We often hear about flat feet being the ‘worse’ foot to have, and the foot type that contributes to most foot pathology. However, is this true?

Pes cavus, commonly referred to as a high-arched foot is characterised by an abnormally elevated medial longitudinal arch. Unlike the more flexible and shock-absorbing normal foot, the cavus foot is typically rigid and less capable of distributing forces evenly during gait. This altered foot structure significantly affects plantar pressure patterns, often leading to pain, instability, and increased risk of musculoskeletal injury.

Understanding the relationship between pes cavus and plantar pressures is important in clinical biomechanics, podiatry, physiotherapy, and sports medicine because abnormal pressure distribution contributes to a wide range of foot pathologies and functional impairments.

A pes cavus foot is defined by excessive elevation of the arch, frequently accompanied by:

  • Rearfoot varus

  • Forefoot equinus or plantarflexion of the first ray

  • Clawed toes

  • Reduced foot flexibility

  • Tight plantar fascia and Achilles tendon

Plantar Pressure Distribution

Plantar pressure refers to the force exerted by the sole of the foot against the ground during standing and walking. In a normal foot, pressure is distributed across the heel, midfoot, and forefoot in a balanced manner.

In pes cavus, the elevated arch reduces contact area between the midfoot and the ground. As a result, body weight becomes concentrated primarily at two regions:

  • The heel

  • The metatarsal heads (forefoot)

This creates significantly increased peak plantar pressures in these areas.

Therefore, this is the foot type that normally produces the most hard skin, heel fissuring and callousing when performing our famous ‘medical pedicure’.

Biomechanical Consequences

The abnormal plantar pressure patterns associated with pes cavus can lead to several biomechanical and clinical issues.

Reduced Shock Absorption

The rigid arch decreases the foot’s ability to dissipate ground reaction forces. Consequently, impact forces travel more directly through the lower limb, increasing stress on bones and soft tissues.

Lateral Instability

Many cavus feet demonstrate excessive supination, shifting pressure laterally during stance and gait. This can increase susceptibility to:

  • Lateral ankle sprains

  • Peroneal tendon injuries

  • Stress fractures of the fifth metatarsal

Forefoot Overload

Excessive loading beneath the metatarsal heads commonly results in:

  • Metatarsalgia

  • Plantar calluses

  • Sesamoiditis

  • Stress fractures

Heel Pain

Elevated heel pressures may contribute to:

  • Plantar fasciitis

  • Heel pad pain

  • Calcaneal stress injuries

Gait Alterations in Pes Cavus

Individuals with pes cavus often demonstrate altered walking mechanics due to the rigid nature of the foot.

Common gait characteristics include:

  • Reduced pronation during stance

  • Increased supination

  • Decreased shock attenuation

  • Shortened contact time of the midfoot

  • Increased loading rates

These changes can affect not only the foot but also proximal joints such as the knee, hip, and lumbar spine.

Management and Treatment

Treatment of pes cavus focuses on reducing abnormal plantar pressures, improving stability, and relieving symptoms.

Orthotic Therapy

Custom foot orthoses are commonly prescribed to:

  • Redistribute plantar pressures

  • Increase midfoot contact

  • Cushion high-pressure regions

  • Improve shock absorption

Footwear Modification

Appropriate footwear may include:

  • Cushioned soles

  • Wider toe boxes

  • Rocker-bottom soles

  • Shock-absorbing materials

Each footwear brand offers their own version. Speak to your podiatrist about which model is most appropriate to your foot, as every foot type would have a more specific shoe suited.

PODIATRY CARE

Rehabilitation may involve:

  • Dry needling/ myofascial release/ hands on manual therapy

  • Stretching of the plantar fascia and Achilles tendon

  • Strengthening intrinsic foot muscles

  • Balance and proprioceptive training

  • Medical pedicures to reduce hard skin growth and relieve pain/ infection

  • Orthotic therapy- This is very specific to the individual foot. In a high arch, a custom orthotic is most suited, as it is prescribed to accurately contact the contours of the high arch.

There are so many other therapies that can be performed by our podiatrist. We recommend an individual consultation for a personalised treatment plan.

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