Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle, Howell & Bloomfield Township, MI
Last reviewed: May 2026
Quick answer: High Arch Foot Problems is a common foot/ankle topic that affects many patients. The 2026 evidence-based approach combines proper diagnosis, conservative-first treatment, and escalation only when needed. We treat this regularly at our Howell and Bloomfield Township practices. Call (810) 206-1402.
Medically Reviewed | Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle, Michigan
The most important clinical decision with High Arch Foot Problems isn’t which treatment to start with — it’s identifying the correct subtype. That changes everything. Call (810) 206-1402.
The most important clinical decision with High Arch Foot Problems isn’t which treatment to start with — it’s identifying the correct subtype. That changes everything. Call (810) 206-1402.
Understanding the High Arch Foot (Pes Cavus)
Pes cavus refers to an excessively elevated medial longitudinal arch — the opposite of flat feet. The high arch reduces the foot’s surface contact with the ground, concentrating pressure on the heel and metatarsal heads. This creates inherent shock absorption deficiency — every step sends more impact force into bones and joints.
Approximately 25% of pes cavus is idiopathic (no identifiable cause). The remaining 75% is associated with neurological conditions: Charcot-Marie-Tooth disease (CMT) is the most common, accounting for up to 50% of neurological cases. Other causes include Friedreich’s ataxia, spinal cord tumors, spina bifida, and polio.
Dr. Biernacki routinely screens high-arch patients for CMT — a hereditary peripheral neuropathy that progressively weakens foot and lower leg muscles. Early diagnosis allows appropriate management and family screening.
Common High Arch Foot Problems
Metatarsal stress fractures: The concentrated forefoot pressure in pes cavus overloads metatarsal shafts. The fifth metatarsal (especially Jones fractures) and the second and third metatarsals are most commonly affected.
Chronic ankle sprains and instability: The high arch tilts the subtalar joint into varus, making lateral ligament sprains extremely frequent. Over time, chronic ankle instability develops.
Claw toes: Intrinsic muscle weakness (often neurological) causes the toes to dorsiflex at the MTP joints and flex at the PIP/DIP joints. These deformities cause pressure ulcers on the dorsal knuckles.
Plantar fasciitis: The plantar fascia is chronically taut in high-arch feet — often worse on the medial side. Heel pain on first steps in the morning is common.
Treatment Options for High Arch Feet
Conservative care centers on custom orthotics with lateral wedging, first metatarsal cutouts (to accommodate the plantarflexed first ray), and generous heel and forefoot cushioning. OTC options work for mild cases but most significant cavus feet benefit from custom fabrication.
Physical therapy addresses calf and hamstring flexibility (frequently tight in pes cavus) and peroneal strengthening to compensate for intrinsic muscle loss.
Surgical options are considered for progressive neurological cases or when conservative care fails. Procedures range from plantar fascia release and metatarsal osteotomies to calcaneal osteotomy and tendon transfers for claw toes.
Dr. Tom's Product Recommendations
CURREX RunPro Insoles
⭐ Highly Rated
Flexible, cushioned insoles designed for high-arch profiles
Dr. Tom says: “CURREX is one of the few OTC insoles with a high-arch profile. It cushions the heel and metatarsal heads without adding rigid arch support that doesn’t fit a cavus foot.”
High-arch feet, pes cavus, supination, active patients
Flat feet, overpronators
Disclosure: We earn a commission at no extra cost to you.
DASS Medical Compression Socks
⭐ Highly Rated
Graduated compression for ankle stability and swelling in high-arch feet
Dr. Tom says: “Ankle instability and chronic lateral swelling are hallmarks of pes cavus. DASS socks provide ankle proprioceptive support and edema management.”
Chronic ankle instability, daily swelling, peroneal tendon support
Severe arterial disease (consult physician)
Disclosure: We earn a commission at no extra cost to you.
✅ Pros / Benefits
- Conservative treatment manages most symptoms effectively
- Custom orthotics dramatically reduce metatarsal stress fracture risk
- Early neurological diagnosis (CMT) allows proactive management
- Ankle bracing reduces sprain frequency significantly
❌ Cons / Risks
- Underlying neurological causes (CMT) are progressive and cannot be cured
- OTC insoles are rarely sufficient for significant cavus feet
- Claw toes may require surgical correction if severe
- High-arch feet have higher lifetime surgical rate than flat feet
Dr. Tom Biernacki’s Recommendation
My most important message for patients with high arches: get a neurological evaluation if you haven’t had one. A significant portion of cavus feet have an underlying hereditary neuropathy — and if you have CMT, your children should be screened too. For day-to-day management, the right shoe and a well-fitted orthotic make an enormous difference. Don’t buy stability shoes — that’s the flat-foot prescription, not the high-arch one.
— Dr. Tom Biernacki, DPM | Board-Certified Podiatric Surgeon | Balance Foot & Ankle
Frequently Asked Questions
Are high arches genetic?
Often yes — both idiopathic cavus and neurological causes like CMT have strong hereditary components.
Can high arches be fixed?
The structural arch height cannot be reduced without surgery. But symptoms are very manageable with appropriate orthotics and footwear.
Should I worry about high arches?
If you have pain, frequent ankle sprains, or progressive foot deformity — yes, see a podiatrist. Asymptomatic high arches require monitoring but not necessarily treatment.
What shoes are best for high arches?
Neutral or cushioned shoes with a flexible midsole and deep toe box. Avoid motion-control stability shoes.
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OrthoInfo – AAOS: Cavus Foot (High-Arched Foot)
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Dr. Tom Biernacki, DPM is a board-certified foot & ankle surgeon (ABFAS & ABPM) at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has made him one of the most-followed foot & ankle educators on YouTube.