High Arched Feet (Cavus Foot) In Singapore

Living with high arched feet can significantly impact your daily activities, from simple walking to participating in sports. Cavus foot, the medical term for high arched feet, affects numerous individuals in Singapore and can lead to various complications if not unaddressed. Our Senior Consultant Orthopaedic Surgeon provides assessment and management of this complex foot condition using evidence-based approaches tailored to each patient’s unique needs.

Dr Zackary Chua

Senior Consultant Orthopaedic Surgeon (Adult & Paeds)

MBBS (Aus)MMed (SG)MRCS (Glasgow)FRCSEd (Orth)

Types Causes & Risks Symptoms When to see a Doctor Diagnosis Treatment Complications FAQ Conclusion

What is Cavus Foot?

Cavus foot is a condition characterised by an abnormally high arch in the foot remains elevated when standing. Unlike typical foot arches, which provide flexibility and shock absorption, high arches can cause the heel and ball of the foot to bear more weight. Severity ranges from mild cases with little discomfort to more pronounced arch elevation that can affect mobility.

Types of Cavus Foot

Neurological Cavus Foot

This type develops due to underlying neurological conditions affecting muscle balance in the foot. Progressive conditions like Charcot-Marie-Tooth disease or non-progressive causes from childhood polio or cerebral palsy can lead to muscle imbalances creating the high arch.

Idiopathic Cavus Foot

Occurring without any identifiable neurological cause, idiopathic cavus foot typically remains stable after skeletal maturity. This type often runs in families and presents as a structural variation rather than a progressive deformity.

Post-Traumatic Cavus Foot

Severe foot injuries, particularly those affecting the midfoot or hindfoot, can result in cavus deformity during the healing process. Healing changes, such as malunion of fractures, may alter foot architecture, resulting in a higher arch. This type may develop months or years after the initial injury.

Causes

Neurological disorders (E.g., Charcot-Marie-Tooth disease, spinal cord tumours, spina bifida)
Hereditary factors with genetic predisposition
Traumatic injuries resulting in altered foot mechanics
Muscle imbalances between foot intrinsic and extrinsic muscles
Contracture of plantar fascia or posterior tibial tendon
Childhood conditions like cerebral palsy or polio

Risk Factors

Family history of high arched feet
Previous foot or ankle injuries
Certain neurological conditions
Muscular dystrophy disorders
Prolonged immobilisation during developmental years
History of compartment syndrome in the lower leg

Signs & Symptoms

Mild Symptoms

Foot fatigue after prolonged standing or walking
Mild discomfort in the arch area
Difficulty finding comfortable footwear
Calluses on the ball or heel of the foot
Occasional ankle instability
Tightness in the calf muscles

Moderate Symptoms

Persistent foot pain, especially in the arch and heel
Frequent ankle sprains or “giving way”
Visible claw toe or hammer toe deformities
Significant callus formation requiring regular care
Limited ankle flexibility
Pain extending to the lower leg

Severe Symptoms

Severe, constant foot pain affecting daily activities
Inability to walk on uneven surfaces
Stress fractures in the foot bones
Chronic ankle instability requiring bracing
Progressive muscle weakness
Development of painful corns between toes

The progression of symptoms varies significantly depending on the underlying cause. Neurological cavus foot typically shows gradual worsening, while idiopathic cases may remain stable for years before developing symptoms.

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When to See a Doctor

Individuals with cavus foot may benefit from medical review if they experience persistent foot pain that does not improve with rest or simple measures. A consultation may also be considered if there is progressive weakness in the foot, frequent ankle sprains, or difficulty walking on uneven surfaces. Some symptoms that may require earlier review include sudden onset of foot drop, rapidly worsening deformity, or sensations such as numbness or tingling.

During the consultation, the orthopaedic surgeon may conduct a comprehensive evaluation including medical history, physical examination of both feet, and assessment of walking pattern. The doctor may examine muscle strength, joint flexibility, and overall foot alignment. This assessment helps determine the severity of the condition and guides further diagnostic testing.

Diagnosis & Testing Methods

Accurate diagnosis of cavus foot requires a systematic approach combining clinical examination with modern imaging. The orthopaedic surgeon may begin with a detailed physical examination, which can include assessing the height and flexibility of your arch, evaluating muscle strength, and checking for associated deformities. The Coleman block test may be used to determine whether the hindfoot deformity is flexible or fixed, which can influence treatment planning.

Weight-bearing X-rays of both feet are commonly used to provide essential information about bone alignment and arch height. These images can show the relationship between different foot bones and may help identify arthritic changes or stress fractures. In cases where neurological causes are suspected, electromyography (EMG) and nerve conduction studies may be performed to evaluate nerve and muscle function. MRI scanning may be considered to assess soft tissue structures, including tendons and ligaments, or to investigate suspected spinal cord abnormalities.

For patients with progressive deformity or family history suggesting hereditary conditions, genetic testing may be discussed. Gait analysis using specialised equipment can provide objective data about walking patterns and pressure distribution across the foot. Results from these assessments are usually made available within a reasonable timeframe, which then helps in planning treatment.

Treatment Options Overview

Conservative Management

Physiotherapy is often recommended as part of non-surgical treatment for cavus foot. exercises may include stretching tight structures like the plantar fascia and Achilles tendon while strengthening weakened muscles. These sessions can teach specific techniques to improve balance and proprioception, reducing the risk of ankle sprains. Treatment typically involves twice-weekly sessions for 6-8 weeks initially.

Custom Orthotics

Prescription orthotics specifically designed for cavus feet aim to redistribute pressure away from painful areas. These devices may incorporate features like metatarsal pads, heel cushioning, and lateral posting to support foot alignment. Unlike over-the-counter insoles, custom orthotics are tailored to individual foot structure and may help reduce discomfort and improve function. Patients usually require adjustments over the first few weeks to optimise comfort.

Bracing Solutions

Ankle-foot orthoses (AFOs) may provide additional stability for individuals with significant weakness or frequent ankle sprains. Modern lightweight materials allow for discreet wear inside regular shoes. For less severe cases, ankle braces worn during activities can offer extra support without restricting daily function. The type and duration of bracing depend on symptom severity and activity level.

Injectable Therapies

Targeted corticosteroid injections may provide temporary relief for specific painful areas such as inflamed bursae or arthritic joints. Platelet-rich plasma (PRP) injections are sometimes used for chronic tendon problems associated with cavus foot. These treatments are typically considered adjuncts to other conservative measures. Injections are usually limited to 3-4 doses per year avoid tissue damage.

Soft Tissue Procedures

Plantar fascia release involves surgically dividing the tight plantar fascia. Tendon transfers may be performed to rebalance muscle forces, often moving the peroneus longus tendon to assist weak dorsiflexors. Achilles tendon lengthening is sometimes done to address equinus contracture commonly associated with cavus foot. These procedures can sometimes be performed through minimally invasive techniques, depending on the patient’s suitability.

Osteotomies

Calcaneal osteotomy involves cutting and repositioning the heel bone to help improve alignment. First metatarsal osteotomy may lower the front of the foot to reduce pressure on the ball of the foot. Midfoot osteotomies are sometimes used for severe deformity by removing a wedge of bone to flatten the arch. These procedures typically require 6-12 weeks of protected weight bearing during healing.

Joint Fusion Procedures

Triple arthrodesis fuses three joints in the hindfoot and may be considered for severe, rigid deformities. Selective joint fusions target specific joints while attempting to preserve motion in others. These procedures may offer more permanent deformity correction but eliminate joint motion. Recovery typically involves 3-4 months of progressive weight bearing.

Combination Approaches

Surgical corrections may involve combining procedures to address different aspects of the deformity. The specific combination depends on severity, flexibility, and underlying cause. Staged procedures may be considered for severe cases, allowing recovery between operations.

Every patient’s condition is unique.

Our Senior Consultant Orthopaedic Surgeon will assess your specific situation and recommend the suitable treatment approach for you.

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Complications if Left Untreated

If left unmanaged, cavus foot may lead to a range of complications that can affect foot function and overall quality of life. Chronic pain can develop as abnormal pressure distribution contributes to conditions such as metatarsalgia, plantar fasciitis, or heel pain. The altered biomechanics may place additional stress on specific areas, increasing the risk of stress fractures, particularly in the metatarsal bones.

Ankle instability may worsen over time, sometimes resulting in recurrent sprains that can damage ligaments and potentially contribute to ankle arthritis. The abnormal foot position may also increase the likelihood of degenerative changes in joints such as the ankle, subtalar, and midfoot. Some patients may adopt compensatory gait patterns that place extra stress on the knees, hips, or lower back, which can occasionally lead to discomfort in these areas.

Progressive muscle imbalances may further contribute to deformity, which can make surgical correction more complex if required. In severe cases, patients may experience reduced mobility or limitations in employment and recreational activities. Early assessment and management can help reduce the risk of these complications and support long-term foot health.

High arched feet (Cavus feet)

Frequently Asked Questions

Can cavus foot be corrected without surgery?

Many patients with mild to moderate cavus foot may respond well to conservative treatment including custom orthotics, physiotherapy, and appropriate footwear modifications. The success of non-surgical treatment depends on the underlying cause, deformity severity, and how early treatment begins. Neurological causes may require ongoing management as the condition progresses. Regular monitoring helps determine whether surgical intervention is needed.

What type of shoes should I wear with high arched feet?

Shoes for cavus feet should have adequate cushioning, particularly in the heel and forefoot areas. Look for models with removable insoles to accommodate custom orthotics. A wider toe box helps prevent crowding of claw toes, while good ankle support may reduce the risks of sprains. Avoid shoes with rigid soles that don’t bend at the ball of the foot. Professional fitting at specialised shoe stores can help ensure optimal comfort and support.

Is cavus foot hereditary?

Idiopathic cavus foot sometimes runs in families, suggesting genetic factors may play a role. Not all children of affected parents develop the condition. Neurological causes such as Charcot-Marie-Tooth disease have clearer hereditary patterns. If you have cavus foot, it may be useful to monitor your children for signs of developing high arches, especially during growth spurts. Early detection allows timely care if required.

How long is recovery after cavus foot surgery?

Recovery varies depending on the procedures performed. Soft tissue procedures typically require about 6–8 weeks of protected weight bearing. Osteotomies may take 10–12 weeks for bone healing. Triple arthrodesis generally requires longer recovery, often 3–4 months before full weight bearing. Full recovery with return to normal activities can take 6–12 months. Post-operative physiotherapy may support rehabilitation.

Can cavus foot get worse over time?

Progression depends on the underlying cause. Neurological cavus foot may worsen as the neurological condition advances. Idiopathic cavus foot often remains stable after skeletal maturity but can develop symptoms over time due to cumulative stress. Without appropriate care, secondary issues such as arthritis or tendon problems may occur. Regular follow-up allows timely intervention if needed.

Will I need special shoes for life after treatment?

Many patients benefit from supportive footwear and custom orthotics even after treatment. Surgery may reduce but not always eliminate the need for these. The aim is to maximise comfort and function while reducing the risk of recurrence of symptoms. For many patients, quality footwear and orthotics are helpful in maintaining activity levels.

Conclusion

Cavus foot is a condition that can present challenges and may affect daily activities. Management involves assessment and monitoring by a healthcare professional, and treatment options can include both conservative care and surgery depending on the severity. Understanding the condition helps patients and families make informed decisions about foot health in collaboration with their healthcare team.

Take the First Step Towards Better Health

Living with cavus foot can be challenging. Our Senior Consultant Orthopaedic Surgeon has experience diagnosing and treating high arched feet using evidence-based approaches.

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Dr Zackary Chua (蔡克祥医生)

Senior Consultant Orthopaedic Surgeon (Adult & Paeds)

MBBS (AUS)|MMed (Singapore)|MRCS (Glasgow)|FRCSEd (Orth)

A senior consultant orthopaedic surgeon with dual specialisations in Foot & Ankle Surgery and Paediatric Orthopaedics. Backed by his extensive years of training and experience, Dr Chua brings the necessary knowledge and skills to ensure a smooth recovery journey.

Rooted firmly by two fundamental philosophies: “When one’s feet hurt, one hurts all over” and “Children are not little adults”, Dr Chua’s approach to patient care reflects his compassionate care for adults and children.

Singhealth Quality Excellence Award – Silver (2011)
Service From the Heart Award (2021)
Singapore Health Quality Service Award – Gold (2023)
NUS Medicine Dean’s Award for Teaching Excellence (2023)

His active participation in the medical community extends to mentoring, research supervision, and contributions to key professional forums and symposiums, both locally and internationally.