Causes of High-Arched (Cavus) Foot
A high-arched foot (pes cavus) is most commonly caused by underlying neurologic or neuromuscular disorders, with approximately two-thirds of cases having an identifiable neurologic etiology 1, 2. The remaining cases are idiopathic, post-traumatic, or congenital in origin.
Primary Etiologies
Neurologic Causes (Most Common)
The cavus foot results from muscle imbalances that disrupt the normal tripod structure of the foot (heel, first metatarsal, fifth metatarsal) 3, 4. Key neurologic conditions include:
- Charcot-Marie-Tooth disease - the most common genetic cause 3
- Friedreich's ataxia 5
- Cerebral palsy 5
- Spinal cord tethering - particularly important in pediatric presentations 6
- Other spinal cord or peripheral nerve disorders 1, 2
Non-Neurologic Causes
- Idiopathic - accounts for the minority of cases where no underlying cause is identified 7
- Post-traumatic - following foot or ankle injuries 3, 7
- Residual clubfoot deformity 7
- Congenital structural abnormalities 3
Clinical Significance
Because two-thirds of cavus foot cases have an underlying neurologic diagnosis, recognition of this deformity mandates thorough neurologic evaluation 2. The deformity represents a three-dimensional malalignment characterized by:
- Exaggerated medial longitudinal arch elevation
- Hindfoot varus positioning
- Plantar flexed first ray
- Forefoot pronation (apparent supination)
- Claw toe deformities 8
Evaluation Priorities
Look specifically for:
- History of frequent ankle sprains or unstable gait - suggests chronic lateral instability 2
- Pain along metatarsal heads or lateral foot border - indicates abnormal pressure distribution 2
- Muscle atrophy in calves ("saber shins") - may mimic Charcot-Marie-Tooth syndrome 6
- Progressive symptoms - back/leg pain, sensory deficits, bowel/bladder dysfunction suggesting spinal cord tethering 6
- Family history - particularly for hereditary neuropathies 3
Confirm diagnosis with lateral weight-bearing radiographs showing increased arch height 2. In diabetic patients, cavus feet create high-risk pressure points requiring aggressive preventive foot care to avoid ulceration 8.
The critical clinical imperative is identifying the underlying neurologic cause through coordinated multidisciplinary evaluation, as this determines both prognosis and treatment approach 1, 2.