From the Guidelines
High arches, also known as pes cavus, are a foot deformity that can lead to increased pressure on the ball and heel of the foot, potential instability, and a higher risk of developing conditions like plantar fasciitis, ankle sprains, and metatarsalgia, as defined by the IWGDF guidelines 1.
Causes and Implications
The causes of high arches can be genetic, though they can sometimes result from neurological conditions or other medical issues. Having high arches means the middle part of the foot is raised significantly off the ground when standing, which can lead to several implications, including:
- Increased pressure on the ball and heel of the foot
- Potential instability
- A higher risk of developing conditions like plantar fasciitis, ankle sprains, and metatarsalgia
- Pain or discomfort when standing or walking for long periods
Management and Treatment
To manage high arches, supportive footwear with cushioning is essential, and custom orthotic inserts may be beneficial, as stated in the guidelines for therapeutic footwear 1. Regular stretching of the calf muscles and the plantar fascia can help prevent tightness and pain. If you experience persistent foot pain, consulting with a podiatrist is recommended for a proper evaluation and personalized treatment plan, which might include physical therapy exercises to strengthen foot muscles and improve stability. Some key considerations for managing high arches include:
- Wearing custom-made or pre-fabricated medical-grade footwear that meets the specific needs of the person
- Using in-shoe (semi-)rigid orthosis to achieve pressure reduction or alteration in the function of the foot
- Practicing foot self-care, such as foot inspection, washing of feet, and careful drying between the toes
- Avoiding walking barefoot or on socks only or in thin-soled slippers, and avoiding exposure to excessive cold and heat, as recommended in the guidelines for foot self-care 1
From the Research
Causes of High Arches (Pes Cavus)
- Neurologic disorders, such as Charcot-Marie-Tooth disease, are a common cause of pes cavus 2, 3
- Traumatic and idiopathic processes can also lead to the development of high arches 4
- Muscle imbalance is a primary factor in the formation of cavus foot deformity 4, 3
- Pes cavus can occur as a variant of normal or as a component of a foot deformity, with various clinical situations and causes 5
Implications of High Arches (Pes Cavus)
- People with pes cavus often suffer from substantial foot pain 6
- High arches can lead to abnormal plantar pressures, which can be alleviated with custom-made foot orthoses (CFO) 6
- If left untreated, pes cavus can become a fixed bony deformity, leading to further complications 2
- The goal of treatment is to obtain a plantigrade, mobile, pain-free, stable, motor-balanced foot 2
Treatment Options for High Arches (Pes Cavus)
- Conservative treatment modalities, such as orthoses and shoe wear modification, are often used first 4, 5, 3
- Surgical intervention, including tendon transfers, corrective osteotomies, and fusion, may be necessary for refractory cases 4, 2, 3
- Redistribution of abnormal plantar pressures is a key factor in effective orthotic therapy for pain relief in pes cavus 6