High Arch (Pes Cavus)

Overview

If you stood on a big piece of paper with wet feet, would the impression leave only the heel and front of your foot? If so, then you have pes cavus, whose literal translation is “hollow foot.” In everyday terms, pes cavus means your arch is much higher than normal. High arches don’t usually cause debilitating pain, though fatigue and foot aches are common. 

Your high arches might be a variation of what’s considered normal. The condition tends to run in families. But in many cases, a high arch – especially if it develops unexpectedly in one foot – could highlight an underlying neurological problem.

Symptoms

Symptoms vary depending on whether your high arches are inherited or stem from a neurological condition. With high arches, your heel (or heels if both feet are affected) will likely be tilted medially (toward the body’s midline) at the ankle. When weight is put on the foot, the arch does not flatten at all.

Other symptoms include:
  • Pain when standing, walking or running due to the extra stress on the metatarsals (bones at the top of the foot)
  • Corns and calluses on the ball or side of the foot, or the heel
  • Arch inflexibility and stiffness
  • Ankle sprain due to instability of the foot
  • Very tight calf muscles at the lower leg

Causes

Most cases of high arches are associated with nervous-system disorders. The conditions that can cause high arches include:
  • Cerebral palsy
  • Spina bifida
  • Muscular dystrophy
  • Polio
  • Stroke
  • Charcot-Marie-Tooth disease
  • Spinal cord tumor

The cause of high arches cannot be determined in about one in five instances. These cases are called idiopathic, meaning the condition arises from an unknown or uncertain cause.

Diagnosis

Identifying the underlying reason for a high arch is important to help your doctor plan the right treatment. Some neurological conditions can cause high arches to worsen progressively.

Family history and physical exam: Your doctor will ask about family history of high arches and neurological conditions. In examining your foot, he’ll look at arch height and any calluses, hammer toes and claw toes. The doctor also will watch how you walk (your gait).

X-rays: To help discern bone conditions and see if degenerative arthritis is present, your doctor may refer you for foot and ankle X-rays. An X-ray of your spine also might be needed to determine if a tumor or other spinal problem exists.

Magnetic resonance imaging (MRI): If clearer images of your spine are needed, your doctor may order an MRI (magnetic resonance imaging). In this diagnostic test, a magnetic field and radio waves are combined via computer to produce exceptionally detailed images.

Electromyography: This test determines the health of muscles and the nerves controlling those muscles. A needle-shaped electrode is inserted into the muscle and an oscilloscope displays the muscle’s electrical activity.

Nerve-conduction studies: This measures the speed of signals traveling through nerves. Several electrodes are placed on the skin above a nerve. An electrode emits a mild electrical impulse to activate the nerve. The activity then continues down the length of the nerve. The distance between electrodes and the time it takes them to move from one electrode to the next determines how fast nerve signals travel.

Complications

High arches may contribute to or result in other conditions:

Claw foot: This is a deformity in which the toe joints nearest the foot bend upward. The distal joints (closer to the end) bend down, creating an impression of a claw.

Hammer toe: This usually affects the second toe (beside the big toe), bending it downward at one or both joints. Other toes might be involved.

Foot drop: This is the inability to raise the front of the foot; the toes point downward while walking. Those with foot drop tend to scuff their toes on the ground or develop an odd gait to avoid scraping their toes. Foot drop can affect one or both feet.

Recovery

If your high arches are inherited, you likely can treat mild cases with insoles, orthotics, differently fitting shoes or corrective shoes – available over the counter or through a podiatrist.

If you have frequent or chronic pain when walking or standing, consult a podiatrist or orthopedist. If you unexpectedly develop a high arch in one or both feet, it could signify a developing neurological condition. Many procedures can relieve foot pain. Quick medical response can limit the likelihood of long-term disability.

Treatments

Treatments vary, depending on the condition’s severity. In general, they include:

  • Alleviating pain and supporting the foot with insoles, corrective shoes or custom-made shoe inserts (orthotics)
  • Relieving pressure on different parts of the foot with silicone or felt pads
  • Removing corns and reducing calluses (best done by a podiatrist)
  • Undergoing surgery on the soft tissues or bones to relieve pain