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Home > Professional Reference > Pes Cavus

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Pes Cavus

This PatientPlus article is written for healthcare professionals so the language may be more technical than the condition leaflets. You may find the abbreviations list helpful.

Synonym: claw foot

This is a foot with a very high arch, which does not flatten on weight-bearing.1
It may be cavovarus (deviated medially from a midline axis) or cavovalgus (deviated laterally).

Aetiology

This condition is caused by an imbalance between the agonist and antagonist muscles in the foot. There is often family history and it is usually bilateral.
One in five cases is idiopathic; however, most are associated with neurological disorders.2

Also associated with club foot or fractures.

Presentation

There is often a range of other foot deformities also present, e.g. claw toes, increased calcaneal angle, 'cocked-up' big toe.

Symptoms

These vary with degree of deformity:

  • Pain in side of foot and metatarsals
  • Calluses on plantar aspect of foot
  • Instability of ankle

NB: a spinal tumour should be suspected in any patient with new unilateral presentation, without previous trauma.

Signs

Investigations

Take a full family history.

  • X-ray of foot
  • MRI of spine if tumour suspected
  • Electromyography

Management

General measures

  • Physiotherapy to loosen tight muscles and improve strength of weak ones.
  • Padding and orthotic shoes.

Surgical

  • Depending on nature of deformity, can be release of plantar fascia, tendon transfer, osteotomy and arthrodesis.2
  • Many need several operations.

Document references

  1. Turner N; Pes Cavus. eMedicine, 2007.
  2. Wheeless Textbook of Orthopaedics. Pes cavus
  3. Burns J, Ouvrier R; Pes cavus pathogenesis in Charcot-Marie-Tooth disease type 1A. Brain. 2006 Jul;129(Pt 7):E50; author reply E51.

Internet and further reading

  • Alexander IJ, Johnson KA; Assessment and management of pes cavus in Charcot-Marie-tooth disease. Clin Orthop Relat Res. 1989 Sep;(246):273-81. [abstract]

Acknowledgements

EMIS is grateful to Dr Hayley Willacy for writing this article. The final copy has passed scrutiny by the independent Mentor GP reviewing team. ©EMIS 2009.
Document ID: 2602
Document Version: 21
Document Reference: bgp2324
Last Updated: 29 Sep 2009
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