Can poor footwear cause cavus (high arches)?

Poor Footwear and Cavus Foot Development

Poor footwear alone does not cause cavus foot (high arches), as this condition is primarily associated with neurologic disorders, muscle imbalances, and genetic factors rather than external causes like shoes. 1

Understanding Cavus Foot

Cavus foot (pes cavus) is characterized by an abnormally high arch in the foot that remains elevated even when bearing weight. This condition typically develops due to:

• Neurologic disorders causing muscle imbalance
• Traumatic injuries
• Idiopathic processes (unknown causes)
• Residual effects from treated clubfoot 1

Unlike flat feet (pes planus), which can sometimes be influenced by external factors, cavus foot is primarily related to internal structural and neuromuscular issues.

Relationship Between Footwear and Foot Deformities

While poor footwear doesn't cause cavus foot, it's important to understand the relationship between footwear and foot health:

• Inappropriate footwear is a major cause of foot ulceration, especially in high-risk patients 2
• Ill-fitting shoes are the most frequent cause of foot ulceration, even in patients with ischemic ulcers 2
• Poorly fitting footwear can exacerbate existing foot deformities and cause pain in those with cavus feet 3

How Footwear Affects Existing Cavus Foot

For those who already have cavus foot, inappropriate footwear can:

• Increase plantar pressure at high-risk areas 2
• Worsen foot pain and functional limitations 3
• Lead to secondary issues like callus formation, stress fractures, and metatarsalgia 4
• Contribute to ankle instability and peroneal tendonitis 4

Proper Footwear for Cavus Foot

For individuals with cavus foot, appropriate footwear is essential:

• Shoes should have adequate length (1-2 cm longer than the foot) 2
• Internal width should equal the width of the foot at the metatarsal phalangeal joints 2
• Height should allow enough room for the toes 2
• Extra-depth shoes may be required for significant deformities 2
• Custom-made footwear may be necessary for severe cases 2

Treatment Approaches for Cavus Foot

Treatment for cavus foot should focus on addressing the underlying cause:

• Custom foot orthoses have been shown to significantly improve foot pain, function, and quality of life in patients with cavus feet 3
• Orthotic devices can help distribute plantar pressure more evenly 5
• Conservative treatment modalities should always be tried first 1
• Surgical intervention is reserved for refractory cases to correct muscle imbalance 1
• Joint mobility testing and mobilization may be beneficial in cases where hypomobility is mistaken for cavus deformity 6

Prevention and Management

For those at risk of foot complications:

• Regular foot inspections should be performed 2
• Properly fitting footwear should be worn both indoors and outdoors 2
• Footwear fit should be evaluated with the patient standing, preferably at the end of the day 2
• Patients with foot deformities should be referred to a podiatrist for evaluation and care 2, 5

Key Takeaways

1. Cavus foot is primarily caused by neurologic, traumatic, or idiopathic processes, not by poor footwear 1
2. While poor footwear doesn't cause cavus foot, it can exacerbate symptoms and lead to complications in those who already have the condition 3
3. Appropriate footwear and custom orthoses can significantly improve pain and function in individuals with cavus foot 3
4. Early intervention and proper management can prevent complications associated with cavus foot 2

Remember that any foot deformity, including cavus foot, requires proper evaluation by a healthcare professional to determine the underlying cause and appropriate treatment approach.