High Arches

Although flat feet are more well known to cause foot problems, a high arch can also lead to unique foot problems.  Often the problems associated with a high arch foot can be worse than than the more controllable flat foot type.  Proper shoes and support are key to preventing these issues.

High arches are due to multiple reasons, but are almost always because of genetics inherited from one’s parents.  High arches are also seen in a number of genetic diseases, and neuromuscular conditions.  Nerve injury and trauma to various tendons can also lead to the development of high arches later in life.  In a high arched (or cavus) foot, the rear portion of the foot is angled too high while the mid or front part of the foot is angled too steeply.  This deformity can be further classified by the location of the steepest portion of the arch.  This type of foot is seen in healthy individuals as well as those with nerve and muscular disorders.  High arched feet can cause a variety of problems.  Because of its prominent position, the ball of the foot can become irritated and calloused.  Years of walking with increased pressure to the ball of the foot will eventually take its toll.  When a flat footed person develops a callus to the ball of the foot, it is usually due to pressure developed toward the end of the walking cycle, after the foot has flattened out and absorbed much of the shock generated by walking.  In high arches, this pressure develops quickly in the walking cycle and the actual level is greater since the foot has not absorbed shock well enough.  Taking the pressure off of this area to help heal these foot ulcers is very difficult, and surgery may be needed eventually to reposition the ball of the foot.  Painful hammertoes can also develop with high arches (as well as with flat feet), as the prominent arch causes a muscle imbalance that will force the toes to contract upward.  The height of this contracture is usually greater in high arched feet than in flat foot-caused hammertoes, and the deformity may be stiffer.  This will result in a significant likelihood that the toes will develop corns, unless one’s shoes are deep enough to prevent toe contact with the shoe.  The heel may also become painful due to poor shock absorption.  The foot’s ability to absorb the shock generated by walking is linked to its ability to flatten out effectively.  A higher arched foot cannot do this as well, and therefore receives excessive shock with every step taken.  Because of this, high arched feet have difficulty with sustained walking or running.

Treatment revolves around addressing the specific symptoms of a high arched foot.  Orthotics (prescription shoe inserts) with shock absorption properties can relieve the excessive forces on the heel and relieve pressure on the ball of the foot.  Unlike with flat feet, over-the-counter arch supports with shock absorbing material like thick foam or gel may be a suitable alternative to prescription devises for high arch feet, as long as the padding is substantial enough.  Properly fitting and supportive shoes are an important consideration, and must be well padded to absorb the forces of walking.  Athletic shoes provide the best capability of shock absorption from the shoe perspective, while flats and heels provide the least amount of absorption.  When hammertoes are present, they can be treated in a number of different ways.  This can include padding, taping, deeper shoes, and surgery to straighten the toes.  When painful corns are reoccurring despite corn care and deeper shoes, surgery to remove the toe deformity is a vital consideration.  Calluses on the bottom of the foot must be treated with periodic trimming of the excessive skin and with padding to decrease the pressure to the bottom of the foot.  Finally, surgery may be used as a last resort to correct the foot position entirely.  The position of the steepest part of the arch determines the level of the surgery, which can include a combination of bone resetting and tendon repositioning.