High-arched feet (cavus foot)

What a cavus foot is

In a typical foot, the arch flattens a little as you stand and walk, spreading your weight. A high-arched foot stays high, so the load is concentrated under the heel and the ball of the foot. In one study, people with high arches had markedly higher pressures under the heel and forefoot than people with typical feet, 60% of them reported foot pain (compared with 23%), and the higher the pressure, the more likely the pain.^[1] In many high-arched feet the heel also tilts inward (a “cavovarus” foot), which overloads the outer edge of the foot and ankle.^[2]

Why it happens

• Inherited foot shape. Some high arches are simply the way a foot is built, and run in families.^[3]
• A nerve or muscle condition. A high arch can develop when some muscles of the leg are stronger than others and pull the foot out of balance. Hereditary nerve conditions such as Charcot-Marie-Tooth disease are a common cause in adults; cerebral palsy, spina bifida, polio, muscular dystrophy and stroke are others.^[3,2,6]
• Old injuries, such as a fracture of the talus, and a clubfoot treated in childhood.^[4,2]

That is why an arch that is getting higher, one that is different from the other foot, or a high arch with weakness, tripping or numbness deserves a careful look.

Symptoms

• Pain in the heel or the ball of the foot when standing or walking.
• Calluses on the ball, side or heel of the foot.
• Claw toes or hammertoes.
• Ankles that roll easily, or repeated ankle sprains.
• Pain along the outside of the foot and ankle, from overloaded peroneal tendons, and sometimes stress fractures.
• In some people, weakness that makes the front of the foot drag (foot drop).^[3,2]

How we evaluate it

We examine both feet standing and walking, check the arch and heel position, look for calluses and toe deformities, and test muscle strength, sensation and balance. A simple block test shows whether the tilted heel is driven by the front of the foot, which guides treatment. Standing X-rays at the practice show the alignment of the bones. If a nerve or muscle condition is suspected, we arrange a neurologic evaluation and nerve testing.^[3,2]

Treatment at the practice

• Custom orthotics. In a Cochrane review of custom-made foot orthoses, painful high-arched feet had the strongest evidence of benefit of any condition studied. A well-made orthotic spreads pressure away from the heel and the ball of the foot.^[5,1] See custom orthotics.
• Shoes that steady the foot: a heel that is a little wider at the bottom for stability, and high-top shoes to support ankles that roll.^[3]
• Bracing for an unstable ankle or foot drop.^[3]
• Stretching and strengthening, especially of the calf and the muscles on the outside of the ankle.
• Treating the calluses and toes that the high arch overloads. See hammertoes.
• Care for sprains and tendon problems that come from the heel tilting inward. See ankle sprains.

Conservative treatment always comes first.^[4] When the cause is a nerve condition that is still progressing, we follow the foot over time, because muscle imbalance can keep changing its shape, and rebalancing the tendons early can prevent lasting damage.^[2]

When surgery is considered

Surgery is considered when pain and instability persist despite orthotics, shoes and bracing, or when the deformity is progressing. The aim is to rebalance the muscles and realign the foot, using tendon transfers, bone cuts (osteotomies) and, for the most severe or rigid feet, fusion; most corrections combine several procedures, planned for each foot.^[3,4,6]

Common questions

Are high arches better than flat feet?

Not necessarily. A high arch concentrates pressure on small areas of the foot, and in studies people with high arches reported foot pain far more often than people with typical feet.^[1] The inward tilt of the heel that often comes with it adds ankle sprains and tendon problems on the outside of the ankle.^[2]

Should I buy arch supports from the store?

Many store-bought arch supports are built to prop up a low arch, which isn’t what a high-arched foot needs. What helps is an insert that spreads pressure over the whole sole; custom orthoses, made for the shape of your foot, have good evidence for painful high arches.^[5]

Could my high arch be a sign of something else?

Sometimes. A high arch in both feet that you have had all your life is often just your foot shape. A new or worsening high arch, one foot that is different from the other, or a high arch with weakness, frequent tripping or numbness can be the first sign of a nerve or muscle condition, and should be checked.^[3,4]

When to seek care