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Feb 16

Written by: Cherri Choate, DPM

The patient with the pes cavus feet, usually presents to the office after the 4th decade of life, as their feet and shoe fit become more painful.  They have spent their lifetime with "unusual" feet that are somewhat challenging, but seldom so painful that they need professional help.  As the 4th and 5th decades approach, the pes cavus foot loses more fat under the metatarsals and heels, and often times the arch has raised and the foot has developed a number of lumps and bumps:  retrocalcaneal exostosis, met cuneiform exostosis and hammertoe deformities. 

So, what are some practical, first level biomechanical treatment options for these patients?  Basically, these feet need improved arch contour to increase pressure distribution and they need cushioning. It may be prudent to start with an athletic shoe insole and add some temporary adjustments such as a arch pad, a forefoot soft extension, and a heel lift.  Once you have determined an appropriate level of function and comfort, fabricating a custom orthotic will be more successful. 

In addition to orthotics,  some recommendations for shoes may be helpful.  Reliable brands for pes cavus are Dansko and Merrell.  More recently I discovered a Salomon style of trail running shoe that offers a "zipping" type of lacing system, a deep toe box, a stiff sole and a "curved" last.  It is currently my favorite recommendation for pes cavus active shoes:  Salomon XT Wings.

Lastly, even socks can be annoying for the structure of pes cavus feet.  About a year ago I was introduced to Keen socks: they are made for the right foot and left foot individually. 

Hope these recommendations are helpful for those patients who present with high arched feet issues.


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