Pes cavus is seen in muscular dystrophy, peripheral neuropathies, and disease of the spinal cord, brainstem, and cerebral cortex. Cerebral palsy, meningomyelocele, poliomyelitis, Charcot-Marie-Tooth disease, and Friedreich ataxia are examples of conditions of neurologic origin that produce pes cavus as a late manifestation. Because of the variety of conditions in which pes cavus is seen and its variability as a manifestation of some of these, incidence in the general population is not known. A family history of pes cavus should be sought because many of the conditions producing this deformity are inherited.[8]

The primary pathological condition is neuromuscular rather than bony, with weakness or paralysis of the intrinsic muscles of the foot and its dorsiflexors, leading to the deformity over time. Pes cavus is therefore not seen at birth and usually does not develop clinically until late childhood or adulthood, depending on the underlying neuromuscular disease. A high-arched foot characterizes the deformity. Pes cavus takes one of two forms: (1) cavovarus, in which the calcaneus is inverted with tightness of the heel cord; and (2) calcaneocavus, in which a high arch with normal heel alignment is present, usually from weakness of the calf muscles resulting in increased ankle dorsiflexion and increased plantar flexion of the forefoot.

Radiographic examination may be necessary, especially if surgical management is under consideration.