PES CAVUS

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Pes cavus is a descriptive term for a foot type that is characterized by a high arch of the foot. The foot with a high arch typically does not flatten with weightbearing. The highest point of the arched foot can be in the forefoot, the midfoot, the hindfoot, or a combination of these sites. Whereas this condition is a common finding, occurring in approximately 10% of the general population; it can also be a sign of a neurological disorder.

Pes cavus often accompanies associated foot deformities, such as clawing or hammering of the toes, posterior hindfoot deformity (calcaneal varus), contracture of the plantar fascia, and a cocked-up great toe. These conditions may cause increased weightbearing on the metatarsal heads, possibly resulting in metatarsalgia and calluses. Moreover, patients with pes cavus commonly experience plantar fasciitis.

Patients with a pes cavus foot type may exhibit lateral (outside) foot pain due to increased weightbearing on the lateral foot. Metatarsalgia, a common pathology causing pain on the ball of the foot, often accompanies the condition, along with the development of plantar corns and calluses. Observations in patients with neuromuscular disease can reveal ankle instability, weakness, and fatigue. Furthermore, individuals with a pes cavus foot type frequently experience ankle sprains and peroneal tendinitis.

Your foot and ankle specialist will assess the severity and cause of this condition initially through a thorough history and complete examination to determine the cause of pes cavus. Neuromuscular disorders may be associated with pes cavus and can be identified based on the family history. In rare cases, a spinal cord tumor may lead to a sudden onset of a one-sided (unilateral) pes cavus foot type, necessitating an interdisciplinary workup with a spine specialist.

Treatment

Your doctor may prescribe conservative treatment for pes cavus, which can offer significant relief. Physical therapy can be recommended to stretch tight muscles on the lateral foot and ankle and to strengthen weak muscles through various balancing exercises.

Your doctor may also prescribe orthotics with extra-depth shoes. Orthotics can help offload bony prominences, prevent toe rubbing, and promote more balanced foot biomechanics. Additionally, lateral wedge sole modifications, ankle supports and braces, and high-top boots may be added to prevent ankle instability.

The treatment goal is to achieve a plantigrade foot (a tripod foot) that distributes weight evenly and enables the patient to walk without symptoms, such as pain. Failure to maintain a pain-free plantigrade foot may indicate the need for surgery.

Surgical Treatment 

Your surgeon or physician will discuss individualized surgical treatment options if conservative management of pes cavus proves ineffective. Surgical management addresses the deforming forces of the foot and aims to restore a tripod or plantigrade foot.

Pes cavus foot reconstruction typically involves bone restructuring, tendon balancing, and soft tissue repair and releases. Your surgeon will outline the different procedures necessary for reconstruction and provide information on the expected healing time.

Immediate postoperative care will entail at least 6-8 weeks of non-weightbearing, physical therapy, and a gradual transition back to comfortable shoes. Follow-up appointments at 12 weeks, 6 months, and annually will be necessary for pes cavus foot correction.

Schedule a visit with your foot and ankle specialist if you believe you have a pes cavus foot type or have any symptoms in the article above.

If you would like to speak to one of our texas orthopedic foot and ankle specialists, give us a call at 817-697-4038, or contact us over the web. Tele-medicine appointments are also available.