Pes Cavus.
Alternative names for pes cavus include, high arch, high foot arch, excessively supinated foot, calcaneocavus, hump foot and Schaeffer’s Foot.
Pes Cavus is usually the result of an abnormal orthopedic or neurological condition. Neuromuscular diseases can cause changes in muscle tone associated with pes cavus. Highly arched feet make fitting shoes very difficult and usually result in a disability.
There are three classifications of cause for pes cavus. The first is the weakening of the lateral ( outside) aspect of the main calf muscle known as the gastrocnemius and the soleus muscle classified as posterior cavus. The second classification is known as anterior cavus and attributed to plantarflexion of the entire foot (flexes foot downward toward the sole) or just the first ray ( the first metatarsal and first cuneiform bones or big toe). The third classification called combined cavus is a combination of both.
Subjective findings include pain in the foot with prolonged walking or standing, foot and leg fatigue, increased risk of ankle sprain particularly during sports activities, difficulty finding shoes that fit and the lateral breakdown of the shoe in the heel and the lateral aspect of the sole.
Objective findings include a high longitudinal arch that does not flatten under weight, abnormal supination with weight bearing, inversion of the rear foot while standing and walking, weight distribution while standing and walking is at the heel, metatsal heads and the outside border of the foot. Claw toes may be present and callus formation on the sole or plantar surface of the foot.
Footwear Solutions.
Choosing the right footwear modification will depend upon the classification for Pes Cavus and the cause of the problem.
If plantarflexion of the foot or first ray is present as in anterior cavus, then a high heel elevation is recommended. To relieve the weight load on the first metatarsal in the case of anterior cavus and combined cavus, an orthotic that has a cut out for the plantarflexed first ray will re-distribute the weight to the second through fifth metartarsals.
For weakened calf muscles of posterior cavus then a low or negative heel is recommended. The relative aspect of the heel can be created by wedges or flares on the shoe or a laterally posted othotic in the shoe.
Because Pes Cavus places additional pressure on the metatarsal heads a metatarsal pad placed just before the heads relieves pressure from the heads. Placement of the metpad is important and shouldn’t be placed as a cushion under the metatarsal heads which will add to the pressure.
Pedors products for Pes Cavus or High Arch.
Option 1) Beats orthotic Neutral Heel No Met Pad – Functional Orthotic
For people with a normal arch or an arch that is moderately higher than normal where there is no ball of foot pain. This set up provides additional support to the fascia muscle for people that may have experienced pain related to arch pain like plantar fasciitis.
Option 2) Beats orthotic Neutral Heel With Met Pad - Functional Orthotic
For people with a normal arch or an arch that is slightly higher arched foot and experiencing ball of foot pain or metatarsalgia
Option 3) Pedors 3P inserts – Accommodative Insert.
Accommodative devices are used for feet with rigid or limited motion that cannot be acted upon by an orthosis to encourage correct biomechanical function or for neuropathic patients that need protection from high vertical forces. Accommodative devices are used as a comfort device to absorb shock and to redistribute pressure away from high pressure points to areas of lower pressure so that the pressure is carried equally across the whole foot.
Option 4) None of the above: If excessive supination is present then you should consider going to see a foot care professional like a Pedorthist who can evaluate the degree of supination and from there determine what would be the best pedorthic device should be fitted. An off the shelf device is not going to work. There are various options including a laterally posted orthotic device that can be worn inside the shoe to external modifications made to the shoe itself to provide additional support and biomechanical assistance to the foot and ankle.