What is the treatment for bilateral cavus (high arches) of the feet in a 53-year-old active female?

Treatment for Bilateral Cavus Feet in a 53-Year-Old Active Female

Custom foot orthoses are the most effective treatment for bilateral cavus feet in active adults, providing significant pain relief, improved function, and better quality of life compared to standard insoles.

Understanding Cavus Foot Deformity

Cavus foot (pes cavus) is characterized by an abnormally high arch in the midfoot region. This condition can lead to:

• Increased plantar pressure in specific areas of the foot
• Foot pain and instability
• Potential development of calluses, metatarsalgia, and ankle instability
• Limited shock absorption during walking and other activities

In a 53-year-old active female, this condition requires appropriate management to prevent pain, maintain activity levels, and prevent long-term complications.

Diagnostic Considerations

Before treatment, it's important to determine:

1. Flexibility of the deformity: Whether the high arch is rigid or flexible
2. Presence of neurological causes: Cavus feet can be associated with neurological conditions like Charcot-Marie-Tooth disease
3. Severity of symptoms: Pain locations, functional limitations, and impact on activities
4. Foot alignment: Assessment of heel position (varus/valgus) and forefoot position

Treatment Approach

First-Line Treatment: Custom Foot Orthoses

Custom foot orthoses (CFO) are the most effective first-line treatment for cavus foot pain and associated functional limitations 1. A randomized controlled trial demonstrated that custom orthoses provide significantly better outcomes than sham insoles, with improvements in:

• Foot pain (8.3 points better than control)
• Function (9.5 points better than control)
• Physical functioning aspects of quality of life
• Plantar pressure distribution 1, 2

Proper Footwear Selection

For optimal results, footwear should:

• Have adequate depth and width to accommodate the high arch
• Provide proper support for the foot structure
• Include extra depth when using custom orthoses 3

As recommended by guidelines:

• Extra wide or deep shoes should be provided
• For severe deformities, custom-molded shoes may be necessary when commercial therapeutic footwear cannot accommodate the foot 3

Exercise Program

Implement an exercise program including:

• Strengthening exercises for foot and ankle muscles
• Stretching exercises for tight structures
• Balance training
• Core stability training
• Aerobic exercise for general fitness 3

Monitoring and Prevention

• Regular foot inspection for injuries, especially in areas with potential sensory loss
• Monitoring skin temperature to detect inflammation
• Assessment of muscle strength, balance, and functional capacity
• Monitoring for development of pressure points 3

When to Consider Surgical Intervention

Surgery should be considered when:

1. Conservative measures fail to provide adequate pain relief
2. Foot/ankle joint instability is present
3. Deformity presents high risk for developing ulcers
4. Pain cannot be adequately managed with conservative measures 3

Surgical options may include:

• Soft-tissue and plantar fascia releases (for flexible deformities)
• Osteotomy (for fixed deformities)
• Tendon transfers (to restore muscle balance) 4, 5

Mechanism of Orthotic Effectiveness

Research shows that the primary mechanism by which custom foot orthoses provide pain relief is through redistribution of abnormal plantar pressures rather than simply reducing pressure magnitude 2. The Dynamic Plantar Loading Index, which measures pressure redistribution, significantly correlates with pain relief.

Important Considerations

• If the cavus foot is related to a neurological condition, treatment of the underlying cause may be necessary
• Triple arthrodesis should be avoided when possible as it can accelerate the development of osteoarthritis in adjacent joints 6
• For patients with significant deformity and instability, below-knee customized devices may provide additional protection and support 7

Conclusion

For a 53-year-old active female with bilateral cavus feet, custom foot orthoses represent the most effective evidence-based treatment approach. These should be combined with appropriate footwear, exercise, and regular monitoring to maintain optimal function and quality of life.