Foot

Cavus Foot in Children: Recognising the High Arch

A markedly high arch: cavus foot needs to be distinguished between constitutional forms and those requiring neurological assessment.

Updated: April 2026·Medically reviewed by Dr. Daniele Priano

Quick Answers

Is cavus foot in children always a neurological condition?
It may be constitutional, but can also accompany neurological or neuromuscular conditions. This applies to children too: history, foot examination and neurological assessment guide investigations. New onset, progression, asymmetry, weakness or sensory changes require particular attention.
My child often sprains his ankle: could it be due to cavus foot?
Yes, it's a frequent association. Cavus foot shifts load to the lateral border of the foot, making the ankle more unstable and prone to sprains. Helpful options include load-redistributing orthotics, physiotherapy for peroneal strengthening and proprioception, and ankle braces during sports.
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Cavus foot (an excessively high plantar arch) is less common than flatfoot but always deserves careful attention. Unlike flatfoot, a high arch may be constitutional, but a structured cavus foot, especially with hindfoot varus or progression, requires assessment for an underlying cause: in a significant proportion of cases it is the first visible sign of a neuromuscular condition, particularly hereditary neuropathies such as Charcot-Marie-Tooth disease.

For this reason, when faced with a bilateral, progressive cavus foot — especially if associated with claw toes, ankle instability or running difficulties — a complete evaluation including a neurological examination (and, if indicated, EMG and spinal MRI) is recommended.

During the visit I assess hindfoot flexibility with the Coleman block test: the heel and lateral border are supported on the block while the first ray remains free. Correction of heel varus shows a flexible hindfoot component; the test does not alone determine treatment or prognosis and is performed by the clinician. When the foot is rigid or symptomatic, or when a progressive neurological cause is present, the management is more articulated and may involve orthotics, targeted physiotherapy and, in selected cases, corrective surgery.

Assessment and treatment

When to seek evaluation

  • Foot with a markedly accentuated arch
  • Claw or hammer toes
  • Recurrent ankle instability
  • Pain on the sole of the foot
  • Difficulty fitting shoes

What is evaluated

  • Plantar arch assessment in weight-bearing
  • Coleman block test for hindfoot flexibility
  • Complete neurological examination
  • Weight-bearing foot X-rays
  • EMG when indicated

Treatment options

  • Custom orthotics for load redistribution
  • Physiotherapy and stretching
  • Appropriate footwear
  • Surgical correction in severe symptomatic cases
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When Surgery Is Needed

Severe or progressive cavus foot, particularly when symptomatic with pain, ankle instability or toe deformity, may require surgery. The aim is to restore a more physiological plantar contact and improve foot function. Learn more about cavus foot surgery in children.
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Frequently Asked Questions

Is cavus foot in children always a neurological condition?▼
It may be constitutional, but can also accompany neurological or neuromuscular conditions. This applies to children too: history, foot examination and neurological assessment guide investigations. New onset, progression, asymmetry, weakness or sensory changes require particular attention.
My child often sprains his ankle: could it be due to cavus foot?▼
Yes, it's a frequent association. Cavus foot shifts load to the lateral border of the foot, making the ankle more unstable and prone to sprains. Helpful options include load-redistributing orthotics, physiotherapy for peroneal strengthening and proprioception, and ankle braces during sports.
Does cavus foot worsen with growth?▼
It depends on the cause. Constitutional forms (familial, non-neurological) tend to remain stable. Forms linked to progressive neuropathies can worsen over time, particularly during puberty. Once the diagnosis is made, periodic follow-up is essential to detect any progression early.

Important Notice: The information on this page is for educational and informational purposes only and does not constitute medical advice. Each clinical case is unique: the appropriate treatment is determined during the specialist consultation, based on a thorough clinical examination and, where necessary, diagnostic imaging. For any doubts or concerns, please consult a specialist.