaces.

Ankle instability and recurrent sprains

People with cavus foot are significantly more likely to sprain their ankles than those with normal arches. This happens because the heel tilts inward, placing the ankle in a vulnerable position that's prone to rolling outward. Some studies suggest that people with cavus foot are up to four times more likely to experience ankle sprains.

What makes this particularly problematic is that each sprain further weakens the ankle ligaments, making future sprains more likely. This creates a cycle of chronic ankle instability that can be difficult to break. People with this problem often feel like their ankle "gives way" unexpectedly, especially when walking on uneven ground.

Calluses and skin problems

The abnormal pressure distribution in cavus foot leads to thick calluses forming on the ball of the foot and the outer edge of the heel. While calluses themselves aren't harmful, they indicate areas of excessive pressure that may eventually develop into more serious problems like blisters, ulcers, or infections - particularly in people with diabetes or reduced sensation in their feet.

When Should You See a Doctor for Cavus Foot?

See a doctor if you experience persistent foot or ankle pain, frequent ankle sprains (more than twice a year), numbness or weakness in the feet, progressive worsening of foot shape, or if a child develops a noticeably high arch. Early diagnosis is important as cavus foot may indicate an underlying neurological condition.

Not everyone with high arches needs medical attention. Many people live their entire lives with naturally high arches and never experience any problems. However, there are certain situations where a medical evaluation is important.

The most important reason to see a doctor is if your cavus foot is causing symptoms that affect your quality of life. Persistent pain when walking, difficulty finding shoes that fit, or feeling unstable on your feet are all valid reasons to seek help. Many people put up with these problems for years, not realizing that effective treatments are available.

You should also seek evaluation if your foot shape seems to be changing or if symptoms are getting progressively worse. Progressive cavus foot often indicates an underlying neurological condition that may need treatment in its own right. Early detection of conditions like Charcot-Marie-Tooth disease allows for better planning and management.

Signs that require prompt medical attention

• Frequent ankle sprains: More than two ankle sprains per year suggests chronic instability that needs treatment
• Numbness or tingling: These symptoms suggest nerve involvement and warrant neurological evaluation
• Muscle weakness: Difficulty lifting your foot or toes can indicate an underlying condition
• Foot drop: Inability to lift the front of your foot when walking is a serious symptom requiring immediate evaluation
• Worsening deformity: If your arch seems to be getting higher or your toes more curved, see a doctor
• Family history: If relatives have similar foot problems or neurological conditions, you should be evaluated

Evaluation in children

Cavus foot in children deserves special attention. While all babies have flat feet and arches normally develop by age 6-8, a noticeably high arch in a child should be evaluated. Children's feet are still developing, and early intervention can sometimes prevent problems from becoming more severe.

Parents should watch for signs like the child preferring to walk on their toes, frequently tripping or falling, complaining of tired legs, or having trouble keeping up with peers during physical activities. A child with high arches who also has balance problems, muscle weakness, or difficulty with coordination should see a pediatric neurologist.

How Is Cavus Foot Diagnosed?

Cavus foot is diagnosed through physical examination assessing foot shape, muscle strength, and gait. X-rays show bone alignment, while neurological testing (including EMG and nerve conduction studies) helps identify underlying conditions. The Coleman block test determines if the deformity is flexible or fixed.

Diagnosing cavus foot itself is usually straightforward - the high arch is often visible to the naked eye. However, a thorough evaluation goes far beyond simply confirming the diagnosis. The real goals are to assess severity, determine whether the condition is progressive, and identify any underlying causes that may need treatment.

Physical examination

Your doctor will start by examining your feet while you're sitting, standing, and walking. They'll look at the height of your arch, the position of your heel (whether it tilts inward), and whether your toes are developing claw or hammer deformities. They'll also check whether your foot is flexible (can be manually corrected to a more normal position) or rigid (fixed in the abnormal position). This distinction is important because flexible deformities are generally easier to treat and have a better prognosis.

The Coleman block test is a specific examination that helps determine where the deformity is coming from. You stand with the ball of your foot on a wooden block while your heel hangs off the edge. If your heel position corrects when the front of the foot is unloaded, this tells the doctor that the problem is primarily in the forefoot rather than the hindfoot, which affects treatment planning.

Muscle strength testing is essential. Your doctor will check the strength of the various muscles that control foot and ankle movement. Weakness in specific muscles can point toward an underlying neurological condition and also helps determine which muscles might need to be addressed if surgery is considered.

Imaging studies

X-rays are the primary imaging study for cavus foot. Weight-bearing X-rays (taken while you're standing) show the true position of the bones under load. The doctor will measure specific angles to assess the severity of the deformity and track whether it's changing over time. X-rays also reveal any arthritis that may have developed as a result of the abnormal joint mechanics.

MRI scans may be ordered if there's concern about soft tissue problems like tendon damage or if a spinal cord abnormality is suspected. MRI is particularly useful for evaluating the spine in cases where the cause of cavus foot isn't clear.

Neurological evaluation

Given that most cases of cavus foot have an underlying neurological cause, a neurological evaluation is often recommended. This may include:

• Electromyography (EMG): Measures the electrical activity of muscles to detect nerve damage
• Nerve conduction studies: Measures how quickly electrical signals travel through nerves
• Genetic testing: May be recommended if Charcot-Marie-Tooth disease is suspected
• Spine MRI: Checks for spinal cord abnormalities that might be causing nerve damage

These tests help determine whether there's an underlying condition that needs to be treated and provide important information about prognosis. If a progressive neurological condition is found, treatment planning takes into account that the foot deformity may worsen over time.

How Is Cavus Foot Treated?

Treatment for cavus foot depends on severity. Conservative options include custom orthotics (shoe inserts), supportive footwear, physical therapy for stretching and strengthening, and activity modification. Surgery is considered when conservative treatment fails and may include osteotomy, tendon transfer, or fusion procedures. About 85-90% of patients improve with non-surgical treatment.

The good news about cavus foot is that most people can be effectively managed without surgery. The key is finding the right combination of treatments that address your specific symptoms and needs. Treatment is usually approached in a stepwise fashion, starting with the simplest interventions and progressing to more complex options only if needed.

Custom orthotics and shoe modifications

Custom-made orthotics are the foundation of conservative treatment for cavus foot. Unlike over-the-counter insoles that are generic, custom orthotics are made from molds of your feet and designed specifically to address your unique foot shape and problems. They work by redistributing pressure more evenly across the foot, supporting the high arch, and accommodating any toe deformities.

A properly designed orthotic for cavus foot typically has a deep heel cup to stabilize the heel, a well-shaped arch support, and extra cushioning under the metatarsal heads (the bones at the base of the toes) to relieve ball-of-foot pain. The orthotic should feel comfortable and make walking easier - if it causes increased pain, it needs to be adjusted.

Shoe selection is equally important. People with cavus foot generally do best with:

• High-top shoes or boots: These provide extra ankle support and can help prevent sprains
• Wide toe boxes: Allow room for claw toes without rubbing
• Firm heel counters: Help stabilize the heel
• Shock-absorbing soles: Reduce impact on the heel and ball of foot
• Lace-up or adjustable closures: Allow for a secure, customized fit

Physical therapy

Physical therapy plays an important role in managing cavus foot, particularly for strengthening weak muscles and improving flexibility. A physical therapist can design an exercise program tailored to your specific needs.

Common components of a cavus foot exercise program include:

• Calf stretching: The Achilles tendon is often tight in cavus foot and needs regular stretching
• Plantar fascia stretching: Helps relieve heel pain
• Ankle strengthening: Particularly the peroneal muscles on the outside of the ankle to improve stability
• Intrinsic foot muscle exercises: Strengthen the small muscles within the foot
• Balance training: Improves proprioception (your body's awareness of foot position) and reduces fall risk

Bracing and ankle support

For people with significant ankle instability, an ankle brace or ankle-foot orthosis (AFO) may be helpful. These devices provide external support to the ankle, reducing the risk of sprains and improving walking confidence. Options range from simple lace-up ankle braces to more substantial AFOs that extend up the lower leg.

Surgical treatment

Surgery is considered when conservative treatment has failed to provide adequate relief after a reasonable trial period (usually at least 6-12 months) and when symptoms significantly impact quality of life. Approximately 10-15% of people with cavus foot eventually require surgery.

Surgical options for cavus foot include:

Soft tissue procedures: These include plantar fascia release (cutting the tight tissue under the arch), Achilles tendon lengthening, and tendon transfers (moving tendons from stronger muscles to replace the function of weaker ones). Soft tissue procedures are often combined with bone procedures for optimal results.

Osteotomy: This involves cutting and repositioning bones to correct alignment. A calcaneal osteotomy shifts the heel back to a more normal position, while midfoot osteotomies can lower the arch. Modern techniques often allow these procedures to be done through small incisions with faster recovery.

Fusion procedures: In severe cases or when significant arthritis is present, joints may need to be fused (permanently stiffened) to provide stability and relieve pain. While fusion does limit motion, it can provide excellent pain relief and function.

The choice of surgical procedure depends on many factors including the severity and flexibility of the deformity, which specific structures are affected, whether there's an underlying progressive condition, and your activity goals. Often, multiple procedures are combined in a single surgery to address all aspects of the problem.

Can Cavus Foot Be Prevented or Complications Avoided?

While cavus foot itself often cannot be prevented (especially when caused by genetic or neurological conditions), complications can be minimized through proper footwear, custom orthotics, regular stretching exercises, and avoiding activities that increase ankle sprain risk. Early treatment prevents progression and secondary problems.

Prevention strategies for cavus foot depend on the underlying cause. If you have a genetic predisposition or an underlying neurological condition, you cannot prevent the high arch from developing. However, you can take steps to minimize symptoms and prevent complications.

Preventing symptoms and progression

If you know you have cavus foot or are at risk (for example, if it runs in your family), the following measures can help:

• Wear appropriate footwear: Consistently wearing supportive shoes with proper cushioning reduces stress on the foot
• Use orthotics: Even if you don't have symptoms yet, well-designed orthotics can prevent problems from developing
• Maintain flexibility: Regular stretching of the calf muscles and plantar fascia keeps tissues from becoming too tight
• Strengthen supporting muscles: Strong ankle and foot muscles provide better support and stability
• Avoid high-risk activities: Activities that increase ankle sprain risk (like trail running on uneven terrain without ankle support) may need to be modified
• Regular monitoring: If you have a progressive neurological condition, regular follow-up allows early intervention if the condition worsens

Preventing complications

The main complications of untreated cavus foot include chronic ankle instability, stress fractures, plantar fasciitis, metatarsalgia (ball of foot pain), and eventually arthritis. Most of these can be prevented or minimized with proper care:

• Ankle sprains: Use ankle braces during high-risk activities, strengthen the peroneal muscles, and practice balance exercises
• Stress fractures: Use cushioned, supportive footwear and avoid sudden increases in activity level
• Calluses and ulcers: Regular podiatry care, properly fitting shoes, and monitoring for pressure areas
• Arthritis: Proper alignment through orthotics or surgery when needed reduces abnormal joint wear

What Is It Like Living With Cavus Foot?

Most people with cavus foot can lead active, normal lives with proper management. Key strategies include wearing custom orthotics daily, choosing supportive footwear, doing regular exercises, and seeking treatment promptly when symptoms develop. Many athletes successfully compete despite having high arches.

Living with cavus foot is different for everyone, depending on the severity of the condition and whether there's an underlying neurological cause. Many people with mild to moderate cavus foot find that with proper orthotics and footwear, they can do almost everything they want to do.

The key to living well with cavus foot is consistency. Wearing your orthotics every day, choosing appropriate shoes (even when you'd prefer fashionable ones), and keeping up with stretching exercises all make a significant difference over time. Many people find it helpful to have multiple pairs of orthotics so they can wear them in different shoes.

Activity modifications

While most activities are possible with cavus foot, some modifications may help:

• Running: Many people with cavus foot run successfully, but may need to be more careful about shoe selection and gradually increase mileage to avoid stress fractures
• Hiking: High-top hiking boots with ankle support are recommended. Trekking poles can help with balance on uneven terrain
• Sports: High-impact sports may increase injury risk. Ankle bracing is often recommended for activities involving jumping or quick direction changes
• Standing jobs: May require more attention to footwear and potentially more frequent breaks

Long-term outlook

The prognosis for cavus foot depends largely on the underlying cause. Idiopathic (no known cause) cavus foot that remains stable over time has an excellent prognosis - most people do well with conservative management indefinitely. Progressive cavus foot associated with neurological conditions may require more intensive management over time, including possible surgery if the deformity worsens significantly.

With modern treatment approaches, even severe cavus foot can usually be managed effectively. The key is working with a knowledgeable healthcare team, following treatment recommendations consistently, and seeking help promptly when new symptoms develop.