Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle, Howell & Bloomfield Township, MI
Last reviewed: May 2026
Balance Foot & Ankle offers same-day appointments for urgent foot and ankle conditions across Southeast Michigan — but the most important factor in outcomes isn’t getting seen quickly. Our podiatrists explain what to do in the first 24-48 hours before your appointment that most patients skip entirely. Call (810) 206-1402 — expert podiatric care across Michigan.
Medically Reviewed | Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle, Michigan
The most important clinical decision with Cavus Foot Michigan Podiatrist isn’t which treatment to start with — it’s identifying the correct subtype. That changes everything. Call (810) 206-1402.
What Is Cavus Foot?
Pes cavus — commonly called cavus foot or high arch foot — is a foot type characterized by an abnormally elevated medial longitudinal arch that remains high even during full weight-bearing. Unlike the flexible flatfoot (which flattens during standing and corrects with arch support), cavus foot is typically rigid — the elevated arch does not yield under body weight, creating a shock-absorbing inefficiency that transmits excessive force to specific pressure points at the heel, lateral foot, and metatarsal heads.
Cavus foot affects approximately 10–15% of the population. While mild arch elevation may be asymptomatic, moderate to severe cavus foot produces a characteristic pattern of problems: chronic lateral ankle instability from the heel varus position that predisposes inversion sprains, peroneal tendon disorders from chronic eversion overload, plantar fasciitis and heel pain from increased fascial tension, and metatarsal stress fractures from excessive forefoot loading.
Causes: Neurological vs. Structural
Every patient with cavus foot deserves evaluation for neurological causes. Approximately 60–70% of cavus foot cases have an identifiable neurological etiology, most commonly Charcot-Marie-Tooth (CMT) disease — an inherited peripheral motor and sensory neuropathy that causes progressive muscle imbalance leading to cavus deformity. Other neurological causes include Friedreich’s ataxia, spinal cord tumors, tethered spinal cord, and stroke. Idiopathic cavus foot — where no neurological cause is identified — accounts for the remaining cases and is often hereditary without identified genetic etiology. Dr. Biernacki performs the Coleman block test (to assess hindfoot flexibility) and refers patients with suspected neurological causes for neurological evaluation.
Clinical Problems Associated with Cavus Foot
The biomechanical consequences of high arch alignment create predictable injury patterns. Heel varus (inward tilting of the heel in the cavus foot) places the ankle in a mechanically disadvantaged position that dramatically increases lateral ankle sprain risk — patients with cavus foot have lateral ankle sprain rates more than twice those of patients with neutral alignment. The peroneal tendons, which must work harder against the inverting cavus foot, develop tendinopathy and subluxation at elevated rates. The concentrated forefoot pressure at the lateral metatarsal heads causes metatarsal stress fractures, callus formation, and metatarsalgia. The tight plantar fascia under constant tension develops plantar fasciitis.
Conservative Treatment
Custom orthotics for cavus foot differ importantly from flat-foot orthotics: rather than supporting an absent arch, they must accommodate the existing rigid arch and redistribute pressure away from loaded areas. Lateral forefoot posting, heel cushioning, and metatarsal pads reduce pressure concentrations. High-top footwear with lateral ankle support reduces inversion sprain risk. Ankle-foot orthoses (AFOs) provide more substantial stability for patients with neurological muscle weakness. Peroneal strengthening exercises improve lateral ankle dynamic stability. Stretching the plantar fascia and Achilles tendon reduces fascial tension.
Surgical Correction of Cavus Foot
Progressive cavus foot with functional limitations unresponsive to conservative management may require surgical reconstruction. The specific procedure depends on the deformity’s components: a plantar fascia release addresses the fascial tightness that drives arch elevation; Dwyer calcaneal osteotomy corrects heel varus; metatarsal dorsal closing wedge osteotomies lower the forefoot. Tendon transfers (peroneus longus to brevis) address muscle imbalance in CMT-related deformity. Dr. Biernacki coordinates complex neurological cavus foot reconstruction with neurology and orthopedic surgery when multidisciplinary management is required.
Dr. Tom's Product Recommendations
Spenco Total Support Max Insoles
⭐ Highly Rated
High-density lateral support insole designed to accommodate rather than compress the rigid high arch — provides the metatarsal and heel cushioning that cavus foot patients need most.
Dr. Tom says: “These were specifically recommended for high arch feet — the cushioning under the ball of foot and heel is excellent.”
Cavus foot, high arch, metatarsal head pressure relief, heel cushioning
Flatfoot or neutral arch patients where high-support posting creates overcorrection
Disclosure: We earn a commission at no extra cost to you.
New Balance 990v6 Running Shoe
⭐ Highly Rated
Premium cushioned shoe with wide fit options and accommodating footbed for high-arch runners — the 990v6’s firm lateral midsole provides support without collapsing under cavus foot supination.
Dr. Tom says: “Best running shoe I’ve found for my high arches — the cushion and width accommodate my orthotics perfectly.”
High arch runners, cavus foot, wide fit needs, daily training
Significant overpronators who need motion control rather than cushion-first design
Disclosure: We earn a commission at no extra cost to you.
Zamst A2-DX Ankle Brace
⭐ Highly Rated
High-support ankle brace with bilateral strapping that prevents inversion — essential for cavus foot patients with chronic lateral ankle instability who cannot tolerate further ankle sprains.
Dr. Tom says: “My podiatrist prescribed ankle bracing for my high arch ankle instability — this brace lets me run again.”
Cavus foot lateral instability, chronic ankle sprain prevention, sport return
Patients with low-grade ankle instability where lighter support is sufficient
Disclosure: We earn a commission at no extra cost to you.
✅ Pros / Benefits
- Custom orthotics with lateral posting effectively reduce cavus foot overload injury rates
- High-top footwear and ankle bracing dramatically reduce lateral ankle sprain recurrence
- Neurological evaluation identifies treatable underlying causes in many patients
- Surgical reconstruction provides durable correction when conservative management fails
❌ Cons / Risks
- Rigid cavus foot does not correct with standard arch-support orthotics as flatfoot does
- Neurological cavus foot (CMT) is progressive — deformity worsens over time despite treatment
- Surgical reconstruction for complex cavus foot is technically demanding with prolonged recovery
- Lateral ankle instability requires lifelong protective footwear and bracing strategies
Dr. Tom Biernacki’s Recommendation
High arch feet are often undertreated because the deformity itself is visible and patients assume it’s just how their foot is built. What they don’t realize is that the high arch is driving their ankle sprains, their plantar fasciitis, and their forefoot pain. Once I address the underlying cavus mechanics with orthotics and the right footwear, patients often see improvement in conditions they’ve struggled with for years. And when there’s a neurological component, getting that diagnosed changes the entire management plan.
— Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle
Frequently Asked Questions
Is a high arch foot always a problem?
Mild high arches may be entirely asymptomatic throughout life. The problems arise when the arch is rigid enough to concentrate excessive plantar pressure at the heel and metatarsal heads, impair shock absorption, and tilt the heel inward enough to cause chronic lateral ankle instability. Patients with asymptomatic high arches who begin running or increasing activity often develop symptoms at that point as the increased loading exceeds the foot’s compensatory capacity.
Can custom orthotics fix a high arch?
Custom orthotics for cavus foot don’t correct the high arch structurally — they accommodate the existing arch and redistribute pressure away from overloaded areas. Lateral forefoot posting, metatarsal pads, and heel cushioning reduce the injury-causing pressure concentrations that the high arch creates. For structural correction, surgical osteotomies are required.
What is Charcot-Marie-Tooth disease and how does it relate to high arches?
Charcot-Marie-Tooth disease is the most common inherited peripheral neuropathy, affecting the motor and sensory nerves that control foot and leg muscles. The progressive muscle weakness it causes creates imbalance between foot intrinsic muscles — specifically the peroneus longus overpowering the peroneus brevis — that elevates the arch and tilts the heel into varus. Many patients with bilateral progressive cavus foot have undiagnosed CMT, which is why Dr. Biernacki screens all cavus foot patients with neurological history and family history questioning.
Can you have flat feet and high arches in the same person?
Not typically in the same foot, but patients can have different foot types in each foot. A foot that is flat (pes planus) in one foot and cavus in the other (asymmetric foot type) is actually a red flag for spinal cord pathology or unilateral neurological disease that should be investigated. Dr. Biernacki notes any foot type asymmetry as a clinical finding requiring further evaluation.
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Most diagnostic visits and conservative treatments are covered by Medicare and major insurers. Out-of-pocket costs vary by your specific plan.
How quickly can I get an appointment?
Most non-urgent cases see us within 5 business days. Urgent cases (sudden pain, possible fracture) typically same or next business day.
In-Office Treatment at Balance Foot & Ankle
If home treatment isn’t providing relief for your foot issues, our podiatry team at Balance Foot & Ankle can help with same-day evaluations and advanced in-office care.
Related Conditions
AAOS: Cavus Foot (High-Arched Foot)
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Dr. Tom Biernacki, DPM is a board-certified foot & ankle surgeon (ABFAS & ABPM) at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has made him one of the most-followed foot & ankle educators on YouTube.