Quick answer: Pes Cavus High Arch affects roughly 1 in 4 adults in our practice. Effective treatment starts with a targeted diagnosis, conservative-first treatment, and escalation only when needed. We treat this regularly at our Howell and Bloomfield Hills practices. Call (810) 206-1402.
The most important clinical decision with Pes Cavus High Arch isn’t which treatment to start with — it’s identifying the correct subtype. That changes everything. Call (810) 206-1402.
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| Brooks Adrenaline GTS 23 | Flat feet, overpronation | Snug toe box | Buy |
| Altra Torin 8 | Wide feet, bunions, Morton’s toe | Zero-drop transition | Buy |
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Medically reviewed by Dr. Tom Biernacki, DPM · Board-Certified Podiatric Surgeon · Last reviewed: April 2026 · Editorial Policy
Related Conditions
Quick Answer
High Arched Foot (Pes Cavus): Causes, Problems, and Treatmen relates to arch concerns — typically caused by foot structure or fatigue. Most patients improve in 6-12 weeks with intervention with conservative care. Same-week appointments in Howell + Bloomfield Hills: (810) 206-1402.
Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.
What Is Pes Cavus (High Arched Foot)?
Pes cavus—commonly called a high arched foot or cavus foot—is a structural deformity characterized by an abnormally elevated longitudinal arch, plantar flexion of the forefoot relative to the hindfoot, and variable degrees of claw toe deformity. Unlike pes planus (flat foot), which is common and often asymptomatic, pes cavus is present in approximately 10% of the population and is more frequently associated with neuromuscular pathology and symptomatic foot problems. The foot type itself is not inherently pathological, but its rigidity and altered biomechanics create predictable problems that podiatric care can address.
Pes cavus exists on a spectrum from mild (cosmetically apparent high arch with minimal symptoms) to severe (rigid, contracted deformity with significant functional impairment). Understanding the cause of the cavus deformity is critical—approximately 70% of cases have an underlying neurological condition, and evaluation of a new or progressive cavus deformity should include neurological screening.
Causes: Neurological vs. Idiopathic
The most important cause to identify is Charcot-Marie-Tooth disease (CMT)—the most common hereditary neuropathy, affecting 1 in 2,500 people. CMT causes selective weakness of the intrinsic foot muscles and peroneal muscles while sparing others, creating the characteristic muscle imbalance that produces progressive cavus deformity, claw toes, and ankle instability. CMT should be considered in any patient with bilateral progressive cavus deformity, particularly with family history of high arches, ankle instability, or peripheral neuropathy.
Other neurological causes include: other hereditary motor sensory neuropathies, Friedreich’s ataxia (causing bilateral symmetric cavus), poliomyelitis (causing unilateral cavus from asymmetric muscle weakness), cerebral palsy, and tethered spinal cord or spinal dysraphism. Idiopathic cavus (no identifiable neurological cause) exists but is a diagnosis of exclusion—thorough workup including electrodiagnostic testing and neurology referral is appropriate for progressive cavus deformity.
Problems Associated with High Arched Feet
The cavus foot produces predictable mechanical problems due to its rigidity and altered load distribution. Lateral ankle instability is extremely common—the hindfoot varus (heel turning inward) associated with most cavus feet increases inversion stress during gait, making recurrent ankle sprains and peroneal tendon injuries much more frequent. Metatarsalgia (forefoot pain under the metatarsal heads) results from the elevated arch transferring more load to the forefoot. Plantar fasciitis and heel pain are common because the tight plantar fascia under a high arch is under constant tension. Claw toe deformities develop from intrinsic muscle imbalance.
Treatment
Conservative treatment focuses on accommodating the deformity and addressing specific symptomatic problems. Custom orthotics are the mainstay—a lateral heel post (wedge) corrects the hindfoot varus, metatarsal padding offloads the overloaded metatarsal heads, and a deep heel cup provides hindfoot stability. Wide, deep footwear with adequate forefoot volume accommodates claw toes and avoids forefoot compression. Ankle bracing (lace-up or stirrup) addresses lateral instability. Physical therapy targeting calf stretching, peroneal strengthening, and proprioception training reduces ankle sprain risk.
Surgical correction of pes cavus is considered when conservative measures fail to adequately control symptoms or when the deformity is progressive. The surgical approach depends on the specific deformity components: soft tissue procedures (plantar fascia release, tendon transfers to address muscle imbalance) for flexible deformities; bony procedures (calcaneal osteotomy to correct hindfoot varus, metatarsal osteotomies to lower the forefoot) for rigid deformities; and toe corrections for symptomatic claw toes. Addressing the underlying neurological condition (if identified) is coordinated with neurology and guides the surgical plan—particularly in CMT, where progressive neuropathy may influence the durability of surgical corrections.
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When to See a Podiatrist
If foot or ankle pain has been bothering you for more than a few weeks, home care alone may not be enough. Balance Foot & Ankle offers same-week appointments at our Howell and Bloomfield Hills clinics — no referral needed in most cases. Bring your current shoes and a short list of symptoms and we’ll build you a treatment plan in one visit.
Call Balance Foot & Ankle: (810) 206-1402 · Book online · Offices in Howell & Bloomfield Hills
Frequently Asked Questions
Is having high arches a problem?
Not always—many people with high arches have mild deformity and are completely asymptomatic. High arches become a problem when they cause symptoms: recurrent ankle sprains, lateral foot pain, metatarsalgia, heel pain, or toe deformities. The degree of arch elevation, the rigidity of the deformity, the presence of associated hindfoot varus, and the patient’s activity level determine whether the cavus foot is symptomatic. High arches are less likely to be symptom-free than flat feet—the rigidity of the cavus foot means it cannot adapt and absorb shock as well as a flexible flat foot. If you have high arches and experience recurrent ankle sprains, chronic lateral foot pain, or forefoot pain, a podiatric evaluation and custom orthotics can substantially reduce these symptoms.
What shoes are best for high arched feet?
High arched feet need well-cushioned shoes with adequate forefoot volume—the elevated arch increases forefoot loading, so cushioning reduces metatarsal pressure. A wide, deep toe box accommodates claw toes without compression. Motion control shoes are typically not appropriate for high arched feet (they are designed for flat feet)—instead, neutral or cushioned running shoes that do not have a built-in arch wedge allow the foot to function in its natural position with an orthotic if needed. Avoid highly rigid, inflexible soles for most activities, as they do not allow any natural foot motion. Running shoes with high cushion (Hoka, Brooks Ghost/Glycerin, ASICS Gel-Nimbus) are well-tolerated by most patients with cavus feet. Custom orthotics with a lateral post and metatarsal padding are more effective than shoe selection alone for managing high arch biomechanics.
Can high arched feet cause ankle problems?
Yes—lateral ankle instability is one of the most common and significant problems associated with high arched feet. The hindfoot varus (calcaneus tilting inward) that accompanies most cavus deformities positions the ankle in a more inverted posture during the gait cycle, increasing the load on the lateral ankle ligaments with every step. This predisposes to recurrent inversion ankle sprains and chronic lateral ankle instability. Peroneal tendon injuries—tendinopathy, longitudinal tears, and subluxation—are also disproportionately common in cavus feet because the tendons work harder to counteract the inversion tendency. If you have high arches and have experienced multiple ankle sprains, ankle bracing, custom orthotics, and peroneal strengthening exercises are important preventive measures. Persistent instability despite conservative care may warrant surgical ankle ligament reconstruction combined with cavus foot correction procedures.
Medical References & Sources
- American Orthopaedic Foot & Ankle Society — Cavus Foot
- PubMed Research — Pes Cavus Neurological Causes
- PubMed Research — Cavus Foot Treatment Outcomes
Dr. Tom Biernacki, DPM is a board-certified podiatric surgeon at Balance Foot & Ankle in Howell and Bloomfield Hills, Michigan. He evaluates and treats pes cavus deformities including neurological screening, custom orthotics, ankle stabilization, and reconstructive surgery for cavus foot.
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Howell, MI 48843
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Pros & Cons of Conservative Care for foot care
Advantages
- ✓ Conservative care first
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Considerations
- ✗ Self-treatment can mask issues
- ✗ See a podiatrist if pain >2 weeks
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About Your Care Team at Balance Foot & Ankle
Dr. Tom Biernacki, DPM · Board-Certified Foot & Ankle Surgeon. Specializes in conservative-first care, minimally invasive bunion surgery, and complex reconstruction.
Dr. Carl Jay, DPM · Accepting new patients. Specializes in sports medicine, athletic injuries, and routine podiatric care.
Dr. Daria Gutkin, DPM, AACFAS · Accepting new patients. Specializes in surgical reconstruction and pediatric podiatry.
Locations: 4330 E Grand River Ave, Howell, MI 48843 · 43494 Woodward Ave Suite 208, Bloomfield Township, MI 48302
Hours: Mon–Fri 8:00 AM – 5:00 PM · (810) 206-1402
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Dr. Tom Biernacki, DPM is a board-certified podiatrist + Amazon Associate. Picks shown are products he prescribes to patients at Balance Foot & Ankle Specialists. We earn a commission on qualifying purchases at no extra cost to you. All products independently tested + reviewed for 30+ days minimum. Last verified: April 28, 2026.
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In-Office Treatment at Balance Foot & Ankle
If home treatment isn’t providing relief for your high arch foot, our podiatry team at Balance Foot & Ankle can help with same-day evaluations and advanced in-office care.
Same-day appointments available. (810) 206-1402
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