Subtle Cavus Foot

Overview
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.

Causes
The most frequent cause of cavus foot in children is a nerve or muscle disease. The condition usually is not present at birth but rather develops slowly during the first 10 years of life. Among cavus diabetic foot ulcers?s most common causes are Charcot-Marie-Tooth disease (CMT), Spina bifida, Polio, Muscular dystrophy, Injuries to the nerves in legs or spinal cord, Injuries to the leg muscles, Cavus foot also may be an inherited structural abnormality.

Symptoms
Symptoms of a cavus foot type are higher arch than normal while standing. Sometimes the heel is seen to be angled inward as well as the toes appearing to be drawn inward. People with a cavus foot type also sometimes develop clawtoes as the toes will be curled up like claws. Frequent ankle sprains may also occur as the foot has a tendancy to roll over on the outside of the ankle with a higher arch. Conditions such as plantarflexed metatarsals, Haglund's deformity, and equinus may co-exist. A person with a cavus foot type typically is unable to stand as long as a normal foot structure as it does not have a good shock absorption mechanism. Some problems may be unnoticed until the person takes up heavier levels of activity, like running. In other extreme cases the deformity may not be well suited to the shoes your wearing and cause an ulcer. This is a strong reason to consult a podiatrist.

Diagnosis
Diagnosing the cause of the cavus foot position is essential prior to surgical planning. Usually, performing a laterally based calcaneal osteotomy and a distally based metatarsal osteotomy together or each procedure alone can help position the foot properly.

Non Surgical Treatment
Initially a 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. Wear shoes with a good cushioning, depth and arch support which may help relieve pain and improve walking. Debridement of corns and calluses. Various pads made from silicone or felt can be used to get pressure off the painful areas. Control body weight to decrease load on the feet. Physical therapy modalities such as laser therapy for associated tendonitis. Foot and ankle joint manipulations to help increase joint range of motion. Foot orthotic devices can provide support for stressed joints and soft tissues. Foot orthoses are constructed to increase shock absorption and aid in the redistribution of weight relieves stress placed on the metatarsals. Foot orthoses are usually custom-made semi-rigid or semi-flexible functional posted orthotics that helps prevent the foot from supinating. They often include shock absorbing material in the arch. These devices are prescribed based on a thorough biomechanical examination, gait analysis and if required having the patient walk or run over a pressure mat. 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.

Surgical Treatment
Most people with cavus feet do not need operations. However, if your cavus feet cause a lot of pain, rub badly on your shoes so that the skin breaks down, or your foot or ankle are very unstable, and simple treatment has not helped, it may be worth considering an operation to straighten your foot. Your GP can refer you to an orthopaedic foot and ankle surgeon to advise you about surgery.