Cavus Foot

The deformity of the foot cavity consists of an abnormal elevation of the foot arch. "Cavus foot is a structural change that creates a plantar arch that is higher than normal," said Javier Torralba Estellés, president of the Spanish Association of Podiatric Surgery. The toes may become rigid or bend inward, reducing the size of the foot.

Incidence

Cavus foot is quite common in the general population, although in milder forms. These mild cases of cavus foot do not require special treatment as long as they do not cause discomfort or interfere with walking. The age of presentation is between eight and twelve years, although a patient may sometimes present the first toe at birth.

Causes

In 80% of cases, the origin of cavus foot is related to a neurological disorder. According to Torralba, there is a high probability that this change occurs due to neuromuscular involvement, so it is very important for the patient with cavus foot to consult a specialist to determine the exact origin of the problem. There are also cases where the cause is idiopathic because the increase in the plantar arch occurs without a valid reason. On the other hand, experts confirm that this condition has a high familial frequency, although it was not possible to identify a real hereditary transmission.

Symptoms

This disorder begins to manifest as pain in the arch and heel areas, as well as in the forefoot area and beneath the toes. "It is associated with tension and shortening of the plantar muscles of the foot and the back leg," emphasizes the expert. Highly arched feet tend to hurt when more tension is applied to the section of the foot between the ankle and toe. This leads to a shortened foot length, difficulties in wearing appropriate shoes, and a feeling of pain when walking, standing, and running. Cavus foot causes excessive muscle tension and ankle stiffness. When it appears at an early age, there is very little discomfort and generally does not change the gait significantly, except for those with a neurological cause. However, over the years, the condition becomes stiffer, and characteristic symptoms begin to manifest in adulthood.

- Metatarsalgia: Pain in the pads of the toes when supporting weight.

- Talalgia: Pain in the heel when supporting weight.

- Plantar hyperkeratosis: Painful calluses in high-pressure areas.

- Clawed toes (flexed inward).

- Appearance of tendinitis.

- Difficulty putting on shoes.

- Frequent lower back pain.

- Difficulty or extreme fatigue standing without moving.

- When the deformity is more pronounced, some symptoms may worsen with age.

Prevention

According to the specialist, although there is no effective prevention for cavus foot, stretching exercises could help avoid its appearance. Some of the most suitable exercises for plantar fascia stretching are as follows:

- Place the toes of the foot on the edge of a step and slowly lower the heels, holding the stretch for 30 seconds.

- Place your arms extended on a wall, one leg forward and the other back, forming a 45-degree angle, and hold the tension for 30 seconds.

- Roll a cold can with the foot and repeat the motion 30 to 50 times.

- Pull the toes back, stretching the arch and holding the tension for 30 seconds, bending and stretching the knee alternately.

- Place the foot on a towel and try to crumple it with the toes.

Types

There are two types of cavus feet:

- Posterior cavus foot or calcaneovarus: A type of cavus foot where the heel drops.

- Anterior cavus foot: More common, where the metatarsals become vertical or drop, often associated with clawed toes.

Mixed forms can also occur.

Additionally, based on the position of the heel, cavus foot can be classified as varus, rectus, or valgus.

Diagnosis

"The diagnosis is purely clinical and symptomatic," says Torralba. First, it is advisable to rule out the possibility of a neurological origin for the disorder by referring the patient to the appropriate specialist. The specialist will then examine the foot and ankle, assessing the elevation of the plantar arch and detecting possible calluses, hammer toes, and claw toes. The muscle resistance of the foot will also be evaluated, as well as the walking pattern and coordination of the patient. In some cases, a podoscope may be used or an X-ray may be ordered for a more precise evaluation. "In cases of very painful cavus feet, a radiological diagnosis focused on surgical treatment will be necessary," concludes Torralba.

Treatments

Cavus feet present very few discomforts and typically do not significantly alter gait, except in cases with a neurological cause. Therefore, the main goal of treatment is symptom relief. "The fundamental treatment consists of the use of custom-made orthotics adapted by a podiatrist," says Torralba.

In general, it is recommended to wear comfortable, flexible, and wide shoes, especially in the toe area, to allow mobility of the toes, and to apply physiotherapy. Some physiotherapists recommend massage therapy to prepare the foot for some of the following exercises recommended for those who suffer from persistent foot pain:

- Walking barefoot on hard surfaces.

- Climbing an inclined surface, first placing the heel down.

- Descending an inclined surface backward, first placing the heel down.

Surgical Intervention

Surgery for severe cavus feet requires a complete surgical approach that corrects all the causes of the deformity, according to David López Capapé, a specialist in traumatology and orthopedic surgery.