In high arch foot medial arch is high and most of the sole does not touches the ground and most of the weight bearing happens through heel and ball of the foot. High arch foot is associated with few other foot deformities like clawing of toe, heel deformity, planter fascia contracture, cock-up deformity of great toe.
Most of the time high arch foot is due to some form of neuromuscular deficit either hereditary or acquired both are progressive. Common neurological causes are charcot-marry-tooth disease, cerebral palsy, spina bifida, polio, muscular dystrophy, spinal tumour, stroke. It start developing at puberty and become prominent in early adult hood and gradually becomes rigid. Non-neurological one also can be hereditary or acquired and non-progressive. Common causes are trauma- malunited calcaneum and talus, ankle, compartment syndrome, post burn contracture, untreated or undertreated club foot, planter fibromatosis, hereditary non-neurological subtle cavus foot also known as under pronator foot.
Cavus feet can present with variable features depends on the severity of deformity and causative factor. Pain is a common symptom while walking and standing. Gait is usually unsteady due to inward tilting of heel. Foot drop may happen in neurological cavus foot due to weakness of the muscles and one can drag his foot while walking. High arch foot is commonly associated with; different toe deformities like claw toe, hammer toe, cock-up great toe, callosities on ball of the foot, lateral border of the foot and heel, planter fascia contracture , repeated ankle sprain and stress fracture of 5th metatarsal
Treatment of high arch feet depends on its causative factor and approach towards neurological and non-neurological cavus foot is totally different. So the main aim of cavus feet diagnosis is directed towards diagnosing the causative neuromuscular disease. Neurologist evaluation is mandatory for evaluation of neurological aetiology. X-ray of foot and spine, CT foot, MRI spine, nerve conduction (NCV), electromyogram (EMG) is require to evaluate the severity of deformity and diagnose the cause.
Treatment is variable and prognosis also unpredictable depends on severity of deformity and cause of the deformity. Mild deformity with fewer symptoms are managed conservatively and severe deformity requires surgical correction. Mild deformity with associated complication like ankle instability and fracture of 5th metatarsal may require surgical correction of deformity in addition to the treatment of these conditions.
- Accommodative foot insole with extra support to heel and recession at ball of 1st ray
- Supportive braces in muscular weakness and ankle instability
- Physical therapy
Surgical: Aim of surgical treatment is to get a plantigrade foot to achieve well distributed weight bearing sole. Surgical procedure is contraindicated in vascular compromise foot. Prognosis is very poor in foot with sensory deficite.
- Soft tissue release
- Osteotomy and tendon transfer to correct deformity and balancing muscle function
- Arthrodesis alone or with osteotomy to correct deformity