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Overview<br>A foot deformity characterized by an elevated longitudinal arch, caused by fixed plantar flexion of the forefoot, may be seen in both pediatric and adult populations. 2/3 of patients have neurologic condition, when bilateral, often hereditary. deformity caused by contracted plantar fascia, weak tibialis anterior being over-powered by peroneous longus, table of foot deformity muscle imbalances.<br><br>Causes<br>In many people, we do not know the cause of their cavus foot. These people tend to have milder deformities and the foot appearance sometimes runs in the family. Many medical conditions which cause weakness or lack of co-ordination of muscles can result in a cavus foot. Examples of such conditions include spina bifida, muscular dystrophy and conditions in which the small nerves in the legs do not work properly. It is thought that even when no definite medical condition can be found, cavus feet are probably due to very slight weakness of muscles in the legs and feet.<br><br>Symptoms<br>There are many symptoms believed to be related to the cavus foot. These include shoe-fitting problems, lateral ankle instability, lower limb stress fractures, knee pain, iliotibial band friction syndrome, back pain and tripping. Foot pain in people with pes cavus may result from abnormal plantar pressure loading because, structurally, the cavoid foot is regarded as being rigid and non-shock absorbent and having reduced ground contact area. There have previously been reports of an association between excessive plantar pressure and foot pathology in people with pes cavus.<br><br>Diagnosis<br>Investigations will be guided by the suspected aetiology. Weight-bearing radiographs are performed to assess the degree of bony deformity and look for arthritic changes. In cases of suspected HSMN, nerve conduction testing and electromyography may be useful. A CMT DNA duplication detection test may be performed for confirmation. If the onset is during adulthood, and especially if rapidly progressive or unilateral, a central disorder such as spinal dysraphism or a space occupying lesion must be excluded by magnetic resonance imaging of the brain and spinal cord.<br><br>Non Surgical Treatment<br>Careful investigation is needed to rule out any neurological condition that is causing the high arched foot. This will depend on what is causing the pain, if anything. For instance, flexible high arches may not need any treatment. can't wear high heels for long shoes with a good cushioning, depth and arch support. Control body weight to decrease load on the feet. Over-the-counter arch supports may be helpful for mild cases of pes cavus, but they are often a poor fit for persons with severe pes cavus.<br><br>Surgical Treatment<br>Soft-tissue surgery. Cavus foot is caused in part by an over-pull of one of the lateral ankle muscles. A release of this tendon can be performed on the outside of the ankle. Additionally, a transfer of this tendon can be performed to help in correcting deformity of the ankle joint. Often patients will have a tightness of their gastrocnemius muscle, one of the main muscles in the calf. This can increase the deformity or prevent a correction from working. It is addressed with a lengthening of a part of the calf muscle or Achilles tendon. This is often performed through one or more small cuts in the back of the leg/ankle. Finally, the plantar fascia may be tight. The plantar fascia is a cord-like structure that runs from the heel to the front part of the foot. Partial or complete plantar fascia release may be done. Tendon transfers. Too much pull of certain muscles and tendons is often the cause of the deformity related with a cavus foot. Moving one of these muscles or tendons may help the foot work better. In addition, patients with a cavus foot may have weakness in moving the foot up, which is sometimes called a foot drop. In these cases, a tendon from the back of the ankle may be moved to the top of the foot to help improve strength. Bony surgery. Correcting the deformity of the foot may not be possible with soft tissue procedures alone. In these instances, one or more bone cuts (osteotomies) may be needed. Instead of a bone cut, a fusion (arthrodesis) procedure may be used. A fusion removes the joint between two bones so they grow together over time. During a fusion the bones may be held in place with plates or screws. Dorsiflexion osteotomy of the first metatarsal. This procedure flattens out the arch. Calcaneal osteotomy. This procedure is performed to bring the heel bone back under the leg. This is needed if correction of the deformity in the front of the foot does not also correct the back of the foot or ankle. A calcaneal osteotomy can be performed several ways and is often held in place with one or more screws. Fusion. Sometimes patients have a deformity that has caused damage to the joints. In these cases, soft tissue procedures or bone cuts may not be enough, and it may be necessary to eliminate the joint. Toe surgery. Clawed toes are a common problem with cavus foot deformity. This can be treated with tendon surgery, fusion or removal of part of the toe bones. Following surgery the toes are often temporarily held in place with pins.