Health condition · Clinically reviewed
Cavus foot, the high-arched foot — neurological screening, orthoses and reconstruction.
A high-arched foot with forefoot equinus, hindfoot varus and clawing. Often has a hereditary neurological cause (Charcot-Marie-Tooth). Modern stratified care: orthoses and physio for flexible feet; joint-sparing osteotomies for fixed deformities; arthrodesis for arthritic feet.
Why trust this guide
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Clinically reviewed
Written by our editorial team and reviewed by a registered UK clinician before publication.
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Sourced from guidance
Every claim is checked against BOFAS, NICE and peer-reviewed sources you can see at the end.
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Current for 2026
Reflects current UK practice on neurological screening, orthoses and joint-sparing reconstruction.
Key facts
Cavus foot at a glance.
The essentials, in plain English — what cavus foot is, why the Coleman block test matters, and what modern reconstruction actually involves.
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Definition
A high-arched foot with hindfoot varus and forefoot equinus — often with clawing of the toes.
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Neurological cause
Around two-thirds of cases have an underlying neuromuscular cause — Charcot-Marie-Tooth disease is the most common.
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Coleman block test
The Coleman block test is the key clinical exam — it distinguishes a flexible from a fixed hindfoot deformity.
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Imaging and nerves
Standing foot X-ray, MRI of the ankle and nerve conduction studies together build the picture.
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Associated problems
Cavus feet predispose to lateral ankle instability and peroneal tendinopathy from chronic lateral overload.
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Modern reconstruction
Joint-sparing osteotomies and tendon transfers now do most of what triple arthrodesis used to — reserved for arthritic feet.
Why this guide matters
Screen the nerves, save the joints.
Cavus feet used to mean triple arthrodesis. Modern practice screens for the neurological cause first, then rebalances the foot with joint-sparing surgery — arthrodesis is a last resort.
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Screen for the neurological cause
Around two-thirds of cavus feet have a neurological cause — most commonly Charcot-Marie-Tooth. Nerve conduction studies matter.
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Coleman block guides surgery
A flexible hindfoot on the Coleman block test can be corrected by forefoot surgery alone — a very different operation to a fixed hindfoot.
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Joint-sparing where possible
Modern reconstruction uses osteotomies and tendon transfers to rebalance the foot — arthrodesis is reserved for the arthritic foot.
How the diagnosis is made
From high-arched foot to a clear plan.
The steps a UK GP, podiatrist and foot & ankle team will follow, in order — so you know what to expect and why.
Phase 1 · Recognising
Family history, neurological screen and Coleman block
Phase 2 · Confirming
X-ray, MRI, nerve studies and associated pathology
Phase 3 · Managing
Foot & ankle surgery consultation
- 01
Recognising
Family history + neurological screen
A careful family history and neurological examination — cavus feet are a common first sign of an inherited neuropathy.
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Recognising
Coleman block test
The Coleman block test tells you whether the hindfoot varus corrects on standing — a flexible hindfoot changes management.
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Recognising
Standing X-ray + Meary’s angle
Weight-bearing foot X-rays with Meary’s angle quantify the deformity and guide surgical planning.
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Confirming
MRI ankle
MRI assesses coexisting peroneal tendon disease, cartilage and any soft-tissue pathology contributing to symptoms.
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Confirming
Nerve conduction studies
Nerve conduction studies confirm or exclude an underlying neuropathy — essential before major reconstructive surgery.
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Confirming
Assess instability + peroneals
A structured assessment for lateral ankle instability and peroneal tendon disease — often the reason for presentation.
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Managing
Foot & ankle surgery consultation
A specialist opinion for staged, individualised reconstruction — orthoses first, joint-sparing surgery where indicated.
Typical timeline: 6–12 weeks from first appointment to a settled plan.
Symptoms
What cavus foot actually looks and feels like.
The pattern is telling — a high arch, an inverted heel, clawed toes and lateral overload, often against a family history of neuropathy.
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High arch
A visibly elevated medial longitudinal arch that does not flatten on weight-bearing.
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Hindfoot varus
The heel sits inverted when viewed from behind — a classic cavovarus sign.
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Clawing of toes
Lesser toes held in a clawed position — hyperextension at the MTP joints with flexion below.
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Ankle instability
Recurrent giving-way of the ankle from the varus hindfoot loading the lateral ligaments.
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Lateral foot overload
Painful callus and overload along the lateral border of the foot and 5th metatarsal.
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Difficulty walking on uneven ground
The rigid, high-arched foot copes poorly with uneven terrain — trips and stumbles are common.
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Family history
A family history of cavus feet, foot drop or hand weakness — a strong pointer to Charcot-Marie-Tooth.
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Red flag
Rapidly progressive weakness or bilateral cavus in a child — urgent neurology referral to exclude CMT or spinal cord pathology.
Treatment
How cavus foot is treated in the UK.
A stratified approach — orthoses and physio for the flexible foot, joint-sparing osteotomies and tendon transfers for fixed deformity, arthrodesis for the arthritic foot.
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Custom orthosis
A prescription orthosis with a lateral post and medial forefoot post to offload the lateral border and rebalance the foot.
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Physiotherapy
Structured peroneal strengthening, calf stretching and balance work — the cornerstone of non-operative care.
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Ankle brace
An ankle-foot orthosis or lace-up brace for recurrent instability — particularly useful in early CMT.
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Botulinum toxin (specialist)
Targeted botulinum toxin injection in selected neuromuscular cases — delivered by a specialist team.
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Plantar fascia release
Surgical release of a tight plantar fascia — often part of a combined soft-tissue rebalancing procedure.
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Calcaneal osteotomy
A lateralising calcaneal osteotomy shifts the heel out of varus and rebalances the hindfoot.
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1st metatarsal dorsiflexion osteotomy
A dorsiflexion osteotomy of the first metatarsal to lift the plunging first ray and unload the forefoot.
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Triple arthrodesis
Reserved for the arthritic or fixed cavus foot where joint-sparing reconstruction is no longer feasible.
What this guide is based on
The sources behind every claim on this page.
UK national guidance and specialist society standards, current at the time of last review.
Key references
Guidelines and standards we relied on.
A quiet reminder
This guide is for information, not medical advice.
Your GP, podiatrist or foot and ankle team knows your history and can tell you which parts apply to you. If in doubt, get seen.
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British Orthopaedic Foot and Ankle Society (BOFAS). Patient information and clinical standards.
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NICE MSK guidance on foot and ankle conditions.
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American Orthopaedic Foot & Ankle Society (AOFAS). Cavus foot clinical resources.
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Charcot-Marie-Tooth Association. Clinical guidance on foot deformity in CMT.
Red flags
When cavus foot needs urgent attention.
Most cavus feet are stable and managed in the outpatient clinic. These are the situations where a different or more urgent path is needed.
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Progressive neurological weakness
New or worsening weakness alongside the foot deformity — needs urgent neurological review.
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Underlying CMT
A family history and bilateral cavus feet point strongly to Charcot-Marie-Tooth — confirm with nerve studies.
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Spinal cord pathology
Rapidly progressive unilateral cavus, especially in a child, can reflect a tethered cord or syrinx — image the spine.
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Post-op non-union
Persistent pain after osteotomy or arthrodesis — imaging to exclude non-union of the surgical site.
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Recurrent deformity
Return of the cavus deformity after surgery — often reflects untreated muscle imbalance.
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Post-op nerve injury
New numbness or motor loss after cavus surgery — needs urgent review by the operating team.
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Chronic ankle instability
Repeated ankle sprains from a cavus foot — untreated they drive cartilage damage and early arthritis.
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Peroneal tendon rupture
Sudden lateral ankle pain with weakness of eversion — suggests peroneal tendon rupture in a cavus foot.
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Diabetic Charcot mimicking cavus
A hot, swollen, deformed foot in a person with diabetes may be Charcot neuroarthropathy — not a mechanical cavus.
Living with it
A lifelong condition, but a very manageable one.
Four things that make the biggest difference day to day — orthoses, footwear, rehab and long-term review.
A quiet reminder
Consistency beats intensity, every time.
Small, steady changes — kept up for years — do more than a heroic month that does not last.
- 01 Orthoses
Wear the orthosis, daily
A well-prescribed orthosis only works when it is worn — build it into every pair of shoes.
- 02 Footwear
Deep, supportive shoes
Choose shoes with a deep toebox and firm heel counter — the wrong shoe undoes a good orthosis.
- 03 Rehab
Keep the peroneals strong
Ongoing peroneal strengthening and balance work reduces sprains and lateral overload.
- 04 Reviews
Long-term surveillance
Cavus feet change slowly over years — a regular podiatry or foot & ankle review keeps things on track.
Frequently asked
Everything we get asked about cavus foot.
Quick answers on causes, the Coleman block test, orthoses, surgery and when to seek help.
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What actually causes cavus foot?
Around two-thirds of cavus feet have a neurological cause — most commonly Charcot-Marie-Tooth disease, an inherited neuropathy. The rest are idiopathic, post-traumatic or related to prior childhood conditions such as clubfoot.
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What is the Coleman block test?
A simple standing test where a wooden block is placed under the lateral foot. If the hindfoot varus corrects on the block, the hindfoot is flexible and driven by the forefoot — that changes the surgical plan considerably.
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Do I need nerve conduction studies?
Yes — for any adult with a cavus foot without a clear traumatic cause, nerve conduction studies are recommended to look for an underlying neuropathy. This is essential before considering major reconstructive surgery.
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Can orthoses fix a cavus foot?
Orthoses do not correct the deformity but they can substantially reduce lateral overload, ankle instability and lateral foot pain. For many people with a flexible cavus foot, a good orthosis is all that is needed.
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When is surgery considered?
Surgery is considered for fixed or progressive deformity, recurrent ankle instability, painful peroneal tendon disease or a foot that cannot be managed comfortably in an orthosis. Modern joint-sparing osteotomies and tendon transfers are the mainstay.
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What is the red flag I should not ignore?
Rapidly progressive weakness, bilateral cavus feet developing in a child, or new neurological signs alongside the foot deformity — these need urgent neurology referral to exclude Charcot-Marie-Tooth or spinal cord pathology.
Related content
Keep reading.
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Chronic ankle instability
Recurrent sprains driven by hindfoot varus.
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Peroneal tendinopathy
Lateral ankle tendon pain in the cavus foot.
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Foot MRI
Imaging cartilage, tendons and soft tissues.
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