Cavus Foot

What is cavus foot?

Cavus foot is a condition in which the foot has a very high arch. Though uncommon in young children, cavus foot can occur at any age and affect one or both feet.

Cavus feet can look different depending on how high the arch is, what is causing the condition, and if the condition is causing pain. For some children, the high-arched foot will cause extra pressure on the ball and heel of the foot when standing or walking, leading to pain, difficulty in shoe wear and foot instability (prone to sprains). For others, cavus foot can lead to a severe deformity that leads to the child walking on the outside of their foot.

The causes of cavus foot are varied and can be linked to another condition or injury. For many, the cause of cavus foot is unknown or undetermined.

Treatment for cavus foot ranges from wearing more supportive footwear to surgery.

Causes

The causes of cavus foot are varied and may include congenital, developmental and neuromuscular origins.

In some cases, cavus foot is linked to a neurologic disorder such as spina bifida, cerebral palsy or muscular dystrophy. Children can also inherit the structural anomaly from their parents or develop it after an injury. For some children with cavus foot, the cause remains unknown.

Determining the cause of your child’s cavus foot can help determine the best treatment. If your child’s cavus foot is related to a neurological condition, it is likely to get worse and may require more aggressive treatment.

Signs and symptoms

The most common symptom of cavus foot is a high arch, even when your child is standing still.

In addition, some children may experience:

  • Pain when walking or standing.
  • Instability in the foot due to walking on the outside of the foot or the heel tilting inward.
  • Recurrent ankle sprains
  • Calluses on the ball, heel or side of the foot.
  • Toes that are bent (hammertoes) or clenched (claw toes).
  • Foot drop, a weakness in the foot and ankle muscles. This may cause your child to drag their foot when taking a step.

Testing and diagnosis

Parents are often the first to notice a child’s high-arched foot or symptoms like pain or instability that lead to worry. Early detection of cavus foot and its cause is important for successful management.

At Children's Hospital of Philadelphia (CHOP), a trained pediatric orthopedic physician will review your child’s medical and family history, and conduct a physical and visual examination of your child.

The physician will look for a high-arched foot, as well as other outward symptoms such as calluses, hammertoe or claw toe. A complete lower extremity evaluation will be performed and your child’s foot will be tested for muscle strength. The doctor will observe your child walking and standing to better understand the mechanics of your child’s feet. Clinicians may also ask you to bring your child’s regular shoes to the appointment so they can evaluate the wear patterns. If your child appears to have a neurological condition, referral to a neurologist for a complete neurological exam may be recommended.

If your child is experiencing foot pain, doctors may also order imaging tests such as:

  • X-rays, which produce images of bones.
  • EOS imaging, an imaging technology that creates 3-dimensional models from two flat images. Unlike a CT scan, EOS images are taken while the child is in an upright or standing position, enabling improved diagnosis due to weight-bearing positioning. It is used to analyse the overall alignment of the limb.
  • Computed tomography (CT) scan, which uses a combination of X-rays and computer technology to examine bones and produces cross-sectional images ("slices") of the body.
  • Magnetic resonance imaging (MRI), which uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs, soft tissues, muscles, ligaments and other structures within the body. Your child is exposed to no radiation during an MRI.

Treatments

In most cases, children with cavus feet will require some form of treatment. While many children can be helped with non-surgical treatment, some will require surgery to treat their condition.

Non-surgical treatment

For children who are experiencing pain or instability associated with cavus feet, doctors may recommend a variety of non-surgical treatments, including:

  • Orthotic devices — Your child’s doctor may recommend custom-designed orthotic devices that fit into your child’s shoes. These can provide stability and cushioning for the foot.
  • Shoe modifications — Shoes with higher tops and a wider base on the heel can better support the ankle and provide more foot stability.
  • Bracing — In some cases, your child’s doctor may recommend a brace to provide more stability to the foot and ankle. This can also be helpful if your child has foot drop.

Surgery

If non-surgical treatments don’t improve your child’s condition, surgery may be needed to decrease pain, increase stability and address any foot weakness.

The goal of surgery is to improve the function of your child’s foot, decrease pain and reduce the risk of other injuries, such as ankle sprains, that are common with cavus foot.

There are a number of different surgical procedures to correct cavus foot. Your child’s surgeon will discuss the best options to address your child’s individual condition.

Surgery may include correcting a bone deformity, muscle imbalance or ankle looseness to provide more even distribution of weight in the foot. In some cases, these procedures can be done with minimally invasive techniques, which leave smaller scars and shorter recovery time.

Safety in surgery

Surgery can dramatically improve the long-term outcomes for your child with cavus foot, but it can also be a stressful experience for you and your child.

At CHOP, we offer a wealth of resources that can help you and your child prepare for surgery. Additionally, we follow many best practices before, during and after surgery to decrease the risk of infection and increase positive outcomes. Our safety protocols have been so successful that many other institutions have adopted them.

To learn more, read how we make safety in surgery a top priority.

Follow-up care

In most cases, children with cavus foot will require long-term follow-up care. Follow-up visits at two-weeks post-operatively, and again a month later, will allow the physician to assess your child’s recovery.

At Children's Hospital of Philadelphia, we offer a wealth of ongoing support and services for your child and family at our Main Campus and throughout our CHOP Care Network. Our team is committed to partnering with you to provide the most current, comprehensive and specialized care possible for your child.

We recognize your child's pediatrician as an important part of the clinical team and provide regular updates on your child's progress. If continued care and monitoring is necessary into adulthood, we will help transition your child's care to an adult orthopedic team.

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