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.

    Medically reviewed: April 2026·Dott. Daniele Priano

    Quick Answers

    Is cavus foot in children always a neurological condition?
    No, but it must always be ruled out in pediatric age. Unlike adults, where cavus foot is often constitutional, in children and adolescents the appearance or progression of bilateral cavus foot can be the first sign of a hereditary neuropathy (Charcot-Marie-Tooth being the most common). For this reason, neurological examination is part of the routine assessment.
    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.
    See all 3 questions →

    Cavus foot (an excessively high plantar arch) is less common than flatfoot but always deserves careful attention. Unlike flatfoot, cavus foot in a child is rarely just a constitutional variant: 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: if the heel varus corrects when the lateral border of the foot is placed on a block, the deformity is still flexible and may respond well to conservative treatment. 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.
    🔗View surgical options for this condition →

    Frequently Asked Questions

    Is cavus foot in children always a neurological condition?▼
    No, but it must always be ruled out in pediatric age. Unlike adults, where cavus foot is often constitutional, in children and adolescents the appearance or progression of bilateral cavus foot can be the first sign of a hereditary neuropathy (Charcot-Marie-Tooth being the most common). For this reason, neurological examination is part of the routine assessment.
    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.

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