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Cavus Foot

What is cavus foot?

Children with cavus foot have arches that are much higher than usual. Often, their heels point inward, and all of their toes are flexed.

Children are rarely born with this problem. Instead, cavus foot usually develops slowly over the first 10 years of life.

Many diseases that cause weakness in the muscles, especially muscles in the legs and feet, can cause cavus foot.

Cavus foot
Typical cavus foot.

Children with cavus foot have trouble finding shoes that fit. The tops and middles of their feet become sore. They may have pain, and develop thick calluses under the ball and at the outer edges of their feet.

Because their high arches make their ankles roll outward slightly, children with cavus foot may feel like their ankles are about to give out. In fact, sometimes they sprain their ankles over and over again.

How do you evaluate cavus foot?

First, we ask your child to stand while we examine his feet for signs of cavus foot. Because cavus foot tends to run in families, we often will ask to examine the feet of parents and other family members, too.

Since cavus foot often comes along with diseases that make your child’s muscles weak, we will test the strength of his legs, ankles, feet and toes.

We will check his spine to make sure it is the right shape and is flexible. We also will test the reflexes in his legs and abdomen.

We will ask whether he has had any problems controlling his bowel movements or bladder. Finally, we will take radiographs radiographs of his back and feet.

Once we know that your child has cavus foot, we will begin to look for the cause of the problem.

At Children’s Hospital, our orthopedic doctors work closely with our neurologists to find the right answer.

Your child may need to have several tests, including an electromyogram and nerve conduction velocity (EMG/NCV) study, a blood test for Charcot-Marie-Tooth disease (CMT) and an MRI of the spine and brain.

Who gets cavus foot?

In almost all cases, children develop cavus foot because they have a nerve or muscle disease.

The disease makes some of the muscles weaker than others. These unbalanced muscles, especially in the foot and ankle, work unevenly, causing the high arch and other signs of cavus foot.

An inherited disorder called Charcot-Marie-Tooth disease is the most common cause of cavus foot. However, there is a long list of disorders that may cause the problem.

Children who have Charcot-Marie-Tooth disease, muscular dystrophy, and spina bifida spina_bifida, for example, are more likely than others to develop cavus foot in both feet.

Cavus foot can affect only one foot, too. Again, there is a long list of disorders that make it more likely children will develop this condition.

Cavus foot in one foot is more common in children with injuries to the nerves in their legs or spinal cord or to the muscles in their legs.

Cavus foot
Cavus foot.

Other conditions that make it more likely a child will develop cavus foot are poliomyelitis, cerebral palsy, and spinal cord tumor.

What experience do you have with cavus foot?

Dr. Vincent S. Mosca, chief of foot and ankle medicine at Children’s, is known internationally for his expertise in conditions affecting children’s feet.

Over the last two decades, he has conducted research that has led to landmark discoveries in understanding and managing cavus foot and other foot problems in children and teenagers.

Dr. Mosca’s work has uncovered information on evaluating, classifying and treating cavus foot. The techniques for surgical reconstruction developed at Children’s have become the standards used by orthopedic surgeons around the world.

How do you treat cavus foot?

First, our orthopedic surgeons work closely with neurologists to find the cause of your child’s cavus foot. Next, we consult with specialists at Children’s to try to treat an underlying disease that is causing the condition.

In some cases, as with Charcot-Marie-Tooth disease, there is no treatment for the underlying nerve or muscle problem.

Once we have addressed the underlying problem, we determine the best treatment for your child’s cavus foot. In most cases, the best treatment is surgery.

In the very early stages of cavus foot or with mild cases that are not progressing, we may be able to use arch supports and shoe modifications to help relieve problems until surgery becomes necessary.

Read more about possible underlying conditions in Neurology.

Surgeries for cavus foot

Surgery for cavus foot is complex, and often requires two operations performed two weeks apart.

In the first operation, the doctor cuts and releases the tightest of the soft tissues in the arch. The rest of the tissues relax during the following two weeks.

In the second operation, the doctor cuts and reshapes at least one bone using a bone graft, and moves several tendons to new locations on the foot to improve muscle balance.

When we perform reconstruction surgery for cavus foot, our main concern is to correct the deformities without joining together any joints (fusion) and to balance out the muscles so that the problem is less likely to happen again.