High Arches (Pes Cavus): Causes, Problems & When to Worry

Quick answer

High arches (medically: pes cavus) means the arch of your foot is unusually high, leaving the midfoot raised off the ground when standing. Some people are simply born with this shape and have no problems. But when high arches develop later in life — or get worse over time — it can be the first visible sign of a neurological condition affecting the muscles of the foot.

How to recognize it

• Visibly high arch — the inside of the foot doesn’t touch the ground when standing
• Wear pattern — shoes wear out on the outer edges of the soles
• Hammertoes or claw toes often accompany high arches
• Ankle instability — frequent rolling or spraining
• Pain at the ball of the foot (metatarsalgia)
• Heel pain sometimes
• Calluses under the ball of the foot and outside edge
• Difficulty finding shoes that fit comfortably

Two important categories

The distinction matters more than people realize:

Idiopathic / familial high arches

• Present from childhood
• Family history common
• Stable — doesn’t get worse over time
• Often asymptomatic
• Many high-arched feet need no treatment at all

Acquired / progressive high arches

• Develops or worsens over months to years
• Often signals an underlying neurological condition
• The most common cause: Charcot-Marie-Tooth (CMT) disease — an inherited neuropathy
• Other causes: stroke, polio, spinal cord injury, cerebral palsy, talipes equinovarus (clubfoot residual)
• A foot specialist or neurologist should be involved when arches are progressive

Why high arches cause problems

The mechanics:

• Less surface area contacts the ground
• Weight concentrates on the heel and ball of the foot
• The foot is a poor shock absorber — it doesn’t roll inward (pronate) the way a normal foot does
• The ankle works harder to stabilize, predisposing to sprains
• The toes claw as compensating muscles overwork

The compensations cause secondary symptoms over time.

What to do about it

Asymptomatic high arches

If your arches are high but you have no pain or functional problems, no treatment is needed. Many people live their entire lives with high arches and never know it.

Symptomatic high arches

• Cushioned shoes with good shock absorption
• Wide toe box to accommodate clawing toes
• High-top shoes for ankle support during high-risk activities
• Custom orthotics — typically with a deep heel cup, lateral wedge, and metatarsal pad to redistribute pressure
• Calf stretching — tight calves often coexist
• Strengthening of foot intrinsic muscles
• Physical therapy for gait training and balance
• Activity modification — supportive shoes for hiking, hard surfaces

Surgery

For severe cases that don’t respond to conservative care, surgical options include:

• Soft tissue releases for milder deformities
• Osteotomies (bone realignment) for the calcaneus and metatarsals
• Tendon transfers
• Triple arthrodesis for severe rigid deformities

These are major procedures, used selectively.

When the high arch warrants a deeper workup

• The arch is getting higher over months to years
• Family history of CMT or other inherited neuropathies
• Asymmetric (one foot much higher than the other)
• Foot drop alongside the high arch
• Numbness or tingling in the legs
• Atrophy of muscles in the foot or lower leg

In these situations, a clinician will often order nerve conduction studies / EMG and consider genetic testing for CMT.

Bottom line

Mild high arches without symptoms or progression are usually nothing to worry about. Progressive high arches, especially with toe deformities and ankle instability, are worth investigating — they’re sometimes the first visible clue to a treatable underlying condition.