The symptoms of pes cavus can vary in severity and typically arise from the uneven distribution of weight across the foot and reduced shock absorption. Common symptoms include:

• Foot Pain: Often in the side of the foot, metatarsals (ball of the foot), or heel. This can be due to increased pressure on specific areas.
• Calluses and Corns: Development of thick skin on pressure points, particularly under the ball of the foot (1st and 5th metatarsal heads) and the heel.
• Instability: Increased risk of ankle sprains due to the foot tending to roll outward (inversion).
• Difficulty Walking or Running: Due to altered biomechanics and reduced flexibility.
• Problems with Footwear: Finding comfortable and fitting shoes can be challenging.
• Claw Toes/Hammer Toes: Deformities of the toes where they are curled or bent.
• Plantar Fasciitis: Inflammation of the plantar fascia, a thick band of tissue on the sole of the foot.
• Achilles Tendinopathy: Pain and inflammation in the Achilles tendon.
• Stress Fractures: Due to abnormal weight distribution, certain bones (e.g., metatarsals) may be prone to stress fractures.
• Numbness: Can occur if nerves are compressed or due to underlying neuropathy.

Advanced Physiotherapy for Pes Cavus

Manual Therapy

• • Joint Mobilizations: To improve the flexibility and mobility of stiff joints in the foot and ankle, which are often restricted in pes cavus.
  • Soft Tissue Release: Addressing tight muscles (e.g., calf muscles, plantar fascia) through techniques like deep tissue massage, myofascial release, or instrument-assisted soft tissue mobilization (IASTM).
• Stretching and Flexibility Exercises
  • Calf Stretches: Wall stretches or incline board stretches for gastrocnemius and soleus muscles to improve ankle dorsiflexion.
  • Plantar Fascia Stretches: Seated towel stretches or specific foot stretches to address tightness in the plantar fascia.
  • Toe Flexor Stretches: To counter claw/hammer toe deformities.
• Strengthening Exercises:
  • Intrinsic Foot Muscle Training: Exercises like marble pick-ups, towel curls, or short foot exercises to strengthen the small muscles within the foot that are often weak.
  • Ankle Stabilizer Strengthening: Exercises using resistance bands (e.g., eversion and inversion exercises) to improve the strength of muscles supporting the ankle and reduce instability.
  • Hip and Core Strengthening: Addressing proximal weakness can significantly impact lower limb biomechanics and foot stability.
• Balance and Proprioception Training:
  • Single Leg Stance: Progressing from stable to unstable surfaces (e.g., foam pad, balance board) to improve balance and ankle stability.
  • Dynamic Balance Exercises: Including activities like walking on uneven surfaces, tandem walking, or hopping exercises.