Interventions for the prevention and treatment of pes cavus (high-arched foot deformity)

Pes cavus is characterised by an excessively high medial longitudinal arch (the arch on the inside of the foot) and is typically defined as a high-arched or supinated foot type. Population based studies suggest the prevalence of pes cavus is approximately 10%, and its cause is primarily neuromuscular (for example Charcot-Marie-Tooth disease) or idiopathic (unknown) in nature. It has been estimated that 60% of people with cavus feet will experience chronic foot pain at some time in their life, most commonly beneath the forefoot (for example metatarsalgia, sesamoiditis) or heel (for example plantar fasciitis). Conditions such as these are thought to be the result of abnormal pressure distribution across the sole of the foot during walking. Many conservative therapies and surgical procedures have been recommended for cavus-related foot pain. In particular, foot orthoses (aids applied and worn on the outside of the body to support the bony structures) customised to an individual's foot shape are increasingly prescribed by podiatrists, physiotherapists, orthopaedic surgeons and rehabilitation specialists for people with pes cavus pain. This updated review analysed four relevant trials, but only one fully met the inclusion criteria. This trial with 154 adults showed that custom-made foot orthoses can reduce and redistribute plantar foot pressure and subsequently decrease foot pain by approximately 75%. Some biomechanical outcomes, such as pressure distribution, improve with custom-made foot orthoses and footwear, but many other biomechanical outcomes, such as foot alignment or muscle activity, do not improve with botulinum toxin or off-the-shelf foot orthoses, respectively. More research is needed to determine the effectiveness of other interventions for people with painful high-arched feet.