The human foot is a complex structure, with arches crucial for supporting weight and distributing forces. While many have “normal” arches, others have higher or lower arches. This article explores high arches, also known as pes cavus, and discusses when they might cause issues, along with management strategies.
Understanding High Arch Foot
A high arch foot, or pes cavus, features an abnormally elevated longitudinal arch between the heel and the ball of the foot. This concentrates weight on the heel and ball, rather than distributing it evenly across the sole. As a result, less of the foot’s surface area contacts the ground. Unlike a normal arch that flattens to absorb shock, a high arch is often a more rigid structure.
The heel may also tilt inward, known as hindfoot varus. This inward tilt, combined with a plantarflexed first metatarsal (where the bone leading to the big toe points downward), contributes to the foot’s stiff nature. High arches are classified as flexible, flattening slightly under weight, or rigid, maintaining their elevated shape even under pressure.
When High Arches Lead to Problems
While some individuals with high arches experience no issues, altered foot mechanics can lead to problems due to uneven pressure and reduced shock absorption. Concentrated weight on the heel and forefoot can cause pain in the arch, heel, and ball of the foot (metatarsalgia). This increased pressure may also result in thick calluses on the ball, heel, and sides of the foot.
Muscle imbalance and pressure can contribute to toe deformities like hammertoes or claw toes. The inward tilting heel can also lead to instability, increasing recurrent ankle sprains. The foot’s rigidity makes it less effective at absorbing impact, potentially causing stress fractures in the lower limbs.
Associated issues include plantar fasciitis and Achilles tendonitis. The altered gait, characterized by supination (walking on the outside of the foot), can also cause pain extending up the leg to the knee, hip, and lower back. In severe cases, high arches may lead to significant functional limitations and discomfort affecting daily activities.
Reasons for High Arches and How They Are Identified
High arches can stem from various origins. Some individuals inherit this foot structure, classifying it as idiopathic. Approximately 8-15% of the general population may have some degree of pes cavus, with about 30% of severe cases being idiopathic. However, many cases, especially severe or progressive ones, link to underlying neurological conditions affecting muscle control and foot structure.
Common neurological causes include Charcot-Marie-Tooth (CMT) disease, a progressive nerve disorder leading to muscle weakness and an exaggerated arch. Other conditions like cerebral palsy, spina bifida, muscular dystrophy, polio, and stroke can also contribute due to muscle imbalances or nerve damage. Identifying the underlying cause is important, as high arches from neurological disorders tend to worsen over time, unlike purely structural or inherited ones.
Diagnosis typically begins with a comprehensive physical examination by a healthcare professional. They observe the foot’s shape, assess flexibility, and analyze the individual’s gait and balance. Simple at-home tests, like the “wet foot test” (making a footprint after wetting the foot), can offer an initial indication by showing only the heel and forefoot with little to no middle arch impression.
Further diagnostic steps may include imaging like X-rays to visualize bone structure. If a neurological cause is suspected, an MRI of the spine or foot, electromyography (EMG), or nerve conduction studies may evaluate nerve function. Genetic testing can also identify inherited conditions, aiding diagnosis and guiding management.
Approaches to Managing High Arches
Managing high arches often involves conservative strategies to alleviate symptoms and enhance foot function. Selecting appropriate footwear is a primary approach, providing ample arch support, cushioning, and a wider toe box. This helps distribute pressure more evenly and absorb impact effectively during walking or standing.
Orthotic devices, custom-made or over-the-counter, are often recommended for personalized support and stability. These inserts redistribute pressure from the heel and ball across the sole, reducing painful pressure points. Custom orthotics are especially beneficial, molded to the individual foot for precise support.
Physical therapy plays a significant role, focusing on stretching and strengthening exercises. Stretching tight muscles, like calf muscles and plantar fascia, improves flexibility. Strengthening exercises target intrinsic foot muscles and ankle stabilizers, enhancing foot mechanics, balance, and proprioception. Examples include toe curls, marble pickups, and single-leg stance exercises.
Other conservative measures include applying ice to reduce inflammation, using over-the-counter pain relievers, and wearing night splints to gently stretch the arch and calf muscles while sleeping. These interventions aim to reduce discomfort and prevent symptom progression.
When conservative treatments are insufficient for severe pain, progressive deformity, or significant functional impairment, surgical intervention may be considered. Procedures are tailored to the high arch deformity. Common options include osteotomy (realigning bones), soft tissue releases to lengthen tight tendons or ligaments, and tendon transfers to rebalance muscle forces. In severe cases, joint fusion (arthrodesis) may stabilize the foot and alleviate pain.