Pes cavus is a common deformity of the foot. Characterised by a high instep arch and a supinated foot (where weight bearing occurs on the outer border of the foot rather than the entire sole), it does not present with a ‘flat foot’. Often referred to incorrectly as ‘high arches’, individuals with this deformity have a severe transfer of weight onto the metatarsal heads during activity. This can have serious repercussions on the quality of life of the affected individual and often requires orthotic intervention.
Pes cavus is a deformity that can be caused by several factors, including genetic components. Pes cavus can be seen in families, so if one family member has a high arches, other family members may also have the same condition. In addition, many cases of pes cavus are caused by conditions that affect the nerves, and in turn cause abnormal functioning of muscles in the foot. For example, individuals with cerebral palsy or other neurological disorders can develop pes cavus due to abnormal muscle action. Charcot-Marie-Tooth disease is a genetic condition that causes peripheral nerves in the body to degenerate, leading to progressive muscle weakness of the hands and feet. This muscle weakness can cause significant plantarflexion and result in a high arch.
It is important to both sufferers of pes cavus and healthcare professionals who treat them that there are various causes of the condition. For the patient with the painful foot it is important to have an understanding of the cause so that appropriate treatment can be sought or continued. For the doctors and therapists it enables them to have a full understanding of the causes and consequently treat each case individually and appropriately.
Pes cavus (p pes cavus) or high arched feet is a common, debilitating deformity affecting the feet, resulting from genetic or neurological causes. It can be limiting for those who have it, as well as the health practitioners who assess and manage it, should both have an understanding of the causes. Pes cavus, or high arched feet, comes with its own set of symptoms that can greatly affect a person’s ability to function in their daily life. Many people who have pes cavus will report suffering some degree of foot pain. The pain could be acute or be persistent, and is usually felt on the inner border of the foot, specifically in the arch and/or heel. This pain is commonly worsened by increased periods of time on their feet standing and/or walking. Many people with this deformity experience difficulty walking due to the lack of shock absorption provided by high arches. This in turn causes them to change the way they walk in order to alleviate discomfort and pain. Other common signs and symptoms may include difficulty rolling the foot onto its inside border, high arches which are visible from the outside, and anxiety or concern over the appearance of their feet (Hossain & Huntley, 2016; Rosenwasser et al., 2022).
Symptoms of pes cavus associated foot pain can make it so that an individual finds it difficult to engage in activities of daily life or enjoy time with family and friends. Activities such as walking to the grocery store or playing with children can be excruciating for individuals with foot pain caused by a cavus foot. In order to avoid foot pain, many people living with a cavus foot limit their activity levels. Over time, not being as active as they would like can cause individuals with pes cavus to become weak in the foot and lower leg muscles, negatively affecting their balance or even leading tocoordination problems. In addition, sedentary lifestyles associated with foot pain can lead to weight gain and a host of other related health problems. However, the most significant effect of living with pes cavus is the decreased quality of life, missing out on activities, hobbies and time with loved ones due to foot pain. Many people suffer in silence and withdraw from their social lives due to embarrassment or fear of being judged by others because of their deformity (Grady et al., 2021).
Pes cavus can have more serious effects on individuals as well. Individuals with a high arch can experience ankle instability. This increased instability can make activities that would normally require little stress upon the feet and ankles, such as running or hiking, more dangerous for those with pes cavus due to the uneven terrain (Williams & Deland, 2012). As a result of these recurring injuries, individuals with a high arch can find themselves becoming increasingly restricted physically. As a result, these individuals can become anxious to even move around and experience a negative effect on their overall quality of life. Each sprain can take weeks to months to heal and have the individual sit idle for an extended period of time, further affecting both physical and emotional well-being.
Symptoms of pes cavus include foot pain and difficulty walking, standing, or participating in physical activities such as sports. Some people have high arches that place them at risk of injuries. However, this condition can also negatively impact one’s quality of life. People with pes cavus may withdraw from social events and activities as they can no longer participate in sports or other activities. This can frustrate the individual and cause more emotional pain. Knowing the causes and symptoms of pes cavus can be the first step to treating it, preventing it, or understanding a loved one’s problems with this common condition. Treatments for pes cavus vary depending on severity, but many people benefit from conservative (mild) treatments. For example, custom orthotics (such as shoe inserts) can help bring the foot into a more natural position. Physical therapy can also help, using exercises that strengthen the muscles of the feet and legs. Exercises may also be used to stretch tight muscles in the foot (Sugathan & Sherlock, 2009; Hossain & Huntley, 2016).
While less severe cases of pes cavus may be treated with supportive devices and exercises to stretch muscles, in more severe cases, orthotics or surgery are required to relieve symptoms when conservative treatment does not alleviate symptoms. Such surgery aims to restore normal positioning of bones and to correct deformity, and also can involve shortening or lengthening of tendons or ligaments to improve correction and relieve pain as well as to enable greater mobility of the foot. With any surgical procedure, there are always potential complications and recovery time is necessary. These and other potential side effects need to be fully discussed with your surgeon.
Current research and advances have offered new treatment options for managing pes cavus. Additionally, research has shown the multidisciplinary approach of treatment is beneficial for patients with severe, rigid pes cavus. In current practice, patients are benefitting from a team approach, with orthopedists, podiatrists, physical therapists, and occupational therapists participating in the treatment and management of pes cavus. This multidisciplinary team is able to provide comprehensive care for the patient with pes cavus, addressing biomechanics, as well as behaviors and psychological issues that affect the patient’s quality of life with severe, foot deformity (Grady et al., 2021; Rosenwasser et al., 2022).
Preventive measures are also important in managing pes cavus and, indeed, in avoiding its progression in risk individuals. Early diagnosis is essential for starting treatment. Performing routine foot check-ups with the aim of detecting early changes in foot structure or function is, therefore, vital. This approach must especially focus on preventing its progression in children with a previous history of family-member foot deformities. Parental awareness of the physical changes that occur in children’s feet is also of paramount importance. Early identification of clinical features ofpes cavus, such as excessive arch and abnormal walking, will enable individuals to receive suitable measures to reduce future disability (Sanpera et al., 2021; García et al., 2024).
Citations:
Sanpera, I., Villafranca-Solano, S., Muñoz-Lopez, C. and Sanpera-Iglesias, J., 2021. How to manage pes cavus in children and adolescents?. EFORT Open Reviews, 6(6), pp.510-517. https://eor.bioscientifica.com/view/journals/eor/6/6/2058-5241.6.210021.xml
Apresyan, V.S., Makinyan, L.G., Mannanov, A.M., Dmitrov, I.A. and Samkovich, D.A., 2025. SURGICAL TREATMENT OF A PES CAVUS FOOT. Vestnik of the Smolensk State Medical Academy, 24(3), pp.130-137. https://journals.rcsi.science/2225-6016/article/view/354302
García, B.E.C., Reyes, B.F.P., Tenesaca, R.P.C., Rosas, E.D.R., Piedra, A.V.R., Cárdenas, P.A.C. and Ordoñez, D.W., 2024. F. The pes cavus, scoping review. Int J Multidiscplinary Reasearch, 10(6), pp.99-104. https://www.researchgate.net/profile/Epra-Trust/publication/383058843_THE_PES_CAVUS_SCOPING_REVIEW/links/66bab1bd8f7e1236bc53ac9d/THE-PES-CAVUS-SCOPING-REVIEW.pdf
Rosenwasser, K.A., Judd, H. and Hyman, J.E., 2022. Evidence-Based Management Strategies for Pediatric Pes Cavus. Journal of the Pediatric Orthopaedic Society of North America, 4(2), p.461. https://www.sciencedirect.com/science/article/pii/S2768276524006126
Walling, A.K., 2008. The adult clubfoot (congenital pes cavus). Foot and ankle clinics, 13(2), pp.307-314. https://www.sciencedirect.com/science/article/pii/S1083751508000077
Hossain, M. and Huntley, J.S., 2016. Evidence-Based Treatment for Pes Cavus. In Paediatric Orthopaedics: An Evidence-Based Approach to Clinical Questions (pp. 183-192). Cham: Springer International Publishing. https://link.springer.com/chapter/10.1007/978-3-319-41142-2_21
Grady, J.F., Schumann, J., Cormier, C., LaViolette, K. and Chinn, A., 2021. Management of midfoot cavus. Clinics in podiatric medicine and surgery, 38(3), pp.391-410. https://www.podiatric.theclinics.com/article/S0891-8422(21)00016-1/abstract
Sugathan, H.K. and Sherlock, D.A., 2009. A modified Jones procedure for managing clawing of lesser toes in pes cavus: long-term follow-up in 8 patients. The Journal of foot and ankle surgery, 48(6), pp.637-641. https://www.sciencedirect.com/science/article/pii/S1067251609002907
Williams, B.R. and Deland, J.T., 2012. Pes cavus deformity. Foot and Ankle Surgery. Philadelphia, PA: Elsevier, pp.275-91. https://books.google.com/books?hl=en&lr=&id=WVGpBAAAQBAJ&oi=fnd&pg=PA275&dq=Symptoms+and+treatment+of+pes+cavus&ots=ZbQ8wgMSbR&sig=lHPyB4spLuxCblwzp3vnY4LuRvo
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