A high arch foot, known medically as pes cavus, is a foot structure characterized by an excessive elevation of the medial longitudinal arch, which gives the foot a distinctly hollow appearance. This structural difference means the foot does not flatten when weight is applied, concentrating pressure on specific areas. While some individuals experience no discomfort, the structure can lead to concentrated pressure points and biomechanical issues over time. This foot shape is relatively common, affecting an estimated 10% of the general population, and its rigidity often dictates whether it will cause functional problems.
Understanding the High Arch (Pes Cavus)
The high arch is defined by a foot morphology that remains arched even when standing, unlike a normal arch which allows for some flattening to absorb shock. The foot’s contact points with the ground are primarily limited to the heel and the ball of the foot. This structure results in the foot tending to supinate, or roll outward, which reduces its natural ability to absorb impact forces during walking or running.
The rigidity of the arch is an important distinction. A rigid pes cavus deformity does not correct, even when the foot is not bearing weight, and often involves a hindfoot that is turned inward (varus alignment). This fixed, stiff structure lacks the necessary flexibility to distribute force evenly, which is why functional issues often arise with this foot type.
Common Symptoms and Functional Issues
The lack of shock absorption and uneven weight distribution frequently leads to several painful symptoms and functional limitations. Concentrated pressure on the forefoot, specifically the metatarsal heads, often causes chronic forefoot pain known as metatarsalgia. This excessive pressure also causes hard, thickened skin, or calluses, to form on the ball of the foot and along the outer border of the foot.
The increased tension on the plantar fascia can lead to plantar fasciitis, resulting in heel pain that is often worse in the morning. Muscular imbalances that create the high arch also contribute to the development of toe deformities, such as hammertoes or claw toes. Furthermore, the inward tilt of the heel (varus alignment) places increased stress on the lateral ankle ligaments, significantly increasing the risk of recurrent ankle sprains and general ankle instability.
The foot’s limited ability to absorb impact can make standing for long periods or participating in high-impact activities difficult. Reduced shock absorption transmits forces up the kinetic chain, sometimes contributing to pain in the knees, hips, or lower back. In more severe cases, the constant stress can result in stress fractures of the metatarsals or a Jones fracture of the fifth metatarsal.
Identifying the Underlying Causes
The cause of a high arch is important because it determines whether the condition is stable or likely to worsen over time. Many high arches are classified as idiopathic, meaning the cause is unknown, and are often simply an inherited structural variation. These cases are frequently non-progressive and may remain asymptomatic throughout a person’s life.
However, a significant number of high arch deformities result from an underlying neurological disorder that causes muscle imbalances in the lower leg and foot. The most common neurological cause is Charcot-Marie-Tooth (CMT) disease, a progressive nerve disorder that weakens specific muscles, leading to an exaggerated arch. Other conditions, such as spina bifida, muscular dystrophy, or cerebral palsy, can also contribute to the development of pes cavus.
It is imperative to seek a medical evaluation if a high arch develops suddenly, progresses rapidly, or is unilateral (only affects one foot). These signs can point to a more serious, progressive neurological issue like a tethered cord or other spinal cord abnormality. If a neurological cause is suspected, a neurologist may recommend specialized testing to confirm the diagnosis, as the underlying condition will affect the long-term management plan.
Treatment and Management Options
The goal of managing a high arch foot is to create a plantigrade foot—one that bears weight evenly and without pain—by redistributing pressure and improving shock absorption. Nonoperative treatments are the first line of defense and can provide significant symptom relief for most individuals.
Custom Orthotics and Footwear
Custom-made orthotics are highly effective, but they are designed differently than those used for flat feet. Instead of aggressive arch support, these devices focus on cushioning, accommodating the high arch, and offloading concentrated pressure points, particularly the heel and metatarsal heads. Appropriate footwear should feature a wide toe box, excellent cushioning in the midsole, and a deep heel cup to provide stability and shock absorption.
Physical Therapy
Physical therapy is also beneficial, focusing on stretching tight structures like the plantar fascia and the Achilles tendon, which commonly shorten due to the foot’s posture. Strengthening the weak muscles around the ankle can help improve stability and reduce the risk of recurrent sprains.
Surgical Intervention
For severe deformities that cause debilitating pain and fail to respond to comprehensive conservative management, surgical intervention may be considered. Surgery is complex and may involve soft-tissue procedures, such as tendon transfers, or bony procedures like osteotomies (cutting and realigning bone). The specific procedure is tailored to the individual’s unique deformity, aiming to realign the foot and ankle joints for a more stable and functional foot.