Cavus foot is a sometimes painful condition in which the foot has a very high arch. Due to the high arch, an excessive amount of weight is placed on the ball of the foot, the heel, or possibly the outside of the foot. when ambulating or standing. Cavus foot can lead to continued pain and at times instability of the ankle.
Causes
Cavus foot is typically caused by a neurologic disorder (i.e. cerebral palsy, Charcot-Marie-Tooth disease, spina bifida, polio, muscular dystrophy, or stroke). In some cases the high arch may represent an structural abnormality that can be inherited.
The underlying cause of the caves foot determines the progression and future prognosis. If the high arch is due to a neurologic disorder it is likely to progressively worsen.
Symptoms
- High arch when standing.
- Hammertoes (bent toes) or claw toes (toes clenched or curved toes)
- Calluses on the ball, side, or heel of the foot
- Pain when standing or walking
- An unstable foot due to the heel varus (tilting inward), which can lead to persistent ankle sprains
- Muscle weakness on the outside of the foot
- Tendonitis, swelling, and pain behind the ankle
- Foot drop (weakness of the muscles in the foot and ankle that results in dragging the foot when taking a step – foot drop is usually a sign of an underlying neurologic condition)
Diagnosis
Diagnosis of cavus foot typically includes a review of the patient’s family history. Your surgeon will examine the foot, evaluate the high arch and possible calluses, hammertoes, and claw toes. Your surgeon will evaluate if the source of the high arch is coming from the front part of the foot or the rear part of the foot with a block test. The foot is typically tested for muscle strength, and the the ambulation pattern as well as coordination. Several other pathologic conditions are typically associated with a symptomatic cavus foot to include ankle instability, peroneal tendonitis, pain underneath the first metatarsal, muscle imbalance, a tight achilles tendon. These will be reviewed and investigated during the clinical evaluation.
X-rays will be ordered to further assess the condition. At times advanced imaging such as a CT scan or MRI will be ordered to determine the extent of the pathology to the soft tissue and bone as well as determine surgical planning should surgery be warranted. In addition, an electromyography and nerve conduction velocity (EMG/NCV) may be ordered to evaluate and/or rule out neurogenic problems. A neurologist referral may be made for a complete neurologic evaluation.
Non Surgical Treatments
Treatment approaches for a cavus foot are based on how long the pathology has been present and the amount of pathology to the soft tissue as well as arthritic conditions to the joints. Conservative treatment options are explored prior to surgical intervention.
- Ice. Putting an ice pack on your foot/ankle for 20 minutes several times a day helps reduce inflammation. Place a thin towel between the ice and your foot; do not apply ice directly to the skin.
- Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to reduce pain and inflammation.
- Orthotic devices. Custom or over the counter orthotic devices that fit into your shoe may help improve the underlying mechanical structure of the foot/ankle.
- Bracing. May reduce pain, assist with ambulation, assist with foot drop during ambulation and help prevent further deformity.
- Physical therapy. Exercises to strengthen the muscles may provide greater stability and help avoid injury that could worsen the condition.
- Stretching exercises. Exercises that stretch out the calf muscles.
- Limit activities. Reduce extended physical activities
- Shoe modifications. Wearing supportive shoes that have a rigid heel and a good arch support and a slightly raised heel reduces stress on the foot/ankle
Surgery
If non-surgical treatment fails to adequately relieve pain and improve stability, surgery may be needed to decrease pain, increase stability, and compensate for weakness in the foot.
Your surgeon will discuss the best surgical procedure or combination of procedures based on each individual case. In some cases where an underlying neurologic problem exists, surgery may be needed again in the future due to the progression of the disorder. Additionally some surgical cases may require a staged approach (more than one surgery), this depends on the severity of the condition.
Depending on what surgical procedure is scheduled it can be either an outpatient (day surgery) or inpatient (48-72 hour stay in hospital). Surgery is typically scheduled at your convenience.
A splint or boot will be placed on your surgical foot/ankle after surgery. No weight to the surgical foot/ankle is advised until your surgeon encourages weight bearing (typically 6-10 weeks post surgery).