The high arched foot, also described as cavus foot, is the opposite of a flatfoot condition. Many underlying causes may be responsible for this foot positioning, the most common being Charcot-Marie-Tooth disease, or now more properly referred to as hereditary sensorimotor neuropathy. This is a congenital condition with a strong relationship to other family members and can be a progressive problem with time and age. The muscles of the foot and ankle become weaker in a reliable way, causing progressive weakness of the muscles that allow the ankle to bend up, and relative overpull of the muscles that cause the big toe to bend down, the arch of the foot to increase, and the heel to bend inward. This leads to the high arched foot position. In some patients with this problem, no family history is noted and this may be a new genetic problem in the individual or may be due to other disorders. In some patients this may be a result of another underlying primary problem, for example, rupture of one of the tendons on the outside of the foot (peroneal tendons) causing this similar muscle imbalance with a relative overpull of other muscles causing this same deformity in a similar fashion.
The treatment for patients with this condition involves identifying the main problem (instability of the ankle, tendon pain, arthritis, callus, imbalance, etc) and planning surgery to correct the entire foot to address these problems and rebalance the entire foot. This can often be occurred by osteotomies of multiple bones (cutting the bones of the foot and realigning them to rebalance the foot), most commonly of the heel bone and / or 1st metatarsal bone. In addition, tendon transfers (routing a tendon from one area of the foot and transferring some or all of the fibers to another part of the foot where the tendon has failed) in order to rebalance the foot. For some patients, if the deformity is severe and the arthritis is too progressed, the joints cannot be saved and welding the joints involved (fusion), or joint replacements, or combinations of these procedures, may be necessary. The reconstruction of this foot condition requires skillful technique to rebalance the foot and consideration for treatment with an orthopaedic foot and ankle specialist familiar with all treatment options and reconstructive methods should be considered to maximize outcomes.