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High arch

Pes cavus; High foot arch

Definition

High arch is a foot arch that is raised more than normal. The arch runs from the toes to the heel on the bottom of the foot. It is also called pes cavus.

High arch is the opposite of flat feet.

Causes

High foot arches are much less common than flat feet. They can be caused by a bone (orthopedic) or nerve (neurological) condition.

Unlike flat feet, highly arched feet tend to be painful. This is so because more stress is placed on the section of the foot between the ankle and toes (metatarsals). This condition can make it difficult to fit into shoes. People who have high arches most often need foot support. A high arch may cause disability.

Symptoms

Symptoms include:

Shortened foot length
Difficulty fitting shoes
Foot pain with walking, standing, and running (not everyone has this symptom)

Exams and Tests

When the person stands on the foot, the instep looks hollow. Most of the weight is on the back and balls of the foot (metatarsals head).

Your health care provider will check to see if the high arch is flexible, meaning it can be moved around.

Tests that may be done include:

X-ray of the feet
X-ray of the spine
Electromyography
MRI of the spine
Nerve conduction studies
Genetic testing to look for hereditary genes that can pass on to your child

Treatment

High arches, particularly ones that are flexible or well cared for, may not need any treatment.

Corrective shoes may help relieve pain and improve walking. This includes changes to the shoes, such as an arch insert and a support insole.

Surgery to flatten the foot is sometimes needed in severe cases. Any nerve problems that exist must be treated and monitored by specialists.

Outlook (Prognosis)

The outlook depends on the condition causing high arches. In mild cases, wearing proper shoes and arch supports may provide relief.

Possible Complications

Complications may include:

Chronic pain
Difficulty walking

When to Contact a Medical Professional

Contact your provider if you think you have foot pain related to high arches.

Prevention

People with highly arched feet should be checked for nerve and bone conditions. Finding these other conditions may help prevent or reduce arch problems.

References

Grear BJ. Neurogenic disorders. In: Azar FM, Beaty JH, eds. Campbell's Operative Orthopaedics. 14th ed. Philadelphia, PA: Elsevier; 2021:chap 87.

McClincy MP, Olgun ZD, Dede O. Orthopedics. In: Zitelli BJ, McIntire SC, Nowalk AJ, Garrison J, eds. Zitelli and Davis' Atlas of Pediatric Physical Diagnosis. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 22.

Winell JJ, Davidson RS. The foot and toes. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 694.

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Review Date: 12/12/2022

Reviewed By: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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