High Arched Feet (Cavus Foot): Symptoms, Causes & Treatment

In a cavus foot, the arch remains higher than usual while standing.

But cavus can involve more than arch height. Some patients also have:

• An inward-tilting heel (hindfoot varus)
• A plantarflexed first ray
• More pressure along the outside of the foot
• Hammertoes or claw toes
• A high instep that makes shoes difficult to fit

Some cavus feet are flexible. Others are stiff or rigid.

That distinction matters because the exact shape and flexibility of the foot affect both symptoms and treatment.

High arches may be associated with:

• Heel pain
• Pain under the ball of the foot
• Pain along the outside of the foot or ankle
• Corns or calluses
• Repeated ankle rolling or sprains
• Ankle instability
• Peroneal tendon problems
• Hammertoes or claw toes
• Difficulty fitting shoes
• Discomfort with prolonged standing, walking or exercise

These symptoms are not specific to cavus foot. Heel pain, forefoot pain and ankle pain can have many causes, so the arch should be evaluated as part of the entire foot and ankle examination.

Some high-arched feet are relatively rigid and have less surface area contacting the ground.

That can concentrate pressure beneath areas such as:

• The heel
• The metatarsal heads, or ball of the foot
• The outside border of the foot

If the heel also tilts inward, the foot may load more heavily along its outer edge. This can contribute to calluses, lateral foot pain, tendon problems and ankle instability.

Yes — particularly when the high arch is part of a cavovarus foot pattern.

An inward-tilting heel can increase loading along the outside of the foot and make some patients more prone to recurrent lateral ankle sprains.

If you repeatedly roll the same ankle, the problem may involve more than the ankle ligaments.

Evaluation may also include:

• Heel alignment
• Foot flexibility
• Peroneal tendon and muscle function
• Ankle ligament stability
• Balance and proprioception
• Forefoot alignment

Keep rolling the same ankle? Recurrent ankle sprains may be related to both ankle stability and underlying foot structure. Schedule an evaluation.

There is no single cause.

Some people simply have naturally high arches and never develop significant symptoms.

In other patients, cavus may develop because of muscle imbalance related to a neurologic or neuromuscular condition.

Associated conditions can include:

• Charcot-Marie-Tooth disease
• Other hereditary peripheral neuropathies
• Certain spinal cord or nervous system disorders
• Cerebral palsy
• Residual clubfoot deformity
• Peripheral nerve injury
• Previous trauma

Having a high arch does not automatically mean that you have a neurologic disorder.

However, further evaluation is particularly important if the arch is:

• New or getting progressively higher
• Much more pronounced on one side
• Associated with weakness
• Associated with numbness or sensory changes
• Accompanied by balance or gait changes
• Associated with worsening claw toes

A foot and ankle examination may include:

• Standing foot position
• Heel alignment
• Arch height
• Foot flexibility
• Walking pattern
• Muscle strength
• Ankle stability
• Peroneal tendon function
• Areas of tenderness
• Corns and calluses
• Toe position
• Sensation and neurologic findings when appropriate

A Coleman block test may also be used to determine whether the heel deformity is flexible and whether the forefoot is driving the heel position.

Not everyone with high arches needs imaging.

When cavus is painful, progressive, markedly asymmetric or associated with significant deformity, weight-bearing X-rays can help evaluate alignment.

Additional testing may be considered depending on the findings:

• MRI for suspected tendon, ligament or soft-tissue problems
• CT or weight-bearing CT for selected complex structural deformities
• Nerve testing or neurologic referral when neuropathy or another neurologic condition is suspected

No.

If your arches are high but you have no pain, instability or functional problems, treatment may not be necessary.

Treatment is more likely to be helpful when high arches contribute to:

• Persistent pain
• Recurrent ankle sprains
• Ankle instability
• Painful calluses
• Difficulty walking or exercising
• Progressive toe deformity
• Tendon problems
• Difficulty fitting shoes
• Progressive foot deformity

The goal is not to make every high arch look “normal.”

The goal is to improve comfort, stability, pressure distribution and function.

Treatment depends on the cause, flexibility of the foot and symptoms.

Supportive footwear.

Shoes with adequate cushioning, stability and depth may reduce pressure and improve comfort.

A high instep may also require a shoe with more room through the midfoot.

Orthotics.

Orthotics may help selected patients with painful cavus feet by:

• Redistributing plantar pressure
• Supporting or accommodating the foot
• Improving comfort
• Influencing flexible components of alignment

They do not simply flatten the arch or permanently reshape a rigid cavus foot.

Some patients do well with a prefabricated insert. Others may benefit from a custom orthotic based on their alignment, pressure pattern and symptoms. Learn more about orthotics.

Physical therapy.

Rehabilitation may address:

• Ankle weakness
• Balance deficits
• Recurrent sprains
• Limited flexibility
• Muscle imbalance
• Calf or Achilles tightness

Exercises may improve strength and stability, but they do not structurally correct a rigid bony deformity.

Bracing.

An ankle brace or ankle-foot orthosis may be useful when additional support is needed because of instability, weakness or a neuromuscular condition.

Callus care.

Painful corns and calluses often recur if the underlying pressure remains.

Treatment may therefore address both the skin lesion and the mechanical pressure causing it.

Surgery.

Most people with high arches do not need surgery simply because their arch is high.

Surgery may be considered when a cavus or cavovarus deformity causes significant pain, instability or progressive dysfunction despite appropriate nonsurgical treatment.

There is no single cavus-foot operation.

Depending on the deformity, reconstruction may involve:

• Tendon balancing or transfer
• Soft-tissue procedures
• First-metatarsal or midfoot osteotomy
• Calcaneal osteotomy
• Ligament reconstruction
• Joint fusion in selected rigid or arthritic deformities

Treatment is tailored to the specific location and rigidity of the deformity. Foot and ankle surgery is discussed only after an evaluation.

Orthotics generally do not permanently change the underlying bony shape of a cavus foot.

Instead, they may help:

• Reduce excessive pressure
• Improve comfort
• Support the foot
• Improve stability
• Influence flexible components of alignment

The right device depends on the individual foot — not simply how high the arch looks.

Consider a foot and ankle evaluation if you have high arches along with:

• Persistent foot or ankle pain
• Repeated ankle sprains
• Increasing instability
• Painful calluses or pressure areas
• Difficulty fitting shoes
• Progressive changes in foot shape
• New or worsening hammertoes or claw toes
• A major difference between your two feet
• Weakness or numbness
• Difficulty walking, working or exercising

A new, progressive or markedly one-sided high arch, especially when combined with weakness or sensory changes, should be evaluated for an underlying neurologic or structural cause.

If you are experiencing a medical emergency, call 911 immediately. This website and its appointment tools are not monitored for emergency medical needs.

Are high arches bad?

Not necessarily. Many people have high arches without pain or functional problems. They become more important when they cause pain, pressure, instability, recurrent injuries or progressive deformity.

What is cavus foot?

Cavus foot, or pes cavus, describes a foot with an unusually elevated arch during weight-bearing. Some cavus feet also have an inward-tilting heel, forefoot deformity or clawing of the toes.

Can high arches cause foot pain?

Yes. Some high-arched feet concentrate pressure beneath the heel, ball of the foot or outside of the foot. However, foot pain has many causes, so the arch should not automatically be assumed to be the source.

Can high arches cause ankle sprains?

They can. Cavovarus alignment can increase lateral loading and contribute to recurrent ankle instability in some patients.

Are orthotics good for high arches?

Orthotics can help selected patients by redistributing pressure, improving comfort and supporting the foot. The best device depends on the individual foot structure and symptoms.

Can high arches be corrected?

Many symptomatic high arches can be managed without surgery. Footwear, orthotics, rehabilitation and bracing may improve symptoms and function. Significant rigid, progressive or persistently symptomatic deformities may require surgical reconstruction.

Is cavus foot hereditary?

It can be. Some high arches run in families, while hereditary neurologic disorders such as Charcot-Marie-Tooth disease can also cause progressive cavus deformity.

If high arches are contributing to foot pain, repeated ankle sprains, instability, calluses or difficulty staying active, request an appointment with Dr. Kayla Wright, DPM at Metro Foot & Ankle in Tempe, or call 480-831-0700.

Our office is at 3231 S Country Club Way, Suite 108, in Tempe — see directions and parking.