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Pes Cavus (High Arch Foot)

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Pes cavus is a foot shape where the arch is unusually high, placing increased pressure on the heel and ball of the foot. While some people have no symptoms, others experience pain, instability, or progressive deformity. It can affect one or both feet and may be related to neurological conditions or be inherited.

Symptoms

• Pain in the heel, forefoot, or outer edge of the foot
• Frequent ankle sprains or instability
• Calluses or pressure areas on the ball of the foot or heel
• Clawed toes or hammer toes
• Difficulty fitting into normal shoes

Causes

• Neurological conditions such as Charcot-Marie-Tooth disease or spina bifida
• Previous injury or muscle imbalance
• Inherited high-arched foot structure
• Idiopathic (no identifiable cause)

Non-Surgical Treatment

• Custom orthotics to redistribute pressure
• Shock-absorbing footwear
• Toe splints or padding for clawed toes
• Physiotherapy for strength, flexibility, and balance
• Ankle braces to improve stability

Surgery

Surgery may be recommended for severe or painful deformity, progressive arch collapse, recurrent instability, or failure of non-surgical treatment. It is tailored to the individual and may include:

• Soft tissue releases (plantar fascia, Achilles or peroneal tendons)
• Calcaneal osteotomy — realignment of the heel bone
• Midfoot or forefoot osteotomies to correct bony deformity
• Tendon transfers to improve muscle balance
• Fusion procedures in rigid or arthritic feet

Recovery

Timeframe	What to Expect
0–6 weeks	Non-weight-bearing in cast. Foot elevated.
6–8 weeks	Cast removed. Transition to boot. Begin weight-bearing.
8–12 weeks	Physiotherapy begins. Gradual return to walking.
3–6 months	Improved mobility. Orthotics usually required long-term.
6–12 months	Return to full activity including sport if pain-free.