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Cavus high arches

The High Arch (Cavus) Foot (Charcot Marie Tooth Disorder)

There are many causes for a high arch foot. In the United States, the most common cause for a high arch foot is a form of muscular dystrophy called hereditary sensorimotor neuropathy. Most people recognize this by the more commonly used name of Charcot Marie Tooth disease (CMT). This is a disease of the muscles and the nerves of the legs and occasionally of the hands, in which certain muscles weaken, while others retain their strength. The condition is transmitted as an autosomal dominant condition. This means that 50% of the offspring will statistically inherit the disorder. This is, however, just a statistic. In some families, all the children develop the condition while in others, none inherit it.

The muscle imbalance around the foot and ankle gives rise to a typical pattern of deformity in addition to the high arch (known as cavus). The bone under the big toe (called the first metatarsal) can become very prominent and the toes can curl or clench like a fist (called claw toes). Excessive amount of weight may be placed on the ball and heel of the foot, which can lead to the ankle weakening and giving way (this is referred to as ankle instability) and soreness. Calluses and sometimes stress fractures may occur where the foot is exposed to extra friction or pressure, such as on the outer (or lateral) border of the foot.

The deformity of the high arch foot develops because the muscles that pull the foot inward (inversion) remain strong, while those that pull the foot outward (eversion) are weak or absent. The muscle that remains very strong is called the posterior tibial muscle, and the muscle that gets weak is the peroneus brevis muscle. Another common problem in CMT is the presence of a foot drop. This means that the muscle that pulls the foot (the anterior tibial muscle) upward is weak or paralyzed, leading to an abnormal dropping of the foot when walking.

Evaluation includes a thorough history and physical examination as well as imaging studies such as X-rays. The orthopedic surgeon will look at the overall shape, flexibility, and strength of a patient’s foot and ankle to help determine the best treatment. Nerve tests may occasionally need to be performed to help confirm the diagnosis.

Treatment for this condition depends on the extent of deformity and the amount of disability experienced by the patient. The condition occurs in both children and adults. Once the deformity is present in a child it is going to be progressive. This means that the deformity will slowly get worse as a result of the muscle imbalance and weakness. Although the pattern of muscle and nerve damage may be similar through the generations in a family, this is not always the case. Every cavus foot is unique. Depending upon the symptoms, treatment may include changing the shoes, special orthotic supports (devices that support, adjust, or accommodate the foot deformity), cushioning pads, foot and ankle braces, or surgery.

Surgery may be necessary in situations where the symptoms are likely to get worse over time, or when pain and instability cannot be corrected with external orthopedic devices. The main goals of surgery are:

  1. Correcting all the existing deformity of the toes, the high arch, the ankle and the muscle imbalance
  2. Preserving as much motion as possible
  3. Rebalancing the deforming muscle forces around the foot and ankle
  4. Adding stability to the ankle
  5. Preventing ankle arthritis from occurring as a result of the chronic deformity of the foot and the instability of the ankle

This is a patient of mine before surgery


this is 6 months after