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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 pes cavus is a common finding, occurring in approximately 10% of the general population; it can also be a sign of a neurological disorder.
Associated foot deformities that accompany pes cavus includes clawing or hammering of the toes, posterior hindfoot deformity (calcaneal varus), contracture of the plantar fascia, and a cocked up great toe. This can cause increased weightbearing for the metatarsal heads, which may cause metatarsalgia and calluses. Plantar fasciitis is also quite common with patients with pes cavus.
Patients with a pes cavus foot type can present with lateral (outside) foot pain from increased weightbearing on the lateral foot. Metatarsalgia, one pathology that causes pain on ball of the foot, is a frequent symptom, along with developing plantar corns and callus. Ankle instability, weakness, and fatigue can be observed in patients with neuromuscular disease. Ankle sprains, along with peroneal tendinitis can be frequent with patients who have a pes cavus foot type.
Your foot and ankle specialist will determine the severity and cause of pes cavus initially by completing a thorough history and complete examination to determine the cause of pes cavus. Pes cavus can be associated with a neuromuscular disorders and can be identified based on the family history. Infrequently, a spinal cord tumor may cause a sudden onset of a one sided (unilateral) pes cavus foot type and will need an interdisciplinary workup with a spine specialist.
Conservative treatment of pes cavus may provide significant relief. Physical therapy can be prescribed by your doctor to stretch tight muscles on the lateral foot and ankle and to strengthen weak muscles through different balancing exercises.
Orthotics with extra-depth shoes may be prescribed by your doctor. Orthotics can offload bony prominences, prevent rubbing of the toes, and allow for more balanced foot biomechanics. Lateral wedge sole modification, ankle supports and bracing, and high-top boots can also be added to prevent ankle instability.
The goal of treatment is to produce a plantigrade foot (a tripod foot) that allows even distribution of weight and permits the patient to ambulate without symptoms (eg, pain). Failure to maintain a pain free plantigrade foot is an indication for surgery.
Individualized surgical treatment is always discussed with your surgeon/physician only when conservative management of pes cavus fails. The deforming forces of the foot and restoring a tripod, or a plantigrade foot, are addressed in surgical management. Pes cavus foot reconstruction typically includes bone restructuring, tendon balancing, and soft tissue repair and releases. Your surgeon will discuss the different procedures required for the reconstruction and expected time to heal. Immediate post operative care will require at least 6-8 weeks of non- weightbearing, physical therapy, and slow transition back to comfortable shoes. A 12 week, 6 month, and an annual follow up will be required 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.