Pes Cavus (High-Arched Foot)

Pes Cavus Overview

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 may experience pain, instability, or progressive deformity over time.

This condition can affect one or both feet and may be caused by neurological conditions or be inherited.

Pes Cavus Symptoms and Diagnosis

Symptoms typically include:

• 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 hammertoes

• Difficulty fitting into normal shoes

Diagnosis is made by clinical examination and confirmed by weight-bearing X-rays. In some cases, nerve testing or MRI may be needed to assess underlying neurological causes.

Pes Cavus 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)

Pes Cavus Treatment and Prevention

Non-surgical management is often effective, especially in mild to moderate cases. This may include:

• 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 if needed

Pes Cavus Surgery

Surgery may be recommended for:

• Severe or painful deformity

• Progressive arch collapse

• Recurrent instability

• Failure of non-surgical treatment

Surgery is tailored to the individual and may include:

• Soft tissue releases (e.g. 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

Surgery is performed under general anaesthetic and usually requires a hospital stay of one night.

Risks of surgery may include:

• Pain

• Bleeding

• Infection

• Nerve or blood vessel injury

• Scarring

• Deep vein thrombosis (DVT) or pulmonary embolism (PE)

• Failure to improve symptoms

• Need for further surgery

Pes Cavus Surgery Recovery

After surgery, the foot is immobilised in a cast or boot, and you will be non-weight-bearing for six weeks to allow the bones and soft tissues to heal.

At six weeks, the cast is removed, and you’ll begin gradual weight-bearing in a boot, along with physiotherapy. A custom orthotic insole is often required long term to maintain correction and reduce pressure.

Expected Recovery Timeline

0–6 weeks

Non-weight-bearing in cast. Foot elevated. Rest and healing.

6–8 weeks

Cast removed. Transition to boot. Begin weight-bearing.

8–12 weeks

Gradual return to walking. Physiotherapy begins.

3–6 months

Improved mobility. Orthotics usually required long-term.

6–12 months

Return to full activity, including sports if healing is complete and pain-free.