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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:
Some people with cavus foot may also experience foot drop, a weakness of the muscles in the foot and ankle that results in dragging the foot when taking a step. Foot drop is usually a sign of an underlying neurologic condition.
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:
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. The surgeon will choose the best surgical procedure or combination of procedures based on the patient's individual case. In some cases where an underlying neurologic problem exists, surgery may be needed again in the future due to the progression of the disorder.
Firstly, one should consider highly consider a non-surgical
assessment before considering any surgical intervention.
An assessment by Dr. Pisarek at Advanced Healthcare will determine if the arches have raised up. If they have, this can be addressed by stretches to exercises in order to mobilize and strengthen the muscles of the lower limbs and feet. Also of great benefit will be the use of a 'Footmaxx' computerized custom foot assessment to determine if custom-made orthotics would be of benefit.
Finally, nerve irritation in the lower back can often cause lower limb instability and weakness in the legs. Therefore, Dr. Pisarek at Advanced Healthcare will also assess the spine as a possible source of the problem.
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I have been a patient of Dr. Pisarek for a few years now. Every morning I have to say "thank you Dr. P.!". Your care and your treatment renew my energy... no more pains in my lower back, knee and foot. With your help I lost 20 pounds and I am keeping it off. I am really grateful to you and your wife Hilda for taking care of me. My retirement got a new meaning, thanks to you.