Radiological analysis of pes calcaneocavus reveals a large talo-calcaneal angle. In ‘pure’ pes cavus, the calcaneus is neither dorsiflexed nor in varus and is highly arched due to a plantarflexed position of the forefoot on the rearfoot. A combination of any or all of these elements can also be seen in a ‘combined’ type of pes cavus that may be further categorized as flexible or rigid. Despite various presentations and descriptions of pes cavus, not all incarnations are characterised by an abnormally high medial longitudinal arch, gait disturbances, and resultant foot pathology. Treatment Surgical treatment is only initiated if there is severe pain, as the available operations can be difficult. Otherwise, high arches may be handled with care and proper treatment. Suggested conservative management of patients with painful pes cavus typically involves strategies to reduce and redistribute plantar pressure loading with the use of foot orthoses and specialised cushioned footwear. Other non-surgical rehabilitation approaches include stretching and strengthening of tight and weak muscles, debridement of plantar callosities, osseous mobilization, massage, chiropractic manipulation of the foot and ankle, and strategies to improve balance. There are also numerous surgical approaches described in the literature that are aimed at correcting the deformity and rebalancing the foot. Surgical procedures fall into three main groups: soft-tissue procedures (e.g. plantar fascia release, Achilles tendon lengthening, tendon transfer); osteotomy (e.g. metatarsal, midfoot or calcaneal); bone-stabilising procedures (e.g. triple arthrodesis). Epidemiology There are few good estimates of prevalence for pes cavus in the general community. While pes cavus has been reported in between 2 and 29% of the adult population, there are several limitations of the prevalence data reported in these studies. Population-based studies suggest the prevalence of the cavus foot is approximately 10%. History The term pes cavus is Latin for "hollow foot" and is synonymous with the terms talipes cavus, cavoid foot, high-arched foot, and supinated foot type. Pes cavus is a multiplanar foot deformity characterised by an abnormally high medial longitudinal arch. Pes cavus commonly features a varus (inverted) hindfoot, a plantarflexed position of the first metatarsal, an adducted forefoot, and dorsal contracture of the toes. Despite numerous anecdotal reports and hypothetical descriptions, very little rigorous scientific data exist on the assessment or treatment of pes cavus. See also Arches of the foot Foot type En pointe Foot binding Rocker bottom foot References External links Congenital disorders of musculoskeletal system Foot