Supination and High Arch (Pes Cavus)

High arches can be genetic or in most cases can be caused by wearing improper shoes and/or imbalances of leg muscles. Muscle imbalance can arch the foot. This puts additional pressure under the big toe and toes begin to curl and become “claw toes”. If the toes are curled, it changes the way we walk and stand. We begin putting added pressure on the heel of the foot and because of this, some muscles weaken and others become stronger. We also tend to land on the outside of the foot, which can lead to twisted ankles and sprains.

Most people have an arch along the inner side of the foot shaped like the letter 'c', leaving a gap between the ground and the foot. Some feet have a higher arch than average. This is the opposite of a flatfoot. In combination with a higher arch, the ankle may be "rolled" outwards lightly - this is the opposite of a pronated foot, whereby the ankle rolls inwards. Often this outwards rolling gets referred to as pes cavus or the cavus foot.

High arch causes rigidity in the foot and the body's natural ability to absorb shock is hampered. The mere shape of the foot causes many patients to land on the heel and foot in an unstable manner. Several other problems typically occur due to high arches such as: heel pain, achilles tendonitis, painful bumps on the back of the heel called bone spurs, and arch pain. The arch is typically stretched in a weird way and arch tissue gets inflamed and painful. Due to the instability, bunions or knob like structures on the side of the foot, occur and can get larger. The tendons on the top of the foot will get stretched due to the structure of the foot. If you have corns or calluses on the big toe and the pinky toe, this is sometimes the result of high arched feet. Your shoes can not fit as they should due to the shape of your foot.

What does a high arch foot look like?

When standing with weight on the foot, the arch will appear higher. The heel often tilted inwards at the ankle (but not always). In many, the toes will appeared clawed. When not standing, the front half of the foot (forefoot) will appear to be dropped below the level of the rear-foot.

What causes high arch feet?

High arch feet may just be a normal variant (ie some people just have higher arches), some may be hereditary (ie runs in the family) and in some cases there may be an underlying neurological problem that is causing it.

What are the symptoms of a high arch foot?

The arch of a cavus foot will appear high even when standing. The symptoms of a high arch foot will vary depending on how severe the condition is and the activity levels of the person with it. Most will have no pain or any other symptoms. Symptoms may vary from a mild problem with shoe fitting to significant disability, and may include:

• There may be corns, and calluses under the bases of the first and fifth toes (ball of the foot).
• Shoe may not fit very well because of the high arch, hammertoes (bent toes) or claw toes (toes clenched like a fist).
• There may be some mild pain in the arch area, because of the pressure that it is under when standing or walking.
• The feet will feel stiffer and less mobile than a foot that does not have a high arch.
• An unstable foot due to the heel tilting inward, which can lead to ankle sprains
• An ankle sprain are more common in those with a high arched foot.

How is the high arched foot treated?

This will depend on what is causing the pain, if anything. Initially a careful investigation is needed to rule out if any neurological condition is causing the high arched foot. Generally, treatment may involve:

• We can teach you how to strengthen the proper muscles of your leg and relax strong muscles to keep a balance in your feet.  We also keep your foot moving properly with gentle adjusting and soft tissue work. We can also make custom orthotics, which may be necessary to keep your foot in proper position and prevent twisting and pulling on your leg muscles.
• The use of computerized custom foot orthotics (insoles) to support and protect the foot, provide cushioning and relieve pressure areas.
• Different sorts of pads made from silicone or felt can be used to get pressure off the painful areas
• If corns and callus are present, they can be treated by a Podiatrist.
• Proper fitting of footwear is important. Shoe modifications such as the use of high-topped shoes support the ankle, and shoes with heels a little wider on the bottom add stability.
• Bracing to help keep the foot and ankle stable. Bracing is also useful in managing foot drop.

If non-surgical treatment fails to adequately relieve pain and improve stability, surgery may be needed to decrease pain, increase stability, and compensate for weakness in the foot. In very severe cases, especially if the height of the arch is progressively increasing in height, a surgical consultation referral to an orthopaedist may be considered.