Overview
Pes cavus is an umbrella term describing a spectrum of foot shapes with a high arch. Pure Pes cavus occurs when the metatarsal bones are plantarflexed relative to the hindfoot described as ?forefoot plantaris? which increases the height and curvature of the medial longitudinal arch. When the patient weight-bears, the hindfoot is pushed into dorsiflexion by the plantarflexed forefoot.

Causes
Cavus foot commonly occurs as a result of an underlying medical or neurological condition, such as polio, muscular dystrophy or cerebral palsy. Cavus foot may also occur as a result of congenital defects. They may be inherited from a parent, or they may result from an orthopedic condition or a disease of the nerves or muscles.

Symptoms
In addition to a visibly high arch in the foot, symptoms include, Calluses on the ball, heel or side of the foot, Bent toes (hammertoes) or claw toes (toes clenched like a fist), Pain when standing or walking, Frequent ankle sprains.

Diagnosis
It is critical to establish whether there is a neurological diagnosis and whether it is progressive or static. In the growing foot, the deformity may be progressive although the neurological impairment may be static. The history should cover the onset of foot problems and how they have progressed. Pain, instability, difficulty walking or running and problems with footwear are frequent complaints. Neurological symptoms, such as sensory changes, weakness and clumsiness should be sought. Back pain or headaches may signify a central cause. Family history may suggest a hereditary cause.

Non Surgical Treatment
Suggested conservative management of patients with painful pes cavus typically involves strategies to reduce and redistribute plantar pressure loading with the use of foot orthoses and specialised cushioned footwear. Other non-surgical rehabilitation approaches include stretching and strengthening of tight and weak muscles, debridement of plantar callosities, osseous mobilization, massage, chiropractic manipulation of the foot and ankle and strategies to improve balance.

Surgical Treatment

Soft tissue surgery
Cavus foot is caused in part by an over-pull of one of the lateral ankle muscles. A release of this tendon Can stretching help you grow taller? be performed on the outside of the ankle. Additionally, a transfer of this tendon can be performed to help in correcting deformity of the ankle joint.

Tendon transfers
Too much pull of certain muscles and tendons is often the cause of the deformity related with a cavus foot. Moving one of these muscles or tendons may help the foot work better. In addition, patients with a cavus foot may have weakness in moving the foot up, which is sometimes called a foot drop. In these cases, a tendon from the back of the ankle may be moved to the top of the foot to help improve strength.

Bony surgery
Correcting the deformity of the foot may not be possible with soft tissue procedures alone. In these instances, one or more bone cuts (osteotomies) may be needed. Instead of a bone cut, a fusion (arthrodesis) procedure may be used. A fusion removes the joint between two bones so they grow together over time. During a fusion the bones may be held in place with plates or screws. Dorsiflexion osteotomy of the first metatarsal. This procedure flattens out the arch.

Calcaneal osteotomy
This procedure is performed to bring the heel bone back under the leg. This is needed if correction of the deformity in the front of the foot does not also correct the back of the foot or ankle. A calcaneal osteotomy can be performed several ways and is often held in place with one or more screws. Fusion. Sometimes patients have a deformity that has caused damage to the joints. In these cases, soft tissue procedures or bone cuts may not be enough, and it may be necessary to eliminate the joint.

Toe surgery
Clawed toes are a common problem with cavus foot deformity. This can be treated with tendon surgery, fusion or removal of part of the toe bones. Following surgery the toes are often temporarily held in place with pins.