High Arch (Cavus) Foot Protocol
See background and detailed information on the constellation of symptoms and problems that go along with high arch (cavus) feet
Primary Goals
- Eversion range of motion at the subtalar joint. This can be accomplished with:
- Simple passive manipulation by the therapist
- The patient can use the ground and body weight to force the foot into eversion. To do this, stabilize the bare foot on the ground, then bend the knee and drive the knee forward and to the outside (laterally). This forces the tibia to actually impinge purposefully onto the talar neck and then force it toward the floor. The goal is to try to flatten the arch.
- Offload the lateral foot and medial ankle joint:
- Type 3 FootScientific “Cavus-specific” shoe insert. This is not an arch support: and don’t let anyone EVER put a high-arched patient into an arch support. Putting an arch support under a high arch makes the problem….WORSE! If you look closely, this specialized shoe insert counteracts the high arch by lowering the medial forerfoot and the entire big toe and then raising (posting) the entire outside of the foot, along its entire length.
Usually patients will need to go up 1 or 2 size from their normal shoe size so that it covers the entire forefoot. To trim it, DO NOT trim around the circular shape, as this would remove critical material from the specially-designed forefoot control molding. Instead, cut across the end with a slight angle to follow the normal cascade of the toes. It just so happens that this is the same shape as the kind of shoes I recommend.
- Type 3 FootScientific “Cavus-specific” shoe insert. This is not an arch support: and don’t let anyone EVER put a high-arched patient into an arch support. Putting an arch support under a high arch makes the problem….WORSE! If you look closely, this specialized shoe insert counteracts the high arch by lowering the medial forerfoot and the entire big toe and then raising (posting) the entire outside of the foot, along its entire length.
- Strengthen the foot intrinsic musculature
- The vast majority of patients with an excessively high arch have extremely weak foot intrinsic musculature. The most extreme example of this is either the severe deformities of Charcot-Marie-Tooth disease, or the deformities of neuropathic diabetics who are curling up into an excessively high arch (as ossosed to those who lose their arch completely and eventually go on to a rocker-bottom charcot foot deformity). Both of these kinds of patients have zero intrinsic muscle activity and they also have the most extreme cavus-feet possible. It can be likened to the “claw-hand” deformity of CMT and/or patients with other ulnar neuropathies (since the ulnar nerve supplies all of the intrinsic muscles of the hand).
Secondary Goals
- If having recurrent sprains, prevent them with a Bauerfind Malleloc functional ankle brace. This brace is the only one I know of that effectively prevents foot inversion, which is the position of a sprain.
Other braces can be used if the Malleoloc does not fit or feel right. These include the figure of 8 braces or lace-up braces and they are all similar in their moderate effectiveness, so I have no preferences on which one someone uses. - If patient has a tight calf, stretch it. If present, this is a KEY aspect of treatment and cannot be underestimated in importance.
