High Arch, (cavus foot) is a condition in which the foot has a very high arch. Because of this high arch, an excessive amount of weight is placed on the ball and heel of the foot when walking or standing. Cavus foot can lead to a variety of signs and symptoms, such as pain and instability. It can develop at any age and can occur in one or both feet.
High Arch (cavus foot) is often caused by a neurologic disorder or other medical condition, such as cerebral palsy, Charcot-Marie-Tooth disease, spina bifida, polio, muscular dystrophy or stroke. In other cases of cavus foot, the high arch may represent an inherited structural abnormality. An accurate diagnosis is important because the underlying cause of cavus foot largely determines its future course. If the high arch is due to a neurologic disorder or other medical condition, it is likely to progressively worsen. On the other hand, cases of cavus foot that do not result from neurologic disorders usually do not change in appearance.
The arch of a cavus foot will appear high even when standing. In addition, one or more of the following symptoms may be present:
- Hammertoes (bent toes) or claw toes (toes clenched like a fist)
- Calluses on the ball, side or heel of the foot
- Pain when standing or walking
- An unstable foot due to the heel tilting inward, which can lead to ankle sprains
Some people with cavus foot may also experience foot drop, a weakness of the muscles in the foot and ankle that results in dragging the foot when taking a step. Foot drop is usually a sign of an underlying neurologic condition.
The diagnosis of symptoms occurs through conducting a history and physical in combination with diagnostic testing. The foot specialist examines the foot, looking for a high arch and possible calluses, hammertoes and claw toes. The foot is tested for muscle strength, and the patient’s walking pattern and coordination are observed.
A history of familial high arches and any muscular dystrophy type symptoms in the family are important to consider. The type of pain and what causes the pain to begin are also important to consider. For example, patients who have pain with walking in comparison to only having pain when running may need more aggressive treatment than patients who only have pain with high impact exercises.
Examination of the muscle groups and muscle strength is important. Furthermore, pain along the peroneal tendons may be a sign of a peroneal tendon tear. This may result in a cavus foot much like a posterior tibial tendon dysfunction may result in flatfoot. Instability of the lateral ankle may also lead to a cavus foot position as the talus deviates into a varus position due to the laxity of the lateral ankle ligaments.
Finally, a plantarflexed first metatarsal or a varus heel may lead to a fixed cavus position due to a structural deformity. It is rare to see a pan-forefoot cavus deformity of all the metatarsals but one must also consider this possibility. In general, the first ray is plantarflexed far more often than all the metatarsals.
Diagnostic testing often includes magnetic resonance imaging (MRI) if one suspects a peroneal tendon problem or ankle instability. Perform electromyography and nerve conduction velocity testing if you suspect Charcot Marie Tooth. If a high suspicion of muscular dystrophy is present, perform a sural nerve biopsy.
A 2ft custom made Orthotic puts an end to your foot pain caused by this painful condition. Conservative care is highly successful in the cavus high arch foot. An orthotic with a high lateral heel flange, a valgus post and a sub-first metatarsal cutout can balance the foot. Often, the first ray is plantarflexed and a cutout of the first metatarsal head is essential for forefoot balancing. In severe ankle instability cases, an over the counter ankle-foot orthotic or a custom ankle-foot orthotic can be beneficial in balancing the foot and ankle. Consideration of a first ray cutout should also be part of the bracing process.
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In severe cases of cavus, surgical intervention is often necessary. The main consideration for surgical planning is the cause of the cavus deformity. Consider whether it is a structural deformity or one caused by an underlying traumatic event such as a peroneal tendon tear or ankle instability. Furthermore, in either a structural or traumatic case, it is important to consider if the cavus is from a plantarflexed first ray only, a calcaneal varus only or a combination of the two deformities together. After considering all the information, one can plan for surgery.
Ideally, surgeons should first repair the source of the traumatic event such as the ankle instability or peroneal tear in order to stabilize the laxity about the ankle and subsequently judge the level of deformity in the foot. For example, a varus talus position caused by ankle instability will often make the cavus foot position look worse prior to repair of the lateral collaterals than after repair of the collaterals. After repositioning and stabilizing the talus, one can better judge the varus of the heel and first metatarsal position.
Ankle stabilization procedures often occur via a primary lateral ankle ligament repair or Brostrom procedure. The surgeon should repair both anterior and lateral ankle ligaments in order to stabilize the talus fully.