The high arch foot (pes cavus) is a common orthopedic deformity characterized by an abnormally elevated arch that does not flatten when bearing weight. This exaggerated arch disrupts the foot’s natural ability to absorb shock, leading to excessive pressure on the heel and the ball of the foot. The resulting instability and uneven pressure distribution frequently cause pain and functional issues. Understanding the specific origin of the arch formation is key to finding the correct solution.
Defining High Arches and Underlying Causes
Pes cavus describes a foot structure where the longitudinal medial arch is noticeably raised, often resulting in a fixed, rigid foot position. The normal foot distributes weight across a “tripod” formed by the heel and the first and fifth metatarsal heads, but the high arch disturbs this balance. This deformity can present in several variations, most commonly as pes cavovarus, which includes an inward tilting of the heel.
The causes of high arches fall into two main categories: idiopathic and neurological. Idiopathic cases (cause unknown) are often hereditary and represent a structural variation. Neurological causes are more complex, resulting from underlying conditions that create muscle imbalances in the lower leg and foot.
Charcot-Marie-Tooth (CMT) disease, a group of inherited peripheral neuropathies, is a frequent cause of this deformity. CMT leads to weakness in the muscles that lift the foot, while opposing muscles remain strong, causing the foot to pull into the high-arched, claw-toed position. Other neurological disorders, including cerebral palsy, spinal bifida, and spinal cord injuries, can also cause the muscle imbalances that drive the development of a high arch.
Identifying Symptoms and Professional Assessment
People with high arches often seek professional help due to persistent pain and instability. Common symptoms include foot pain, specifically in the arch, heel, or ball of the foot (metatarsalgia), due to concentrated pressure points. The altered mechanics can also lead to the formation of painful calluses on high-pressure areas and the development of toe deformities like claw toes or hammertoes.
The high arch structure contributes to ankle instability, increasing the risk of frequent ankle sprains because the foot adapts poorly to uneven terrain. Patients may also experience difficulty finding comfortable shoes, often noticing excessive wear on the outer edges of their footwear. A professional assessment by a podiatrist or orthopedic specialist begins with a physical examination, including observing the patient’s gait and testing muscle strength and flexibility.
Diagnostic imaging, such as weight-bearing X-rays, is used to visualize the bones and joints, measuring the arch angle and calcaneal pitch to determine the severity. If a neurological cause is suspected, the specialist may order nerve conduction studies or electromyography (EMG) to evaluate nerve and muscle function. Determining whether the foot is flexible (the arch partially flattens when bearing weight) or rigid is a crucial step in planning the most effective treatment strategy.
Conservative Management and Support Strategies
For the majority of patients, the primary focus is on conservative management aimed at cushioning, support, and pressure redistribution. Custom-made orthotics are the most effective non-invasive treatment, designed to conform closely to the elevated arch, creating a total contact surface. This conformity spreads weight more evenly across the entire sole of the foot, relieving pressure from the heel and forefoot while improving shock absorption.
In contrast, over-the-counter arch supports rarely provide the specific, high-contour support needed for a true high arch foot. Proper footwear is an important complement to orthotics and should feature a deep toe box to accommodate any toe deformities, excellent midsole cushioning, and a straight last for maximum stability. Shoes with adjustable closures, like laces, allow for a secure fit that helps manage foot instability.
Physical therapy plays an important role in managing symptoms by targeting muscle tightness and weakness. Specific stretches, such as deep calf stretches, help relieve tension in the Achilles tendon and plantar fascia, which often become tight due to the foot’s fixed position. Strengthening exercises, including towel scrunches and toe taps, help stabilize the foot and ankle by improving the function of intrinsic foot muscles and ankle stabilizers. For acute pain flare-ups, applying ice or using nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce inflammation and discomfort.
Advanced Interventions and Surgical Considerations
When conservative treatments fail to alleviate pain, or when the deformity is severe, rigid, or progressively worsening, advanced interventions may be considered. Surgery is generally reserved as a last resort, aiming to create a plantigrade foot that can bear weight comfortably and evenly. The specific procedures chosen depend heavily on whether the deformity is flexible or fixed and the extent of the underlying muscle imbalance.
Soft tissue procedures are often performed first to address muscle and tendon imbalances. A common technique involves a tendon transfer, such as moving the tendon of the peroneus longus muscle to alter its pull and better balance the forces across the foot. A plantar fascia release may also be performed to loosen the contracted tissue along the sole of the foot.
Bony procedures (osteotomies) involve cutting and reshaping the bones to correct the structural alignment. This may include cutting the heel bone (calcaneus) to shift its position or performing an osteotomy on the first metatarsal to elevate the front of the foot. In cases of severe, rigid deformities, especially those with arthritic changes, a joint fusion (arthrodesis) may be necessary to permanently stabilize the foot’s position, though this eliminates movement in the fused joints.