- A high-arched foot (pes cavus) is a foot type with an exaggerated arch height that loads the heel and ball of the foot disproportionately.
- It can be inherited or related to underlying neurological conditions — a careful exam matters.
- Common symptoms include recurring ankle sprains, metatarsalgia, lateral foot pain, and plantar fasciitis.
- Custom orthotics with proper cushioning and lateral support, plus appropriate bracing for instability, resolve most cases.
- Surgical correction is reserved for severe deformity that has not responded to conservative care or for cases linked to progressive neurological disease.
What are high arches?
A high-arched foot — clinically called pes cavus or cavus foot — is the opposite of flat feet. The arch is exaggerated, the heel often tilts inward, and weight is concentrated on the heel and ball of the foot rather than being distributed across the entire sole. Cavus feet are rigid and don't absorb shock well, which makes them prone to a specific set of problems.
Cavus foot can be inherited (often runs in families) or related to underlying neurological conditions like Charcot-Marie-Tooth disease, spina bifida, or prior nerve injury. A new or progressing high-arched foot in a child or adult who didn't previously have one warrants a neurologic evaluation. Most cases we see, however, are inherited and stable — patients have had the foot type their whole lives.
At Northwest Extremity Specialists, treatment focuses on cushioning the bony prominences, supporting the lateral foot to prevent ankle sprains, and using custom orthotics designed for the specific mechanics of a cavus foot (cushioned, with appropriate posting and a deep heel cup). Surgical reconstruction is uncommon and is reserved for severe deformities, progressive cases, or patients with associated foot drop or muscle imbalance.
See it in motion
Animations licensed from ViewMedica · Swarm Interactive
In a normal foot, weight is distributed across the heel, lateral foot, and ball of the foot. In a cavus foot, the arch is so high that the middle of the foot makes no ground contact, so weight is concentrated at just two points — the heel and the ball — increasing pressure dramatically at those areas. The hindfoot often tilts inward (heel varus), which makes the ankle vulnerable to rolling outward. The toes often become clawed because of muscle imbalance.
What it feels like
Cavus foot can be asymptomatic, but when it causes problems the pattern is recognizable:
- Recurring ankle sprains, especially when stepping on uneven surfaces
- Pain along the outside (lateral) edge of the foot
- Metatarsalgia or sesamoiditis from forefoot overload
- Heel pain or plantar fasciitis
- Calluses under the heel and ball of the foot
- Claw toes or hammertoes
- A foot that feels "tippy" or unstable
- Difficulty finding shoes that don't feel cramped on top
Why it develops
High arches can be inherited or related to other conditions:
- Inherited foot structure — the most common cause
- Charcot-Marie-Tooth disease and other hereditary neuropathies
- Spina bifida, polio, or other neurologic conditions
- Prior nerve injury (sciatic, peroneal)
- Stroke or cerebral palsy in some cases
- Idiopathic — sometimes no underlying cause can be identified
How we diagnose high arches
A cavus foot exam includes a careful inspection (looking at arch height and heel position), a flexibility assessment (Coleman block test to differentiate flexible from rigid deformity), and a neurologic exam to screen for underlying conditions. Weight-bearing X-rays are taken in our office to measure bony angles. Referral for nerve conduction studies or genetic testing is considered when a hereditary neuropathy is suspected. Most patients leave the same day with a diagnosis and a clear initial plan.
Non-surgical care
Most cavus feet are managed successfully with conservative care:
- Custom orthotics designed for cavus mechanics — cushioned with a deep heel cup and appropriate lateral posting
- Cushioned, shock-absorbing athletic shoes
- Ankle bracing for patients with recurring ankle sprains
- Physical therapy for ankle and peroneal strengthening
- Calf and arch stretching
- Metatarsal padding for ball-of-foot pain
- Activity modification — avoiding uneven surfaces during acute episodes
- Treatment of associated conditions (claw toes, plantar fasciitis)
Surgical care
Surgical reconstruction is considered for severe cavus deformities, progressive cases, recurrent ankle sprains that don't respond to bracing, or cases linked to progressive neurologic conditions. The specific procedure is tailored to the pattern of deformity.
- Calcaneal osteotomy — repositioning of the heel bone to correct varus alignment
- First metatarsal osteotomy to elevate the forefoot
- Plantar fascia release for tight, contracted fascia
- Tendon transfers to rebalance muscle pull
- Claw toe correction (often combined)
- Joint fusions in selected severe cases
Cavus reconstruction typically requires 6–10 weeks of protected weight-bearing in a boot or cast, transition to athletic shoes by 3–4 months, and full return to activity over 6–12 months. The exact timeline depends on which procedures were combined.
When to see a specialist
- Recurring ankle sprains — especially more than 2–3 in a year
- A high-arched foot that is becoming painful or symptomatic
- New or progressing high arches in someone who did not previously have them (warrants neurologic evaluation)
- Lateral foot pain, metatarsalgia, or plantar fasciitis that isn't responding to standard treatment
- Difficulty finding shoes that fit comfortably
Cavus foot evaluation and conservative management is performed by any of our board-certified podiatrists. Complex reconstructions are handled by Dr. Mia Horvath, Dr. Thomas Melillo, and our orthopedic specialist Dr. Ron Bowman, often in coordination with physical therapy.