In short
Pes cavus is an unusually high arch, often with the heel tilting inwards (a cavovarus foot). It concentrates weight on the heel and the outer edge of the foot, and is linked with ankle sprains and instability, peroneal tendon problems, fifth metatarsal stress fractures, clawed toes and pain under the ball of the foot. Some cases are linked to nerve conditions, so an assessment looks for the cause. Insoles and physiotherapy help many people; reconstruction surgery realigns the foot when needed.
What is pes cavus?
In a cavus foot, the arch is higher than normal and does not flatten when you stand. Often the first metatarsal points downwards and the heel tilts inwards (cavovarus). Weight is concentrated on the heel and the outer border of the foot.
What causes it?
- Inherited foot shape, often mild and on both sides
- Neurological conditions, such as Charcot-Marie-Tooth disease, which cause muscle imbalance
- Previous injury, including compartment syndrome or fractures
- Stroke, spinal problems or other nerve conditions
Symptoms and associated problems
- Ankle sprains and ankle instability
- Pain along the outer edge of the foot
- Peroneal tendon problems behind the outer ankle
- Fifth metatarsal stress fractures
- Pain and hard skin under the ball of the foot
- Claw toes
- Difficulty finding shoes that fit
Treatment without surgery
- Custom insoles that cushion the heel and forefoot and correct the heel tilt with a lateral wedge
- Supportive footwear with a deep toe box
- Physiotherapy for peroneal strength, balance and calf stretching
- Ankle bracing for sport
Reconstruction surgery
Tailored to the foot, usually combining several procedures:
- Heel realignment (calcaneal osteotomy) to correct the inward tilt
- First metatarsal osteotomy to lift a dropped first metatarsal
- Tendon transfers, such as peroneus longus to brevis, to rebalance the foot
- Plantar fascia release and calf lengthening
- Ankle ligament repair and claw toe correction at the same time if needed
- Fusion for stiff, arthritic deformity
Common questions
Can a high arch cause ankle sprains?
Yes. When the heel tilts inwards, the ankle is more likely to roll outwards. Treating the foot shape is often part of treating recurrent ankle instability.
Do I need nerve tests?
Some high-arched feet are caused by nerve conditions such as Charcot-Marie-Tooth disease, particularly when both feet are affected or it runs in the family. Your assessment includes checking for this and arranging nerve tests if needed.
Talk it through with a specialist
Consultations at Spire Liverpool, Salford and the Isle of Man. New patients £250.
Consultant Foot and Ankle Surgeon, MB BCh, PhD, FRCS (Tr&Orth), FRCS (Glasg), SFHEA, FFSTEd. GMC 6074953. Hunterian Professor, Royal College of Surgeons of England.
Page last reviewed 25 October 2026. This information is general and does not replace an assessment.
Prof Mason's published research on this topic
Peer-reviewed papers by Prof Mason and his colleagues. Links open the paper or its PubMed record.
- Pearse R, Stringer H, Redfern J, Patel S, Cullen N, Mason LW, Welck M, Malhotra K. Position, size and orientation of the peroneus longus tubercle in patients with cavovarus feet. The Foot, 2026.
- Usuelli FG, Mason LW, Maccario C, Grassi M, Ballal M, Molloy A. Lateral ankle and hindfoot instability: a new clinical based classification. Foot and Ankle Surgery, 2014.
- Durston A, Baboo R, Kadambande S, Hariharan K, Mason LW. Minimally invasive calcaneal osteotomies: are neurovascular structures at risk? A cadaveric study. Journal of Foot and Ankle Surgery, 2015.