Cavus foot
Cavus foot is a deformity in which the arch of the foot is higher than usual. In children it may be associated with a muscle imbalance or a neurological condition, so it is important to investigate the cause, especially if it progresses during growth. When the heel also tilts inwards, it is called cavovarus foot, which can cause pain, claw toes, overload of the outer edge of the foot and ankle instability.
- Also known as
- Pes cavus · Cavovarus foot · High-arched foot
What is it?
Cavus foot is characterised by an increase in the height of the longitudinal arch of the foot. This shape changes how weight is distributed when walking and can concentrate pressure on the heel, the forefoot and the outer edge of the foot.
When the high arch is accompanied by the heel tilting inwards, it is called cavovarus foot. Claw toes, tendon contractures and a greater tendency to ankle sprains may also appear.
In childhood, cavus foot deserves special attention because it may be a sign of a muscle imbalance or a neurological condition. Possible causes include Charcot-Marie-Tooth disease, certain forms of cerebral palsy and other neuromuscular conditions. In some children no specific cause is found.
The deformity may be mild and stable or may progress during growth. So it is not enough to assess the height of the arch: it is essential to study the flexibility of the foot, the position of the heel, muscle strength and the possible presence of an underlying condition.
Signs parents may notice
The most common signs are:
- An excessively high arch.
- The heel tilting inwards, especially when the child is standing.
- Curled or claw toes.
- Weight borne mainly on the outer edge of the foot.
- Calluses or pain under the front of the foot.
- Repeated ankle sprains or a feeling of instability.
- Difficulty finding comfortable shoes.
- Tiredness, pain when walking or limitation in sport.
It is also worth watching for frequent falls, muscle weakness or gradual changes in the way the child walks.
When to see a specialist
A specialist assessment is advisable if the child has a very high arch, especially when it is accompanied by any of the following:
- The deformity increases with growth.
- The heel tilts markedly inwards.
- There are repeated sprains or persistent pain.
- The child starts walking differently, falls often or has difficulty running.
- There is muscle weakness, loss of strength or progressive toe deformity.
- One foot is clearly more deformed than the other.
A cavus foot that is one-sided, progressive or associated with neurological signs requires special attention to rule out an underlying cause.
When is it urgent?
If there is sudden weakness, a sudden loss of the ability to walk or acute neurological symptoms, an urgent medical assessment is needed.
How is it diagnosed?
The diagnosis starts with a full clinical examination of the foot, ankle and lower limbs. The aim is to identify which part of the foot is causing the deformity, determine whether it is flexible and establish whether there is a muscle imbalance or an associated neurological condition.
Clinical examination
The specialist assesses the height of the arch, heel alignment, the position of the forefoot, foot flexibility, muscle strength, reflexes and sensation. Walking and the presence of claw toes or tendon contractures are also examined.
A particularly useful test is the Coleman block test, which shows whether the inward tilt of the heel can be corrected by changing how the forefoot bears weight. This helps determine which components of the deformity need to be corrected.
X-rays
Weight-bearing X-rays of the foot and ankle show the alignment of the bones, locate the apex of the deformity and help plan treatment when needed.
Neurological assessment
When there are signs suggesting a neuromuscular condition, an assessment by a paediatric neurologist may be needed and, depending on the case, electromyography, nerve conduction studies, MRI or genetic testing.
Identifying the cause is essential to establish an appropriate treatment plan and anticipate how the foot may change during growth.
Treatment
Treatment depends on the cause, the severity of the deformity, its flexibility, the presence of pain and the risk of progression.
The aim is a balanced, stable, plantigrade foot (one that rests properly on the ground) that is as flexible and functional as possible.
Conservative treatment
For mild, flexible and stable cavus feet, conservative measures can relieve symptoms and improve pressure distribution.
These include:
- Custom insoles to improve support and reduce overload.
- Footwear adapted to the shape of the foot.
- Physiotherapy and stretching when there is muscle or tendon tightness.
- Exercises to improve strength, balance and ankle stability.
Insoles can help reduce discomfort, but on their own they do not usually correct a structural bone deformity or eliminate a progressive muscle imbalance.
Follow-up during growth shows whether the deformity stays stable or needs further treatment.
Surgical treatment
Surgery may be indicated when there is persistent pain, progressive deformity, instability, significant changes in how the foot bears weight or loss of flexibility.
The operation must be tailored to each patient. There is no single technique for all cavovarus feet: the components of the deformity must be identified and corrected in a balanced way.
Depending on the characteristics of the foot, procedures may include plantar fascia release, osteotomies of the first metatarsal or the calcaneus, tendon transfers and correction of claw toes. The choice depends on foot flexibility, the position of the forefoot, the degree of heel varus and muscle balance.
An option during growth: dorsal hemiepiphysiodesis of the first metatarsal
In certain children with progressive cavovarus foot and growth remaining, a technique may be considered that uses growth to gradually correct the position of the first metatarsal.
Dorsal hemiepiphysiodesis of the first metatarsal guides the growth of its proximal physis asymmetrically. It can be combined with a percutaneous release of the plantar fascia when it is tight.
The aim is to gradually reduce the downward tilt of the first ray and improve foot alignment, avoiding more extensive osteotomies at first in selected patients.
This technique was studied by Sanpera and colleagues, including Dr. Laura Corominas, in a pilot series published in Acta Orthopaedica in 2018. The study included 13 children and 24 feet, with favourable clinical and radiological results during the reported follow-up. However, it is a small series, and the technique requires careful patient selection and X-ray monitoring during growth.
Not all cavovarus feet are suitable for this option. When there is rigid hindfoot varus, a significant muscle imbalance or a deformity located elsewhere, other procedures may need to be added or chosen instead.
Outlook and recovery
Recovery depends on the type of deformity, the surgical technique and any associated neuromuscular condition.
- First weeks: the foot may need to be protected with a cast or boot, depending on the operation.
- Weight-bearing: when it starts depends on the procedures performed and the stability of the correction.
- School: a return is usually possible when the pain is under control and getting around is safe.
- Rehabilitation: adapted to the recovery of movement, strength and balance.
- Return to sport: gradual, once clinical progress allows impact activities to be resumed safely.
In growing children, follow-up is especially important to make sure the correction is maintained and to detect any changes related to growth or the underlying condition.
The aim is not just to lower the arch, but to achieve a balanced, stable, pain-free and functional foot with a good distribution of pressure.
Specialist assessment of cavus foot in children
Dr. Laura Corominas assesses cavus and cavovarus foot in children, investigating the cause of the deformity, its flexibility and how it changes during growth.
Her experience includes research on gradual correction techniques using growth modulation in selected patients. Treatment is tailored to each child’s age, foot anatomy, muscle balance and functional needs.
This page is for general information and does not replace an assessment by a specialist. If you are worried about your child's foot, talk to their paediatrician or book an appointment.