High Arched Foot (Pes Cavus): Causes, Problems, and Treatment

Quick answer: Pes Cavus High Arch affects roughly 1 in 4 adults in our practice. Effective treatment starts with a targeted diagnosis, conservative-first treatment, and escalation only when needed. We treat this regularly at our Howell and Bloomfield Township practices. Call (810) 206-1402.

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

What Is Pes Cavus (High Arched Foot)?

Pes cavus—commonly called a high arched foot or cavus foot—is a structural deformity characterized by an abnormally elevated longitudinal arch, plantar flexion of the forefoot relative to the hindfoot, and variable degrees of claw toe deformity. Unlike pes planus (flat foot), which is common and often asymptomatic, pes cavus is present in approximately 10% of the population and is more frequently associated with neuromuscular pathology and symptomatic foot problems. The foot type itself is not inherently pathological, but its rigidity and altered biomechanics create predictable problems that podiatric care can address.

Pes cavus exists on a spectrum from mild (cosmetically apparent high arch with minimal symptoms) to severe (rigid, contracted deformity with significant functional impairment). Understanding the cause of the cavus deformity is critical—approximately 70% of cases have an underlying neurological condition, and evaluation of a new or progressive cavus deformity should include neurological screening.

Causes: Neurological vs. Idiopathic

The most important cause to identify is Charcot-Marie-Tooth disease (CMT)—the most common hereditary neuropathy, affecting 1 in 2,500 people. CMT causes selective weakness of the intrinsic foot muscles and peroneal muscles while sparing others, creating the characteristic muscle imbalance that produces progressive cavus deformity, claw toes, and ankle instability. CMT should be considered in any patient with bilateral progressive cavus deformity, particularly with family history of high arches, ankle instability, or peripheral neuropathy.

Other neurological causes include: other hereditary motor sensory neuropathies, Friedreich’s ataxia (causing bilateral symmetric cavus), poliomyelitis (causing unilateral cavus from asymmetric muscle weakness), cerebral palsy, and tethered spinal cord or spinal dysraphism. Idiopathic cavus (no identifiable neurological cause) exists but is a diagnosis of exclusion—thorough workup including electrodiagnostic testing and neurology referral is appropriate for progressive cavus deformity.

Problems Associated with High Arched Feet

The cavus foot produces predictable mechanical problems due to its rigidity and altered load distribution. Lateral ankle instability is extremely common—the hindfoot varus (heel turning inward) associated with most cavus feet increases inversion stress during gait, making recurrent ankle sprains and peroneal tendon injuries much more frequent. Metatarsalgia (forefoot pain under the metatarsal heads) results from the elevated arch transferring more load to the forefoot. Plantar fasciitis and heel pain are common because the tight plantar fascia under a high arch is under constant tension. Claw toe deformities develop from intrinsic muscle imbalance.

Treatment

Conservative treatment focuses on accommodating the deformity and addressing specific symptomatic problems. Custom orthotics are the mainstay—a lateral heel post (wedge) corrects the hindfoot varus, metatarsal padding offloads the overloaded metatarsal heads, and a deep heel cup provides hindfoot stability. Wide, deep footwear with adequate forefoot volume accommodates claw toes and avoids forefoot compression. Ankle bracing (lace-up or stirrup) addresses lateral instability. Physical therapy targeting calf stretching, peroneal strengthening, and proprioception training reduces ankle sprain risk.

Surgical correction of pes cavus is considered when conservative measures fail to adequately control symptoms or when the deformity is progressive. The surgical approach depends on the specific deformity components: soft tissue procedures (plantar fascia release, tendon transfers to address muscle imbalance) for flexible deformities; bony procedures (calcaneal osteotomy to correct hindfoot varus, metatarsal osteotomies to lower the forefoot) for rigid deformities; and toe corrections for symptomatic claw toes. Addressing the underlying neurological condition (if identified) is coordinated with neurology and guides the surgical plan—particularly in CMT, where progressive neuropathy may influence the durability of surgical corrections.

Frequently Asked Questions

Medical References & Sources

• American Orthopaedic Foot & Ankle Society — Cavus Foot
• PubMed Research — Pes Cavus Neurological Causes
• PubMed Research — Cavus Foot Treatment Outcomes

Dr. Tom Biernacki, DPM is a board-certified podiatric surgeon at Balance Foot & Ankle in Howell and Bloomfield Township, Michigan. He evaluates and treats pes cavus deformities including neurological screening, custom orthotics, ankle stabilization, and reconstructive surgery for cavus foot.

In-Office Treatment at Balance Foot & Ankle

If home treatment isn’t providing relief for your high arch foot, our podiatry team at Balance Foot & Ankle can help with expert evaluations and advanced in-office care.

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