Pes Cavus (High Arches): Symptoms, Causes, Tests, and Treatments

Pes cavus, a foot condition marked by high arches, leads to pain, discomfort, and balance issues in children and adults. Gaining a deeper understanding of the symptoms, causes, and treatment options can help prevent further complications and improve daily life.

Pes cavus affects approximately 8-15% of the population, causing abnormal biomechanics in the foot and placing excessive pressure on the metatarsals and toes. This can impact walking, standing, wearing shoes, and playing sports, making everyday activities challenging. Early diagnosis is crucial, as proper treatment and preventative measures can reduce the risk of soft tissue injuries and fractures.

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Symptoms

People with pes cavus mainly experience the following symptoms in addition to the characteristic high arch include:

• Claw toes - also called hammertoes, toes are bent and clenched like a fist. This can lead to pain and difficulty walking or standing.
• Pain when walking or standing - caused by the foot's limited ability to absorb shock, resulting in discomfort and fatigue during daily activities.
• Instability - frequent tripping and falling because of ankle instability, increasing the risk of injuries and accidents.

In advanced stages, individuals with pes cavus may also experience knee and low back pain, metatarsalgia, ankle arthritis, Achilles tendonitis, plantar fasciitis, stress fracture, or pain under the great toe, and iliotibial band friction syndrome.

Causes

Children with muscular dystrophy (MD) and spina bifida are more likely to develop pes cavus in both feet. Although Charcot-Marie-Tooth disorder, other neurological disorders, spinal tumors, and trauma are common causes of pes cavus, muscle atrophy, bony malalignment, and imbalanced muscle forces play significant roles in the development of this condition. Consequently, pes cavus can lead to ankle deformity and clawed toes.

Pes cavus can arise from neurological, congenital, traumatic, and idiopathic (unknown) causes. Interestingly, 30% of all severe pes cavus cases are idiopathic (e.g., ankle osteoarthritis and rheumatoid arthritis), while 70% occur due to neurological problems (e.g., hereditary sensory motor neuropathy). Additionally, genetic mutations contribute to high arches even in the absence of neurological issues.

Charcot-Marie-Tooth Disorder

Charcot Marie Tooth disorder (CMT) is a hereditary disease that causes damage to the peripheral nervous system (responsible for carrying signals from the brain and spinal cord to the muscles and sensation pathways). It's one of the most common causes of pes cavus and leads to a loss of proper neuronal function, causing the legs to become very thin and leading to a loss of sensation or the ability to move and step correctly. Over time, this results in an abnormal foot structure.

Spinal Tumor

Spinal tumors can affect foot development and cause foot deformity. If a spinal tumor impinges on a nerve that runs to the lower leg, the leg may lose strength, sensation, or both. Loss of sensation can cause a lack of awareness when damaging the foot and result in an altered gait. This damage can lead to the development of pes cavus over time. If you notice any symptoms like ongoing back pain and weakness in the lower legs, seek medical attention immediately.

Coleman Block Test

Traditionally used to distinguish between forefoot- and hindfoot-driven deformity, the Coleman block test evaluates hindfoot flexibility and pronation of the forefoot in pes cavus, where the foot becomes progressively higher arched and rigid. The foot is placed on a block high enough to avoid touching the ground when placing the first part of the foot over the block's edge. If the hindfoot corrects to a neutral position, the deformity is flexible; if not, it's rigid.

Treatments

Conservative management is the first treatment option to correct the high arches, which includes orthotic shoes, stretching exercises, therapeutic modalities, and painkillers.

• Corrective devices - Insoles, custom orthotics, and corrective shoes support and slowly alter the foot shape, providing relief and promoting proper foot alignment.
• Surgery - Surgery may be necessary if other methods do not provide adequate pain relief or recovery. Surgical intervention can correct deformities and improve overall foot function.
• Progressive resistance exercises - Strengthen the foot dorsiflexors (group of muscles for moving the foot upward) and slow muscle weakness.
• Regular stretching and mobility exercises - Help to maintain muscle length and the range of motion of the ankle joint.

Conquering Pes Cavus

Pes cavus is a complex deformity that affects walking and mobility. Timely and effective treatment options can alleviate excessive pressure on the hindfoot and metatarsals, improving foot health and well-being. Choosing the right footwear and insoles and maintaining a regular exercise program is essential for managing high arches.