Pes cavus

Principal authors: Louise Crawford, Jim Barrie

Latest evidence check March 2010

As for most foot conditions, treatment begins simply and follows stepwise progression.

Physiotherapy focusing on Achilles strengthening exercises, muscle strengthening and proprioceptive work may be beneficial as muscle imbalance is key to the pathogenesis of the cavus deformity.

Accommodative footwear and simple podiatric foot care may be all that is required to allow comfortable walking. Initially, use of extra-depth shoes with support to unload the metatarsal heads is often helpful. Patients with a plantar flexed first ray and compensatory flexible hindfoot varus may benefit from use of an insert that posts the lateral forefoot and eliminates the inverting effect of the forefoot valgus on the hindfoot. (Alexander 1989) 

A recent Cochrane review (Burnes 2007) assessed interventions for the treatment of pes cavus. There was only one suitable randomised controlled trial included also by Burns (2006)). The trial showed a significant reduction in the level of foot pain and improvement with functional scores with custom-made foot orthoses versus sham orthoses in adult patients.

There is no evidence for any other type of intervention for the treatment or prevention of foot pain in people with a cavus foot type. Similarly, there is no evidence that conservative measures prevent progression of the deformity. In 1919 Dunn commented “once the deformity is established, treatment by splinting is difficult and usually ineffective.”