High-arched (cavus) foot and tendon transfers
A very high arch can put too much pressure on parts of the foot and make the ankle roll. Custom inserts and braces help many people. Surgery can rebalance the foot when they are not enough.
What is a cavus foot?
A cavus foot (pes cavus) has an arch that is higher than normal. Because the arch is so high, more weight lands on the heel and the ball of the foot. The heel often tilts inward, which can make the ankle roll out. A high arch may slowly get worse over time.
Problems it can cause
- Ankle sprains that keep happening (ankle instability)
- Pain along the outside of the foot
- Thick, painful skin (calluses) under the ball of the foot
- Toes that curl or bend (claw toes or hammertoes)
What causes it?
A high arch can run in families. It can also come from a condition that affects the nerves or muscles. One of the most common is Charcot-Marie-Tooth disease, an inherited nerve condition. Other causes include a past stroke, spine problems, and old leg or foot injuries. Sometimes no cause is found.
Because a nerve problem can be the cause, your doctor may suggest a nerve test. A new high arch, a high arch in only one foot, or a high arch in a child is a reason to be checked.
Treatment without surgery
Many people start with:
- Custom shoe inserts (orthotics) shaped to spread pressure and support the foot
- An ankle brace for instability, or a brace for a weak foot or ankle
- Shoes with a stable heel and enough room for the toes
- Stretching and physical therapy for strength and balance
- Padding and care for painful calluses
When surgery helps
Surgery may be an option when pain, sprains, or sores keep happening after a fair trial of non-surgical care. The goal is a more balanced foot that spreads weight more evenly. The plan depends on how stiff the foot is and the cause. It may include:
- Moving a tendon (tendon transfer): a tendon that pulls too hard is moved so it helps balance the foot
- Reshaping bones (osteotomy): cutting and shifting a bone, often the heel bone or the bone behind the big toe
- Lengthening tight tissues: such as the tight band under the arch (plantar fascia) or the calf and Achilles tendon
- Repairing loose ankle ligaments
- Straightening curled toes
- Joint fusion: joining bones so they heal as one, sometimes used for a stiff, severe, or arthritic foot
Recovery
Recovery depends on which procedures are done and your health. Most people spend several weeks off the foot in a splint, cast, or boot, using a knee scooter, crutches, or a walker. Then you slowly add weight in a walking boot (CAM boot), move into shoes, and start physical therapy. Full recovery often takes many months. Learn more about getting around after surgery.
After surgery, call our office if… you have a fever or chills, new pain or swelling in your calf, or drainage, opening, or spreading redness at the incision. For chest pain, trouble breathing, or another emergency, call 911.
How Dr. Nafal can help
Dr. Nafal is board qualified by the American Board of Foot and Ankle Surgery in Foot Surgery and in Reconstructive Rearfoot and Ankle Surgery. He performs cavus foot reconstruction and tendon transfers, and he sees both adults and children. He explains every option in plain words, including options that don't involve surgery.
Common questions
Why does a high arch cause ankle sprains?
A high arch often tips the heel inward. This makes the ankle roll out more easily, and the ligaments can stretch over time.
Will my child's high arch get worse?
It can, especially if a nerve or muscle condition is the cause. An exam can help find the cause and track changes as your child grows.
Will I still need inserts after surgery?
Many people still benefit from supportive shoes or inserts. Dr. Nafal will explain what to expect for your foot.
Talk to Dr. Nafal about your high-arched foot
Offices in Canton and Troy. New patients welcome.