High Arch (Cavus Foot) Treatment Michigan | Supination Specialist

Quick answer: High Arch Cavus Foot Michigan is a common foot/ankle topic that affects many patients. Effective treatment starts with a targeted diagnosis, conservative-first treatment, and escalation only when needed. We treat this regularly at our Howell and Bloomfield Hills practices. Call (810) 206-1402.

Related Conditions

Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

High Arch (Cavus Foot) Treatment Michigan

Pes cavus (high arch foot) is a structural deformity in which the longitudinal arch is excessively elevated, causing abnormal loading on the heel and ball of the foot and a tendency toward lateral ankle instability. Unlike flatfoot, cavus foot concentrates pressure at the heel and metatarsal heads rather than distributing it evenly. Dr. Tom Biernacki DPM at Balance Foot & Ankle treats high arch and cavus foot conditions in Michigan at our Howell, Brighton, and Bloomfield Hills locations.

Why Cavus Foot Develops

Approximately 60–70% of cavus foot cases have a neurological cause — most commonly Charcot-Marie-Tooth disease (hereditary motor-sensory neuropathy), spina bifida, cerebral palsy, or post-polio syndrome. The remaining cases are idiopathic (unknown) or due to prior foot trauma or clubfoot residual deformity. Any patient with cavus foot should be evaluated for an underlying neurological condition.

Symptoms Associated with High Arches

• Heel and lateral (outer) foot pain from concentrated loading
• Metatarsalgia — pain under the metatarsal heads from forefoot overload
• Recurrent lateral ankle sprains from hindfoot varus (heel tilted inward)
• Claw toes (intrinsic-minus foot deformity)
• Stress fractures of the metatarsals and lateral column
• Plantar fasciitis (tight plantar fascia)
• Difficulty fitting shoes — standard shoe lasts are designed for average arch heights

Diagnosis

Weight-bearing X-rays assess calcaneal pitch (arch height), metatarsal declination angle, and hindfoot alignment. The Coleman block test distinguishes flexible (forefoot-driven) from rigid cavus deformity — critical for surgical planning. Neurological examination and EMG/nerve conduction studies are ordered when a neurological etiology is suspected. Dr. Biernacki refers to neurology for detailed neurological workup when indicated.

Treatment

Custom orthotics for cavus foot require a lateral forefoot post to accommodate the rigid plantar-flexed first ray and reduce lateral column loading. A lateral heel wedge may be added for hindfoot varus correction. These modifications are opposite to flatfoot orthotic design — off-the-shelf insoles are generally not appropriate for cavus foot.

Ankle-foot orthosis (AFO) provides stability for patients with neurological weakness or severe ankle instability.

Surgical reconstruction for flexible cavus foot typically involves plantar fascia release, Achilles tendon lengthening, first metatarsal dorsiflexion osteotomy (raising the dropped first ray), and peroneus longus-to-brevis transfer. Hindfoot osteotomy (calcaneal lateral wall osteotomy) corrects heel varus. Claw toe correction is performed simultaneously. Rigid cavus deformity with established arthritis may require triple arthrodesis.

Frequently Asked Questions

Schedule your cavus foot evaluation at Balance Foot & Ankle in Howell, Brighton, or Bloomfield Hills, Michigan.

Dr. Tom’s Top 3 — The Premium Foot Pain Stack (2026)

If you only buy three things for foot pain, get these. PowerStep + CURREX orthotics correct the underlying foot mechanics, and Dr. Hoy’s pain gel delivers fast topical relief. This is the exact stack Dr. Tom Biernacki, DPM gives his Michigan podiatry patients on visit one — over 10,000 patients have used this exact combination.

Visit Balance Foot & Ankle — Same-Day Appointments Available

Our podiatry team serves patients throughout Michigan including Howell, Brighton, and Bloomfield Hills. If you’re dealing with heel pain, ingrown toenails, or a foot injury, we have same-day appointment availability.

Frequently Asked Questions

When should I see a podiatrist?

See a podiatrist if: foot or ankle pain has lasted more than 2–4 weeks without improvement, you’re changing your gait to avoid pain, you have an open wound or sore that isn’t healing, you notice nail discoloration or thickening, you have diabetes and any foot concern, or pain is severe enough to wake you at night. Most foot conditions are easier and cheaper to treat early — what starts as a minor issue can become a surgical problem with months of delay.

What is the difference between a podiatrist and an orthopedic surgeon?

Podiatrists (DPM — Doctor of Podiatric Medicine) specialize exclusively in the foot, ankle, and lower leg. Orthopedic surgeons (MD/DO) have broader musculoskeletal training but variable foot/ankle subspecialization. For foot and ankle-specific problems, a podiatrist often has more focused training and experience. For injuries involving the leg above the ankle, complex pediatric cases, or multi-level reconstruction, orthopedic consultation may be appropriate. We frequently co-manage patients with orthopedic colleagues.

How do I know if my foot pain is serious?

Signs that warrant same-day or next-day evaluation: severe pain that appeared suddenly without clear cause, swelling, redness, and warmth that appeared suddenly (possible gout, infection, or Charcot fracture), an open wound that looks infected (redness spreading, pus, warmth), inability to bear weight, or any foot problem in a diabetic patient. Pain that’s been present for weeks and is stable is important but not an emergency — schedule within 1–2 weeks.

Can foot problems cause back and knee pain?

Yes — this is a kinetic chain effect. Abnormal foot mechanics (overpronation, supination, leg length discrepancy) cause compensatory changes in knee, hip, and lumbar alignment. Roughly 30% of patients presenting to our clinic with knee pain have a treatable foot-level biomechanical cause. Correcting foot mechanics with orthotics or appropriate footwear often provides significant knee and back relief. If you have chronic knee or back pain and haven’t had your foot mechanics evaluated, it’s worth a consult.

Are orthotics worth it?

For the right conditions, yes — custom orthotics are among the most cost-effective interventions in podiatry. They’re most effective for: plantar fasciitis, flat feet with secondary knee/back pain, leg length discrepancy, metatarsalgia, posterior tibial tendon dysfunction, and diabetic foot pressure management. Quality OTC orthotics ($35–60) resolve symptoms for 60% of patients with mild-to-moderate conditions. Custom orthotics are appropriate when OTC options have failed or when the biomechanical problem is complex. We cast custom orthotics in-office.

How do I choose the right running shoes?

Start with your foot type (flat, neutral, high arch) and running pattern (overpronator, neutral, supinator). Flat feet and overpronators do best in stability or motion-control shoes. Neutral feet do well in neutral-cushioned shoes. High arches need maximum cushioning with flexible soles. Always buy running shoes at the end of the day (foot swelling peaks then), get properly fitted by a specialist, and replace every 300–500 miles. If you’ve been injured repeatedly, a gait analysis can identify the mechanical flaw driving your injury pattern.

What is the difference between a sprain and a fracture?

A sprain is a ligament injury (the tissue connecting bones); a fracture is a break in the bone itself. Both can occur with the same trauma (ankle roll, fall). The old test — ‘if you can walk, it’s not broken’ — is wrong; many fractures are initially weight-bearable. Key differences: a fracture typically produces localized bone tenderness along the bone itself, while a sprain is tender over the ligament. X-ray is the standard to differentiate. High-grade sprains without proper treatment can be as disabling as fractures.

How do I prevent foot and ankle injuries?

The four most impactful prevention strategies: (1) Supportive, appropriately fitted footwear for your foot type and activity. (2) Gradual activity progression — the 10% rule (never increase weekly mileage or intensity by more than 10%). (3) Regular calf and ankle mobility work. (4) Strengthening the posterior tibial tendon, peroneals, and intrinsic foot muscles. Most overuse injuries are preventable; most acute injuries are not — but ankle sprain recurrence (60–70% without rehab) is prevented by balance and proprioception training.