Pes Cavus

What is pes cavus?

Pes cavus is the presence of an abnormally high arch that can occur in either one or both feet and develop at any age. It results in significant pressure being placed on the ball or heel of the foot when walking or standing. Pes cavus is often due to an underlying neurological condition.

Symptoms predominantly include a high arch of the foot resulting in pain and possible fractures, tripping, a loss of sensation in the lower leg, or dragging one's affected foot or feet.

Treatments usually focus on alleviating pain as well as the use orthotics, corrective footwear, and braces. Surgery may occur when more conservative methods are ineffective. Recovery and restructuring of the affected foot or feet occurs gradually and may take months or years.

You should visit your primary care physician if you are experiencing a lot of foot pain. Surgical treatment is only used when there is severe pain.

Pes cavus symptoms

Symptoms of pes cavus include the characteristic high arch, tripping, pain and other complications, as well as stress fractures.

High arch

Pes cavus is characterized by a high arch that places stress on both the ball of the foot and the heel of the foot. The high arch can lead directly to:

• Bone damage: Structurally, the arch is too high to flex and absorb the shock of a normal step, so the bones of the heel (e.g. calcaneus) and the ball of the foot (e.g. metatarsals) are damaged during normal use.
• Further injury: Normally, a foot flattens with weight-bearing, and the absence of this can lead to numerous injuries in joints and long bones from the ankle and lower leg through the lower back.
• Bent toes: Toes that are bent, also called hammertoes or claw toes, can also develop.

Tripping

Tripping in itself can be caused or described by:

• Loss of sensation: Pes cavus is often accompanied by a lack of proper neurological connection to the lower leg, which co-occurs with this symptom.
• Loss of proprioception: Proprioception is an understanding of where your body is in space. Losing track of where the borders of one's feet are during normal activity can cause tripping and falling.
• Drop foot: This is described by difficulty lifting (dorsiflexing) the foot, causing you to occasionally drag your foot on the ground, which likely results in tripping.

What causes pes cavus?

Common causes of pes cavus include Charcot-Marie-Tooth disorder and other neurologic disorders, as well as spinal tumors.

Charcot-Marie-Tooth disorder

This is one of the most common causes of pes cavus. In this disease, nerve development is hindered, specifically in nerves that connect to the limbs.

• How the nerves are hindered: Mutated genes cause the body's inability to produce functional neuronal proteins (proteins used by the nerves).
• How this condition affects function: Loss of proper neuronal function can cause the legs to be very thin and lead to the loss of sensation or ability to move and step correctly.
• How abnormal foot structure develops: Over time, the lack of muscle and improper or insufficient experience walking leads to development of an abnormal foot structure.

Other neurologic disorders

Pes cavus is most commonly associated with a neurological disorder and more frequently associated with a neurological disorder that is present at birth. In addition to Charcot-Marie-Tooth disorder, these may include:

• Polio
• Spina bifida
• Muscular atrophy
• Stroke

Spinal tumor

A spinal tumor can affect foot development and cause foot deformity similarly to how other neurological conditions can cause the development of pes cavus.

• How this condition affects function: If the spinal tumor impinges on a nerve that runs to the lower leg, the leg may lose sensation, strength, or both.
• How abnormal foot structure develops: The loss of sensation or strength can lead to a lack of awareness when damaging the foot as well as an altered gait. Over time, this damage can lead to development of pes cavus.

Treatment options and prevention for pes cavus

Treatment is focused mostly on alleviating associated pain. Nonsurgical methods, in the form of corrective devices, are the first-line of treatment. Surgery may also be needed in some cases.

Corrective devices

Corrective devices include insoles, orthotics, or corrective shoes. In practice, they function similarly to braces for teeth.

• Details: Each corrective shoe, insole, or orthotic supports and alters the foot shape slightly and slowly.
• Duration: Depending on when orthotics are applied and how severe the pes cavus is, it may take anywhere from months to years to recover.
• Prognosis: Orthotics are proven, albeit with four studies, to reduce the amount of pain experienced by individuals with pain due to pes cavus. Custom-made devices are shown to offer more relief than other alternatives.

Surgery

If other methods fail to provide an adequate recovery or pain relief, surgery may be completed to correct foot weakness, discomfort, and instability. Specific procedures may include a combination of:

• Soft-tissue releases
• Tendon transfers
• Osteotomies: Cutting or removing pieces of bone

When to seek further consultation for pes cavus

While it is possible to eliminate pain, and pain is a common reason for seeking additional care, early intervention can prevent many of the consequences of pes cavus.

If you notice loss of sensation, severe pain, or progressive deformity

Although it is absolutely necessary to seek consultation if you have lost sensation in your feet, are experiencing severe pain, or have noticed a progression in the deformity of your foot, pes cavus can be intervened in its early stages.

Suspected pes cavus in children

It is important to seek care if you suspect your child has pes cavus, as orthotic shoes and low acuity interventions work especially well if applied at early ages before bone has taken on its mature shape.

Suspected pes cavus in adults

For adults, you should seek further consultation if you wish to improve the cosmetic appearance of your feet, if you are experiencing pain, ankle instability, or gradually increasing weakness in your legs. The latter especially is a cause of concern because it may further contribute to pes cavus and may also continue to ascend, affecting structures necessary for life maintenance.