Cavus Foot & High Arches

Cavus foot — medically termed pes cavus — describes a foot with an abnormally high arch that does not flatten adequately with weight bearing. Unlike a flexible flat foot that flattens with standing, the cavus foot maintains a high arch under load, concentrating pressure on the heel and the ball of the foot rather than distributing it across the midfoot.

The high rigid arch of cavus foot creates a specific and recognizable pattern of problems. The heel and lateral forefoot bear disproportionate pressure with every step — producing pain at these contact points, callus formation, and over time, stress injury to the bones and soft tissue in these areas. The reduced ground contact area also affects balance and stability, making lateral ankle sprains significantly more common in cavus foot patients than in those with normal or flat arch structure.

Cavus foot is also associated with progressive toe deformities. The pull of the plantar fascia and intrinsic foot muscles in a high-arch foot tends to drive hammertoe and claw toe development over time, particularly when footwear does not provide adequate toe box depth.

An important clinical consideration in cavus foot is the possibility of an underlying neurological cause. A significant proportion of cavus foot deformities — particularly those that are bilateral, progressive, or present with associated muscle weakness or sensory changes — are associated with hereditary motor and sensory neuropathies such as Charcot-Marie-Tooth disease, or with other neurological conditions. This does not apply to every patient with a high arch — many have idiopathic cavus foot without any neurological condition — but it is a clinical consideration that warrants assessment when the presentation suggests it. Dr. Gunter evaluates for neurological contributors as part of his cavus foot assessment and refers for appropriate neurological workup when indicated.

For the majority of patients, cavus foot is managed conservatively with significant success — primarily through precision custom orthotics that redistribute pressure away from the overloaded heel and lateral forefoot, combined with appropriate footwear guidance and ankle stabilization when instability is present.