The area between your heel and the ball of your foot is commonly referred to as the arch of your foot. The height of the arch will vary between patients. For instance, some patients will have a normal arch, while others will have a high or low arch. Patients with high arches most often have a pes cavus foot type while those with low or flat arches have a pes planus foot type. Below is a summary of the pes cavus, associated problems caused by high arches, and available treatments.
Pes cavus foot type is the high type of arch. Patients may have excessively high arches beginning during childhood if they have a neuromuscular disease, spinal cord disorders, degenerative nerve disease, muscular dystrophy, syphilis, polio, tumors that are compressing the spinal cord, or structural deformities, such as clubfoot. If one of these causes is the reason for the high arches, the child will most likely exhibit other symptoms of the disease besides high arches. Not only can patients be born with high arches, they can also develop high arches by suffering from a head injury or isolated nerve injuries. This is especially true if the peroneal nerve, which is located in the leg, is injured.
However, the majority of patients who have mild to moderate high arches will have that foot type due to the biomechanics of the foot. Biomechanics is the study of how the foot works. The entire limb is connected, so the foot must compensate to fix a problem that may be in the ankle, knee or hip. With this compensation, may come pes cavus and pain. Additionally, very commonly, diabetic patients may notice changes in their arch height. The arch height may increase because of the muscles in the foot are weakening.
Symptoms that patients with high arches may have are:
• A callus, which is the thickening of skin in order to protect areas of high pressure, located near the first toe and on the outside of the foot. Patients may also develop calluses on the outside of their heel. These calluses can be painful and it may feel as though you are walking on a stone. To treat these calluses, podiatrists are specially trained to cut down the callus and make the skin smooth again; however, over time this callus will reappear.
• Hammering and the curling under of digits are often common in patients with pes cavus due to muscle imbalance. Metatarsalgia, which is the medical term for pain at the ball of the foot, is a common symptom. The high arch of the foot is putting more force on the ball of the foot, which causes the area to be painful and build up thick callus.
• Patients with pes cavus also may suffer from repetitive ankle sprains. Feet that have high arches may not be stable and may cause the ankle to roll to the outside causing a sprain. An ankle brace can be prescribed for these patients to help prevent sprains.
It is important to note that some patients with high arches may have no pain, so treatment may not be necessary. However, to treat pes cavus foot deformities, that are causing pain, the cause needs to first be identified. For example, if the pes cavus is due to a disease, that disease will first need to be treated in order to help decrease the deformity. If the cause of the pes cavus foot type is due to biomechanics, a podiatrist will be able to measure the amount that your joints are able to move and make you a custom made orthotic insert for your shoes. The goal of orthoses is to make the foot function in the most proper way, support the foot, and to eliminate pain. However, orthotics cannot fix all pes cavus foot types, so if a patient is having extreme pain due to poor biomechanics, surgical treatment may be necessary. Schedule an appointment at the Boulder County Foot and Ankle or Platte Valley Foot and Ankle Clinic for further evaluation of your feet.
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American Academy of Podiatric Sports Medicine