From the Guidelines
A high arching foot is called pes cavus. This condition is characterized by an abnormally high arch in the foot that remains elevated even when bearing weight, as mentioned in the 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline for the management of lower extremity peripheral artery disease 1. Pes cavus can be caused by various factors including neurological disorders, genetic conditions, or structural abnormalities. It often leads to increased pressure on the ball and heel of the foot, potentially causing pain, instability, calluses, and difficulty finding properly fitting footwear. People with pes cavus may experience symptoms such as foot pain, frequent ankle sprains, and development of hammertoes or claw toes. Some key points to consider in managing pes cavus include:
- Referral to a podiatrist for further evaluation and care, as foot deformities like pes cavus can lead to foot ulcers caused by joint immobility, friction, or pressure 1
- Use of therapeutic footwear to prevent many diabetic foot complications, which can be recommended by a specialist who understands the type or shape of the most protective shoe for the individual that fits properly, reduces plantar pressure, and can help prevent a foot ulcer in patients with diabetes who are at risk 1
- Home foot temperature monitoring to identify local increases in skin temperature and areas at risk for ulceration, although additional studies are needed 1 Management typically involves supportive footwear with cushioning, custom orthotic devices to redistribute pressure, physical therapy to strengthen supporting muscles, and in severe cases, surgical intervention may be necessary. The condition differs from flat feet (pes planus) which represents the opposite structural issue where arches are flattened or absent.
From the Research
Definition of High Arching Foot
- A high arching foot is also known as a cavus foot, which is characterized by an abnormal elevation of the medial arch of the foot 2, 3, 4.
- The cavus foot can occur in both children and adults, and it can be caused by various factors, including muscle imbalance, neurologic, traumatic, and idiopathic processes 3, 4.
- The diagnosis of cavus foot can be confirmed with a lateral weight-bearing radiograph, and treatment options are available to alleviate the pain and dysfunction caused by this deformity 2, 3, 5.
Key Characteristics of Cavus Foot
- The cavus foot is defined as a high arch in the sagittal plane, which can occur as a variant of normal or as a component of a foot deformity 4.
- The deformity can be classified into two types: direct pes cavus, which occurs only in the sagittal plane, and pes cavovarus, which is a three-dimensional deformity characterized by rotation of the calcaneopedal unit 4.
- Patients with cavus foot may present with unstable gait, frequent ankle sprains, or pain along the metatarsal heads or the lateral border of the foot 2, 3.
Treatment Options for Cavus Foot
- Conservative treatment modalities, such as orthotic devices, are always used first to treat cavus foot pain and dysfunction 3, 6, 5.
- Surgical intervention, such as tendon transfers, corrective osteotomies, and fusion, may be reserved for refractory cases 3, 4.
- Custom foot orthoses have been shown to be effective in reducing foot pain, improving function, and enhancing quality of life in patients with cavus foot 5.