What causes pes cavus with toe clawing?

• A. Over contraction of the plantar flexors and lacks intrinsic foot muscle control
• B. Underactivity of plantar flexors
• C. Excessive dorsiflexion
• D. Weak toe flexors

Answer: (A)

Pes cavus with toe clawing happens when the plantar flexor muscles (the calf muscles) are overactive and the intrinsic muscles of the foot aren’t providing enough stabilization. That excess plantarflexion and loss of intrinsic control push the hindfoot into an inverted, plantarflexed position, lifting the arch and creating a high-arched foot. At the same time, the overactive toe flexors and weak intrinsic/dorsiflexor balance let the toes curl into a clawed posture because there isn’t enough opposing force to keep them extended or aligned.

If the plantar flexors were underactive, you wouldn’t see the high arch characteristic of pes cavus. Excessive dorsiflexion would tend to flatten the arch rather than create a cavus. Weak toe flexors would reduce clawing rather than cause it.