High arches (cavus foot)

What are high arches, and how common are they?

A high-arched foot (pes cavus, or cavus foot) has an arch that stays raised when you stand on it, instead of flattening¹. The high point can be in the front, middle or back of the foot². Some people have no symptoms, and it may simply be a normal variation¹³. Others have pain, an unsteady ankle, clawed toes or calluses (patches of hard skin)¹.

Estimates run from about 10% to one quarter of people. There's no firm figure, because clinics don't all define a high arch the same way²⁴⁵.

What causes high arches, and who gets them?

Often there's an underlying nerve or muscle condition, which is why a check is worthwhile⁶. The most common is Charcot-Marie-Tooth disease, an inherited nerve condition⁵. It leaves some foot and leg muscles stronger than others, and that imbalance pulls the foot into a high arch⁷. A change in foot shape can be one of its first signs².

Other causes include an earlier foot or ankle injury and clubfoot (a foot shape present from birth)⁷. In some people no cause is found⁸.

High arches in both feet more often point to an inherited cause, and in one foot to an injury⁵. A family history of high arches raises the chance of an inherited nerve condition⁵.

What does it feel like, and how is it diagnosed?

You may notice pain under the ball of the foot, calluses, clawed toes, or an ankle that gives way⁹. The ball of the foot under the big toe is a common site of pain⁷.

A podiatrist or doctor can usually tell what's going on from your history and from examining you standing and walking¹⁰. A simple block test, with your heel and outer forefoot resting on a small block, shows whether the heel can straighten or is fixed¹⁰. Standing X-rays can measure how severe the arch is⁵. Because a nerve condition can sit behind it, they'll also ask about family history, check your strength, reflexes and feeling, and may arrange nerve tests if something points that way¹⁰.

What helps first?

Custom-made foot orthoses (shoe inserts made to fit your foot) are the best-supported first treatment for painful high arches in adults⁸¹¹. Over three months they eased foot pain and took pressure off the sole of the foot⁸¹¹. The design is usually guided by whether the heel can straighten¹². Milder cases may be managed with inserts alone⁵.

It can also help to ease back on activities that aggravate the pain, wear cushioned shoes with room for your foot, and do stretching and strengthening exercises. These can ease symptoms and help the foot work better⁵. It isn't clear yet whether other treatments ease foot pain in high arches⁸.

What helps if that isn't enough?

It's worth asking about a review with an orthopaedic surgeon or surgical podiatrist. For a stiff, fixed deformity, ankle-foot braces are usually used, though they can be harder to tolerate¹².

Surgery is considered only after a nerve cause has been looked for, because missing one can lead to the wrong operation and the problem returning⁷. For Charcot-Marie-Tooth disease, surgery is usually planned as a comprehensive approach¹³. In children and teenagers, some surgeons suggest operating earlier rather than later, because the foot can stiffen as time passes⁶.

If you have surgery, follow your surgical team's written advice on keeping the leg raised, changing position often in a cast, and caring for the wound. Temporary numbness or tingling is common, but patchy numbness can sometimes be permanent⁹.

How long does it take, and how can I stop it coming back?

The outlook depends mainly on the cause. When a nerve condition such as Charcot-Marie-Tooth disease is behind it, the foot usually starts flexible in childhood or the teens and gradually becomes fixed, so how it will change is hard to predict¹⁴. Inserts, exercises and suitable footwear can ease symptoms but may not stop the foot changing, particularly with a nerve condition⁵.

Over time, a heel that tilts inwards can overload the outer ankle and foot. That can lead to repeated sprains, an unstable ankle, tendon problems along the outer ankle, stress fractures in the outer foot, and ankle arthritis⁵¹⁰. It isn't clear yet what stops the problem coming back after surgery.

What helps is spotting problems early: regular reviews, especially for children and teenagers or when a nerve cause is known or suspected, and mentioning sprains or outer-foot pain promptly.