From the Guidelines
Patients with high arch signs, also known as pes cavus, should be referred to a podiatrist for further evaluation and care to prevent foot ulcers and other complications. High arch signs refer to the clinical indicators of a high foot arch, which can include visible elevation of the arch when standing, calluses on the outer edge or ball of the foot, hammertoes or claw toes, foot pain during standing or walking, and instability in the ankle 1. According to the 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline, the presence of foot deformities, including severe high-arch foot, is a risk factor for the development of foot ulcers among patients with peripheral artery disease 1.
Some key signs and symptoms of high arches include:
- Visible elevation of the arch when standing
- Calluses on the outer edge or ball of the foot
- Hammertoes or claw toes
- Foot pain during standing or walking
- Instability in the ankle
- Excessive wear on the outer edges of shoes
- Difficulty finding properly fitting footwear
- Reduced shock absorption when walking or running
Management of high arch signs typically involves:
- Supportive footwear with cushioning
- Custom orthotic inserts to redistribute pressure
- Physical therapy to strengthen foot muscles
- Pain medications like NSAIDs for discomfort
- Referral to a podiatrist or orthopedic specialist for evaluation and treatment to rule out underlying neurological conditions 1.
It is essential to address high arch signs to prevent complications, such as foot ulcers, and to improve the patient's quality of life 1.
From the Research
High Arch Signs
- High arch signs, also known as pes cavus, can be associated with various conditions, including Charcot-Marie-Tooth disease 2, 3, 4, 5, 6
- Charcot-Marie-Tooth disease is the most common diagnosis associated with cavus foot, and the imbalance involving intrinsic and extrinsic muscles is suggested as the main pathogenetic cause of cavus foot in this disease 2
- The goal of surgical treatment for cavus foot in Charcot-Marie-Tooth disease is to correct the deformity and obtain a plantigrade foot, while preserving as much as possible of the overall range of motion of the foot and ankle 2
Characteristics of High Arch Signs
- Pes cavovarus is a foot deformity that can be idiopathic or acquired secondary to other pathology, such as Charcot-Marie-Tooth disease 4
- The foot morphology of Charcot-Marie-Tooth disease-related pes cavovarus and idiopathic pes cavovarus has been found to be morphologically different from healthy feet, with Charcot-Marie-Tooth disease feet exhibiting increased forefoot supination and hindfoot malalignment compared to idiopathic forms 4
- Acquired pes cavus in Charcot-Marie-Tooth disease is characterized by a fixed increase of the plantar arch and hindfoot inversion, and diagnosis of the underlying condition is crucial for decision-making about adequate treatment 5
Treatment of High Arch Signs
- Conservative treatment of cavusvarus foot with physiotherapy, insoles, and shoe modifications is reserved for young patients and mild deformities, while surgical treatment is performed in early stages to correct the deformity and dynamic unbalance 2, 5
- Muscular transfers are used to treat the dynamic unbalance, retracted structures should be either divided or lengthened, and localized osteotomies should be preferred over arthrodeses, which are reserved for stiff and severely deformed feet in adults 5