Ask a Ballantyne Podiatrist: How to Help High Arches

High arches (pes cavus) are the excessive, fixed flexion of the arch of the foot. While weight-bearing stress is typically distributed across the entire foot in people with normal arches, those with high arches carry their weight mainly on the heels and balls of the feet. This places undue stress on the toes and ankles, leading to pain and instability.

Since a high-arched foot lacks the flexibility to absorb shock, it will tend to roll outward (supinate) as the foot rolls through a step. This can increase the risk of an ankle sprain or fracture. High arches can develop at any age and occur in one or both feet. 

The treatment of high arches can vary by the cause and severity of the condition. Efforts are usually made to treat the disorder conservatively whenever possible.

Non-surgical options for high arches

• Custom orthotics are inserted into a shoe to correct the foot position and provide arch support. Doing so can improve stability and add much-needed cushioning to your foot.
• Ankle braces are used to stabilize wobbly ankles and prevent excessive supination while standing or walking.
• Physical therapy may be recommended to teach you stretching and strengthening techniques to improve your muscle tone and tendon flexibility.
• Custom orthotic shoes can also be ordered if adequate footwear cannot be found elsewhere. While expensive, they are often a good solution for people wanting to avoid or delay surgery.

If conservative therapy fails to provide relief, surgery may be explored (generally if the pain is extreme and affecting your ability to move about). No single procedure is appropriate for all situations, and multiple procedures may be needed to achieve the desired result.

Surgical options for high arches

• Plantar Fascia release is a procedure in which the contracted tendon between the heel and ball of the foot is partially cut to release the tension. It is typically performed as an open operation and requires a plaster cast to help the foot heal the right position. Recovery takes around four to six weeks.
• Tendon transfer surgery is one in which a tendon is shifted from its original position to a new one to improve mobility. It is not a transplant technique but rather one in which the tendon is moved to release some of the tension. It is also performed as open surgery, requiring casting and up to eight weeks of recovery time (including four weeks of non-weight-bearing bed rest).
• Osteotomy is an open surgical procedure in which a bone is cut to shorten or lengthen it or change its alignment. When used to correct a high arch, screws and wires will be used to hold the realigned bones in place. For the purpose of high arch treatment, it is most often used to reposition the heel bone (calcaneus). Casting is required. The recovery time is around six weeks.
• Arthrodesis is an open surgical technique in which adjacent bones are moved and fused together to increase stability. Arthrodesis is typically used when there is either severe rigidity in the arch or rapid deterioration of the arch structure. Depending on the location, the recovery time with casting can take anywhere from four to nine weeks.

As with any surgery, there are risks, including infection, nerve damage, postoperative bleeding, the formation of clots, and a reaction to the general anesthesia. Be sure to speak with your surgeon so that you fully understand the benefits and risks of the procedure (as well as the recovery time and pain control option). In cases where an underlying neurologic problem exists, surgery may be needed in the future due to the progression of the disease.

Best Shoes for High Arches

The primary challenge of living with high arches is finding the right shoe to support your foot and distribute your body weight evenly. If you have high arches, always focus on shoes with:

• Thick but flexible soles
• Heels that are no more than one to two inches high
• A fuller (or even tapered) heel to increase stability
• A wider toe box in which you can spread your toes
• Laces you can loosen if you experience tendon pain near the shoe tongue

High-topped shoes or ankle boots can offer extra ankle support.

If a shoe doesn’t offer enough support, you can usually find three-dimensional arch inserts at larger drugstores. There are also retailers like FootBalance that make reasonably priced custom orthotics you can switch between shoes. To prevent toe clenching, purchase a set of inexpensive neoprene or foam toe spacers which you can wear underneath your socks and shoes.

A Word From Ryan Foot and Ankle Clinic

Foot pain is something you never should ignore if you have high arches. By seeing a podiatrist early, you can avoid a worsening of symptoms and even correct structural abnormalities in your gait before other joints are affected. To schedule a visit with our Ballantyne NC podiatrist, click here!