Bone, Joint and Muscle Conditions
What is cavus foot?
Children with cavus foot have arches that are much higher than usual. Often, their heels point inward, and all of their toes are flexed.
Children with cavus foot have trouble finding shoes that fit. The tops and middles of their feet become sore. They may have pain and develop thick calluses under the ball and at the outer edges of their feet.
Because their high arches make their ankles roll outward slightly, children with cavus foot may feel like their ankles are about to give out. Sometimes they sprain their ankles over and over again.
Cavus foot in children
Children are rarely born with this problem. Instead, cavus foot usually develops slowly over the first 10 years of life.
In almost all cases, children develop cavus foot because they have a nerve or muscle disease. The disease makes some of the muscles weaker than others. These unbalanced muscles work unevenly, which causes the high arch and other signs of cavus foot.
An inherited disorder called Charcot-Marie-Tooth disease (CMT) is the most common cause of cavus foot. But there is a long list of disorders that may cause the problem. Children who have muscular dystrophy (MD) and spina bifida, for example, are more likely than others to develop cavus foot in both feet.
Cavus foot can affect only 1 foot, too. Cavus foot in 1 foot is more common in children with injuries to the nerves in their legs or spinal cord or to the muscles in their legs. Other conditions that make it more likely a child will develop cavus foot are poliomyelitis, cerebral palsy and spinal cord tumor.
Cavus Foot at Seattle Children’s
Cavus foot is treated by the experts in our Foot and Ankle Deformities Program.
Dr. Vincent S. Mosca, chief of foot and ankle medicine and surgery at Seattle Children’s, is known internationally for his expertise in treating conditions affecting children’s feet. Over the last 2 decades, he has conducted research that has led to landmark discoveries in understanding and managing cavus foot and other foot problems in children and teenagers.
Dr. Mosca’s work has influenced how doctors evaluate, classify and treat cavus foot. The techniques for surgical reconstruction developed at Seattle Children’s have become the standards used by orthopedic surgeons around the world.
To restore or improve your child’s health, function and quality of life, we often use nonsurgical methods (like medicines, physical therapy and braces), recommending surgery only when we believe it will give your child the best results.
Many of our pediatric orthopedic surgeons have expanded fellowship training in areas such as foot and ankle conditions, sports medicine, tumors, upper extremity surgery, limb deformity, neuromuscular diseases, skeletal dysplasia and spine problems.
We have the largest group of board-certified pediatric radiologists in the Northwest. Our radiologists have special expertise using ultrasound to look for bone and joint changes so we can work with your child to help prevent future problems. If your child needs imaging that uses radiation, we use the lowest amount possible to produce the best image. We also have a 3D low-dose radiation X-ray machine, called the EOS, for safer full-body 3D images.
Funded in part by the Lynn Taylor Staheli Endowed Chair in Pediatric Orthopedics, our growing research program is discovering better ways to diagnose and care for children.
Outcomes research helps us know which treatments produce the best results for children. For example, we use tools to ask patients about their function after surgery for limb deformities. Asking children about their experience is essential to improving their lives.
We participate in several registries (databases that collect information about patients who volunteer) so we can collaborate with doctors around the country and the world to better understand orthopedic conditions, such as hand, arm, foot and leg differences.
Symptoms of Cavus Foot
The most obvious symptom of cavus foot is a very high arch or arches in the feet. People with cavus foot may also have:
- Calluses on the side, heel or balls of their feet
- Bent toes (hammertoes)
- Tightly flexed toes (claw toes)
- Pain while walking or standing
- Tendency to sprain ankles
Diagnosing Cavus Foot
First, we ask your child to stand while we examine their feet for signs of cavus foot. Because cavus foot tends to run in families, we often ask to examine the feet of parents and other family members, too. We also check:
- The strength of your child’s legs, ankles, feet and toes since cavus foot often comes along with diseases that make muscles weak
- Your child’s spine to make sure it is flexible and the right shape
- Your child’s reflexes in the legs and belly (abdomen)
We will ask whether your child has had any problems controlling bowel movements or bladder. Finally, we will take radiographs of your child’s back and feet.
Once we know that your child has cavus foot, we will begin to look for the cause of the problem. At Seattle Children’s, our orthopedic doctors work closely with our neurologists to find the right answer.
Your child may need to have several tests to find the cause of cavus foot, including:
- Electromyogram and nerve conduction velocity (EMG/NCV) studies
- Blood test for Charcot-Marie-Tooth disease (CMT)
- MRI (magnetic resonance imaging) of the spine and brain
Treatment Options for Cavus Foot
Our orthopedic surgeons work closely with neurologists to find the cause of your child’s cavus foot. Then we consult with specialists at Seattle Children’s to treat any underlying disease that is causing the condition.
In some cases, as with Charcot-Marie-Tooth disease, there is no treatment for the underlying nerve or muscle problem.
Once we have addressed the underlying problem, we talk with you and find the best treatment for your child’s cavus foot. In most cases, the best treatment is surgery.
In the very early stages of cavus foot, or with mild cases that are not getting worse, we may be able to use arch supports and shoe modifications to help relieve problems until surgery becomes necessary.
Infants, children and teens are still developing, so they may need different care than adults do, like treatment that takes their growth plates into account. At Seattle Children’s, your child’s team has special training in the medical, surgical, emotional and social needs of young people.
We see your child as a whole person. For example, in our Foot and Ankle Deformities Program, we look not only at your child’s feet and ankles, but also their legs, spine, strength, movement, nerves and other features that might play a role in their condition.
Surgery for cavus foot is complex. It often requires 2 operations performed 2 weeks apart. In the first operation, the doctor cuts and releases the tightest of the soft tissues in the arch. The rest of the tissues relax during the following 2 weeks.
In the second operation, the doctor cuts and reshapes at least 1 bone using a bone graft and moves several tendons to new locations on the foot to improve muscle balance.
When we perform reconstruction surgery for cavus foot, our main concerns are to:
- Correct the problems without joining together any joints (fusion)
- Balance out the muscles so that the problem is less likely to happen again
If you have questions about cavus foot treatment, call our Orthopedics and Sports Medicine Department at 206-987-2109. If you would like an appointment, ask your child’s primary care provider for a referral.
Providers, see how to refer a patient.