High Arches (Cavus Foot)

What cavus foot is

In a normal foot, weight spreads across the heel, the outer edge and the ball of the foot. In a cavus foot, the arch is high and rigid, so less of the sole touches the ground. Often the heel tilts inward (varus), creating a cavovarus foot that rolls toward the outside edge. This is the opposite of overpronation and flat feet.

High arches absorb shock poorly, so more force passes to the heel, the ball of the foot and the ankle.

Causes

About two-thirds of adults with symptomatic cavus foot have an underlying neurological condition, so evaluation is important.

Symptoms and related problems

• pain when standing or walking, especially under the heel and ball of the foot (metatarsalgia)
• thick calluses on the ball, heel or outer edge of the foot
• claw toes or hammer toes
• frequent ankle sprains and a feeling of ankle instability
• outer foot pain and stress fractures of the fifth metatarsal
• plantar fasciitis
• shoe fitting problems, toes rubbing on shoes
• with nerve causes: foot drop, tripping, weakness and numbness

Diagnosis

A foot and ankle specialist or podiatrist will:

• examine the feet standing, walking and on tiptoe; look at shoe wear (outer edges)
• perform the Coleman block test to see whether the heel position is flexible
• check strength, sensation and reflexes, and look for family history
• order weight-bearing X-rays to measure arch height and alignment

Further tests depend on findings:

• nerve conduction studies and EMG for suspected neuropathy
• genetic testing for Charcot-Marie-Tooth disease
• MRI of the spine if a spinal cause is possible, especially with one-sided high arch

Treatment

Non-surgical

• Orthotics: custom or quality over-the-counter insoles that cushion the heel and ball of the foot, support the arch and sometimes tilt the foot outward (lateral posting).
• Shoes: cushioned, with a wide, deep toe box and a broad, stable heel; high-top shoes or boots for ankle support.
• Ankle braces for instability.
• Ankle-foot orthosis (AFO) for foot drop.
• Stretching of the calf and plantar fascia; strengthening of the peroneal muscles on the outside of the ankle.
• Callus care by a podiatrist.

Surgery

Considered for persistent pain, instability or progressive deformity despite non-surgical care. Procedures are tailored and may include:

• plantar fascia release
• tendon transfers to rebalance muscle pull (such as transferring a peroneal tendon)
• osteotomies (cutting and realigning bones) of the heel or first metatarsal
• toe straightening
• fusion of joints for severe, rigid deformity

Outlook

People with stable, painless high arches usually need no treatment. Orthotics and shoes help most people with symptoms. When a nerve condition is responsible, the deformity may progress, and earlier surgery can prevent more rigid deformity and arthritis.

Frequently asked questions

Are high arches a problem?

Not always. Many people with high arches have no symptoms. Problems arise when weight concentrates on the heel and ball of the foot, causing pain, calluses, clawed toes, ankle sprains or stress fractures. A progressive high arch may signal a nerve condition.

What causes high arches?

High arches can be inherited, caused by nerve and muscle conditions such as Charcot-Marie-Tooth disease, cerebral palsy, polio or spinal problems, or result from injury. When one foot is affected or the arch is getting higher, a neurological evaluation is recommended.

What shoes are best for high arches?

Look for shoes with plenty of cushioning, a wide and deep toe box, a broad, stable heel and good shock absorption. Neutral cushioned running shoes often work well. Cushioned or custom orthotics further spread pressure and improve stability.

Can high arches be corrected?

In adults, the foot shape does not change on its own, but orthotics, bracing and exercises control symptoms. Surgery can correct the deformity when it is painful, unstable or worsening. In children with nerve-related cavus foot, earlier treatment may slow progression.