Mr Dishan Singh MBChB, FRCS, FRCS(Orth)

Consultant Orthopaedic Surgeon, Foot & Ankle Specialist

Pes cavus (high arch)

Pes cavus is a high arch of the foot that does not flatten with weight bearing. Sometimes this can lead to other problems in the foot including clawing of the toes, altered position of the heel bone, pressure areas on the outside and ball of the foot, areas of hard skin or callosities and ankle instability. This can lead to pain and difficulties with function.

Pes cavus foot

Reasons for surgery

  • To prevent further deterioration/deformity
  • Pain and decreased function not responsive to simple treatments
  • Instability of the ankle (giving way)

Surgical technique(s)

Operations to correct the position of your foot include:

  • Calcaneal osteotomy – the heel bone can be shifted to bring your heel back under your leg and the position fixed with a screw, or plates and screws
  • First metatarsal osteotomy – the bone leading to your big toe can be shifted and repositioned

Operations to rebalance the pull of the muscles in order to prevent the deformity returning include:

  • Peroneal tenodesis – re-positioning and strengthening of the peroneal muscles (which turn your foot outwards)
  • Tibialis posterior transfer – one of the muscles in your lower leg (called the tibialis posterior), which causes the foot to turn inwards (and cause deformity), is transferred to the outside of the foot to assist the weak muscles that turn the foot outwards

However, surgery may also include one or more of the following: soft tissue releases, other tendon transfers, other bone procedures and joint fusions.

Read more about pes cavus (high arch of the foot):

 A patient's guide to post-operative advice following pes cavus

Images used by permission of RNOH

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