High Arches (Cavus Foot): Why They Hurt and When to Get Them Checked

Some people have an arch that sits very high, even when they stand. Do the balls of your feet ache by the end of the day? Do you keep rolling the same ankle? Is it hard to find shoes that fit? A high arch may be part of the story.

High arches are much less common than flat feet.³ The medical name is cavus foot, or pes cavus.^1,2 Some people never have a problem; others have pain, calluses or shaky ankles. Here's what high arches are, why they can hurt, and when it's worth having them checked.

What Is a High Arch?

A cavus foot is a foot with a very high arch.¹ The arch stays raised even when you put weight on it.² When a provider looks at the foot while you stand, the instep looks hollow. Most of your weight lands on the heel and the ball of the foot.³

With less of the foot touching the ground, the heel and ball of the foot take extra stress during standing and walking.¹ A cavus foot can show up at any age, in one foot or both.¹

What Causes High Arches?

Some people are simply born with high arches, and they can run in families.^1,2 In other cases, a high arch is linked to a condition that affects the nerves or muscles.^1,2 Cleveland Clinic lists neuromuscular disorders as the most common cause of the muscle imbalance behind high arches.² Conditions that can lead to a cavus foot include:^1,2

• Charcot-Marie-Tooth disease
• Cerebral palsy, spina bifida, muscular dystrophy or polio
• Stroke
• Nerve damage from diabetes
• A past injury, or clubfoot at birth

Charcot-Marie-Tooth disease (CMT) is worth knowing about. It is the most common inherited disorder of the nerves that run to the arms and legs. It affects about 1 in 2,500 people.⁴ High arches, curled toes and weakness in the feet are among its signs, and foot weakness is often one of the first symptoms. It usually shows up in childhood or the teen years, but it can start later in life.⁴

Sometimes no cause is found. A medical review notes that in more than half of adults, the cause is labeled unknown after other causes are ruled out.⁵

The cause matters. ACFAS explains that a high arch caused by a nerve condition tends to get worse over time. A high arch with no nerve cause usually stays about the same.^1,2

What Problems Can High Arches Cause?

Not everyone with high arches has pain.³ When symptoms do show up, they can include:^1,2,3,5

• Pain in the ball of the foot or the heel, and arch pain, especially when standing or walking
• Calluses on the ball, side or heel of the foot
• Hammertoes or claw toes, where the toes curl and bend
• Ankle sprains that keep happening. The heel can tilt inward, which makes the foot less stable and the ankle easier to roll.
• Trouble finding shoes that fit
• Foot drop, which means trouble lifting the front of the foot, so it drags or slaps when you walk. This usually points to a nerve problem.¹

High arches can also play a part in overuse problems such as plantar fasciitis, ball-of-foot pain (metatarsalgia) and irritation of the tendons on the outside of the ankle.^2,5 Stress fractures in the long bones of the foot have also been linked to cavus feet.⁵ Over time, some people develop knee or back pain or arthritis in the foot and ankle.²

If your ankles give way often, our article on ankle sprains explains when a sprain needs a closer look. You can also read about hammertoes.

How Is a Cavus Foot Checked?

A foot and ankle provider will ask about your symptoms and your family history.¹ They'll look at your arch, check for calluses and curled toes, and test the strength of your muscles. They'll also watch you walk.¹ Looking at the wear pattern on your shoes can give clues too.¹

A key question is whether the foot is flexible or stiff.^2,3 One simple exam, called the Coleman block test, has you stand with part of your foot on a small block. It helps show whether the heel can shift back into a normal position.⁵ The answer helps guide treatment.⁵

X-rays are common.^1,2 If a nerve condition is suspected, you may be referred to a neurologist. Tests can include nerve studies, a spine MRI or genetic testing.^1,2,3

How Are High Arches Treated?

High arches that are flexible and don't cause trouble may not need any treatment.³ When they do hurt, care usually starts without surgery. Options described by ACFAS, Cleveland Clinic and MedlinePlus include:^1,2,3

• Orthotics. Custom shoe inserts can add cushioning and stability and help position the foot.^1,2
• Shoe changes. High-top shoes can support the ankle, and shoes with a wider heel can add stability.¹
• Bracing. A brace can steady the foot and ankle and help manage foot drop.¹
• Physical therapy and stretching to build strength and flexibility.^2,5
• Pain relief such as ice and over-the-counter anti-inflammatory medicine.² Ask your doctor or pharmacist first if you have other health conditions or take other medicines.

How much do orthotics help? The evidence is limited, but there is some. In one randomized trial of 154 adults with painful high arches, custom orthotics were compared with fake (sham) insoles. Researchers linked the benefit to the way the custom inserts spread pressure more evenly across the sole.⁶ Results vary from person to person.

Surgery may be considered when other care doesn't relieve pain or improve stability enough.¹ The goals are to ease pain, steady the foot and make up for muscle weakness.¹ Procedures vary a lot depending on the foot.^2,5 If a nerve condition is involved, specialists also need to treat and monitor it.³

When Should I See a Podiatrist?

MedlinePlus advises seeing a provider if you have foot pain related to high arches.³ Cleveland Clinic notes that symptoms from high arches can be a sign of an underlying condition.² It's worth having your feet checked if you notice:

• Ongoing pain in the ball of the foot, heel or arch
• Calluses that keep coming back
• Ankle sprains that keep happening
• Toes that are starting to curl
• An arch that is getting higher, or a foot that is changing shape
• Tripping, or a foot that drags or slaps when you walk
• In a child: an unusual walk or feet that seem to be changing. Cleveland Clinic says these children should be checked, because early treatment matters.²

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The Bottom Line

A high arch puts extra load on the heel and ball of the foot. For some people that means pain, calluses, curled toes or ankles that roll easily. The cause matters: a high arch tied to a nerve condition tends to change over time, so new or worsening symptoms are worth a visit. Orthotics, better-fitting shoes, bracing and therapy are common first steps.

If your arches are giving you trouble, request an appointment and our team will follow up within one business day.

This article is for general education and isn't a substitute for medical advice. Talk with a podiatrist or your doctor about your own symptoms.

Sources

1. Cavus Foot (High-Arched Foot). American College of Foot and Ankle Surgeons (FootHealthFacts.org). www.foothealthfacts.org
2. High Arch Feet (Pes Cavus). Cleveland Clinic. my.clevelandclinic.org
3. High arch. MedlinePlus Medical Encyclopedia, U.S. National Library of Medicine. medlineplus.gov
4. Charcot-Marie-Tooth disease. MedlinePlus Genetics, U.S. National Library of Medicine. medlineplus.gov
5. Maynou C, Szymanski C, Thiounn A. The adult cavus foot. EFORT Open Reviews, 2017. PubMed Central, U.S. National Library of Medicine. pmc.ncbi.nlm.nih.gov
6. Najafi B, Wrobel J, Burns J. Mechanism of effective orthotic therapy for the painful cavus foot. Journal of Foot and Ankle Research, 2013 (conference abstract). PubMed Central, U.S. National Library of Medicine. pmc.ncbi.nlm.nih.gov