Pes Cavus (High Arch Foot)

Pes cavus is a foot with an unusually high arch that stays high when standing. It concentrates pressure on the heel and the ball of the foot. Many people have no symptoms. Others develop pain, calluses, clawed toes or repeated ankle sprains. It may be inherited, have no clear cause, or be linked to a nerve condition.

Feet range in shape from flat to high-arched. High-arched feet are common. A high-arched foot is usually stiffer than average, takes weight through a smaller area of the sole and absorbs impact less well. The heel often tilts inwards, a shape called cavovarus. This tilt can make the ankle prone to rolling over. Pes cavus can affect one or both feet.

What are the symptoms?

• Pain in the heel, the ball of the foot or along the outer edge of the foot
• Frequent ankle sprains, or an ankle that feels unstable
• Calluses or hard skin under the ball of the foot or the heel
• Clawed toes or hammer toes
• Difficulty finding shoes that fit comfortably

What causes a high arch?

• Neurological conditions, such as Charcot-Marie-Tooth disease or spina bifida
• Previous injury or muscle imbalance
• An inherited high-arched foot shape
• No identifiable cause (idiopathic)

All forms of cavus foot result from an imbalance between the muscles that move the foot. Most people with a high arch have no underlying cause and only mild symptoms, if any. A high arch that is painful, marked or getting worse warrants a full nerve examination, because a neurological cause is often found. The NHS describes Charcot-Marie-Tooth disease as a group of inherited conditions that damage the peripheral nerves. It can cause muscle weakness in the feet, ankles, legs and hands, numbness, and highly arched or very flat feet. A current concepts review (Moon and colleagues, Journal of Clinical Medicine) notes that more than 70% of people with Charcot-Marie-Tooth disease develop cavovarus foot deformities. Other causes of a high arch include old fractures, nerve injury and previous clubfoot.

When should a high arch be checked?

See a doctor if any of these apply:

• The foot is painful
• The foot is changing shape
• Only one foot is changing shape
• There is numbness in the foot
• The foot feels weak or unstable

The last four in particular may need specialist referral to check the nerves and spine. A high arch that develops in only one foot, or worsens quickly, should always be checked by a specialist.

Non-surgical treatment

Most people with a mildly high arch need no treatment. When symptoms interfere with daily life, the options include:

• Custom orthotics to spread pressure more evenly
• Shock-absorbing footwear
• Toe splints or padding for clawed toes
• Physiotherapy for strength, flexibility and balance
• Ankle braces to improve stability
• Modifying activities that aggravate symptoms

Because cavus feet tend to be stiff, insoles usually work by accommodating the foot shape rather than correcting it.

When is surgery recommended?

Surgery may be recommended for a severe or painful deformity, a foot that is rapidly changing shape, recurrent ankle instability, or when non-surgical treatment has not helped. Each operation is tailored to the individual. It may include:

• Soft tissue releases: of the plantar fascia, Achilles tendon or peroneal tendons
• Calcaneal osteotomy: realigning the heel bone
• Midfoot or forefoot osteotomies: correcting bony deformity
• Tendon transfers: rebalancing the muscles that move the foot
• Fusion procedures: for rigid or arthritic feet

Cavus surgery is a range of procedures selected for each person's deformity. It depends on where the deformity is, whether it is flexible or rigid, and how strong the muscles are. Outcomes are usually good, but not everyone becomes completely symptom-free. Where the cause is a progressive nerve condition, the foot may continue to change shape over time.

What is recovery like?

• 0–6 weeks: non-weight-bearing in a cast, with the foot elevated
• 6–8 weeks: cast removed; change to a boot and begin weight-bearing
• 8–12 weeks: physiotherapy begins, with a gradual return to walking
• 3–6 months: improved mobility; orthotics usually needed long-term
• 6–12 months: return to full activity, including sport, if pain-free

Full recovery can take up to a year.

How Mr Hester can help

Mr Hester is a dual fellowship-trained foot and ankle surgeon (FRCS Tr&Orth), trained at Guy's and St Thomas' and in Toronto and Calgary, and a member of BOFAS and EFAS. He sees patients privately at The London Clinic, Cromwell Hospital, King Edward VII's Hospital and HCA The Shard. His NHS practice is at King's College Hospital.

Insured patients need a GP referral and an authorisation code from their insurer. Self-pay patients are welcome. To book, call 020 7046 8004.

Frequently Asked Questions

Sources

1. Charcot-Marie-Tooth disease. NHS. https://www.nhs.uk/conditions/charcot-marie-tooth-disease/
2. Moon SJ, Min YK, Pfeffer GB, Cho BK, Kang C, Kang YE, Shin WJ, Song JH. Charcot-Marie-Tooth cavovarus foot: current concepts and emerging strategies for deformity correction. J Clin Med. 2026;15(16):6474. PMID: 42652877. https://pubmed.ncbi.nlm.nih.gov/42652877/
3. Sprains and strains. NHS. https://www.nhs.uk/conditions/sprains-and-strains/