High Arches Aren’t Just a Shoe-Fitting Problem — They Can Drive Years of Other Issues
A high-arched foot — called pes cavus — is a foot that has too much arch and not enough flexibility. Instead of spreading impact across the whole foot when you walk, a high-arched foot concentrates all the force on the heel and the ball of the foot. Over time, that uneven loading causes a predictable set of problems: repeated ankle sprains, stress fractures, heel pain, and curled toes.
Many patients with these problems have been treated for each one separately, without anyone recognizing that a high-arched foot structure is the common cause. If you have had multiple ankle sprains, recurring heel pain, and a broken toe or stress fracture, your foot structure deserves a close look. Our podiatrists evaluate and treat high-arch feet at our Coon Rapids and Golden Valley offices, serving patients across the north and west metro including Maple Grove, Ham Lake, Andover, Champlin, Blaine, Plymouth, Wayzata, Minnetonka, St. Louis Park, and Edina.
Important: a high arch that gets worse over time is not normal wear and tear. Progressive high arches — particularly in children, teenagers, or young adults, or when one foot is more affected than the other — are often caused by a nerve condition. The most common is Charcot-Marie-Tooth disease, a hereditary nerve disorder. This is worth ruling out because it affects the whole family, not just the patient in the clinic.
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What Does a High-Arch Foot Actually Mean?
Most people think of flat feet as the foot problem to watch out for. High arches are the opposite — and in some ways harder to manage. A flat foot collapses under load; a high-arched foot stays rigid. That rigidity means it cannot absorb shock the way a normal foot does.
In most people with a high arch, the heel also tips slightly inward. This combination — high arch plus inward-tipping heel — puts the outer edge of the foot under excess strain. It is why lateral ankle sprains and outer metatarsal stress fractures are so common in people with high arches.
What Causes a High-Arch Foot?
- Nerve conditions (most common cause): high arches are often caused by a nerve problem that creates muscle imbalance in the foot. The most common is Charcot-Marie-Tooth (CMT) disease, an inherited condition that weakens specific foot muscles, causing the arch to rise over time. Other nerve conditions — spinal issues, childhood neurological problems — can do the same.
- Hereditary foot shape: some people simply inherit a high-arched foot without any underlying nerve condition. This type tends to be stable rather than progressive and affects both feet roughly equally.
- Prior foot conditions: clubfoot treatment, compartment syndrome, or long-standing plantar fascia tightness can produce a high arch as a secondary effect.
Is it nerve-related or just the way my foot is shaped? The key clues that a nerve problem may be involved: the arch seems to be getting higher over time; one foot is significantly more affected than the other; you’ve noticed weakness or clumsiness in your feet or legs; other family members have the same foot shape. If any of these apply, a nerve assessment is part of our evaluation.
Problems a High-Arch Foot Can Cause
Because of the rigid structure and the tendency to roll outward, high-arch feet can create a recognizable set of downstream problems:
- Repeated ankle sprains: the heel’s inward tilt puts you constantly on the outer edge of your foot, making ankle sprains mechanically much more likely. If you keep spraining the same ankle, your foot structure is almost certainly contributing.
- Stress fractures in the outer foot: the excess load on the outer metatarsal bones (the long bones connecting to your outer toes) causes small cracks — stress fractures — from repetitive impact.
- Heel and arch pain: the plantar fascia — the band of tissue along the bottom of your foot — is under constant tension in a high-arch foot. This produces the same type of pain as plantar fasciitis, though the structural cause is different.
- Curled toes (hammertoes / claw toes): muscle imbalance causes the toes to curl downward over time. This makes shoe-fitting difficult and creates painful pressure points on the top of the toes.
- Shoe-fitting problems: the combination of a high arch, a narrower-than-normal forefoot, and curled toes means that standard footwear rarely fits comfortably.
How We Evaluate a High-Arch Foot
We begin with a clinical exam and weight-bearing X-rays. The most important single test we perform is the Coleman block test.
The Coleman block test: you stand with just the outer part of your foot on a small block of wood or something comparable, letting your big toe side hang free. If your heel straightens out when you do this, the heel position is being driven by the forefoot — and correcting the forefoot mechanics (with an orthotic, or surgically) can fix both at once. If the heel stays tipped inward even on the block, the heel itself needs to be directly corrected. This test helps to determine the appropriate treatment approach, so it matters.
If there’s any sign of an underlying nerve condition — progressive deformity, one foot worse than the other, family history, weakness or balance issues — we also assess nerve function with a clinical exam. We may refer for nerve conduction testing (EMG/NCS) or coordinate with a neurologist when appropriate.
Treatment at Family Foot & Ankle Clinic
Most patients with high-arch feet do well with custom orthotics and the right footwear. Surgery is for cases where the deformity is significant, progressive, or causing problems that conservative care cannot adequately control.
Custom Orthotics
A custom orthotic for a high-arch foot does specific things that an over-the-counter (OTC) insole cannot: it accommodates the dropped first metatarsal (so it isn’t loaded further by a flat surface), wedges the heel outward to counteract the inward tilt, cushions the heel and ball of the foot where impact is concentrated, and helps keep the ankle from rolling outward. This is the most effective non-surgical treatment for managing the secondary problems a high arch causes.
More on our Custom Orthotics page.
Footwear
High-arch feet need shoes with a deep toe box (room for curled toes), firm cushioning in the sole, lace-up or Velcro closure for a secure fit, and enough width for the narrower forefoot. Minimalist and slip-on shoes are the worst options for this foot type. An ankle brace during sport reduces the risk of lateral sprains when the heel is significantly tilted inward. See our Shoe Recommendations Guide for our current picks by category.
Physical Therapy
Stretching the calf and plantar fascia (which are often tight in high-arch feet) preserves the range of motion that remains. Strengthening the peroneal muscles — the muscles on the outer ankle that help resist rolling outward — provides better functional protection against ankle sprains, especially in patients with any nerve weakness.
Surgery
Surgery is considered when the deformity is significant, getting worse, or causing problems that orthotics and footwear cannot control. The Coleman block test determines the approach:
- If the heel corrects on the block (forefoot-driven): the procedure focuses on the forefoot — specifically lifting the first metatarsal so it stops driving the heel inward. When the forefoot is corrected, the heel often corrects itself without needing direct intervention.
- If the heel stays inward on the block (fixed): the heel bone itself needs to be repositioned. This is done with a bone-cutting procedure that shifts the heel into a neutral position. Additional procedures to loosen tight tissue and rebalance muscle pulls are often performed at the same time.
See our Foot & Ankle Surgery Overview for information on surgical care at our clinic.
Frequently Asked Questions
I have high arches but no pain. Do I need to do anything?
Not necessarily. Stable, asymptomatic high arches in an adult who has no pain, ankle problems, or functional limitations don’t require active treatment. What is worth doing: wearing supportive footwear, being aware of the ankle sprain and stress fracture risk, and getting a baseline evaluation to document the deformity. If the arch seems to be getting higher, or if you start developing any of the problems described above, come in sooner rather than later.
Could a nerve problem be causing my high arches?
Possibly — particularly if your arches seem to be getting higher, if one foot is more affected than the other, if you’ve noticed any weakness or clumsiness in your legs or feet, or if other family members have similar feet. Charcot-Marie-Tooth disease is the most common cause of progressive high arches, and it often runs through families without being formally diagnosed. A nerve conduction test is the most reliable way to check. If this sounds like it could apply to you, mention it when you call — we’ll include a neurological screen in your evaluation.
I keep spraining my ankles on the same side. Is my high arch to blame?
Almost certainly. When the heel tips inward — which it does in most high-arch feet — your weight sits on the outer edge of the foot, and every step is a small inversion stress. You’re not clumsy. The structure of your foot is setting you up for those sprains. Treating the ankle without addressing the underlying foot shape is why so many high-arch patients keep re-spraining the same ankle even after treatment.
Will my child’s high arches get better as they grow?
Unlike flat feet, which often improve as children grow, high arches do not self-correct. If your child has a high arch that seems to be getting worse rather than staying the same, that’s the more important question — and it warrants an evaluation to determine whether a nerve condition is involved. See our Pediatric Flatfoot page for context on how arch development works in children.
High Arches Causing Pain, Sprains, or Shoe Problems? Let’s Find the Source.
Many high-arch patients have been managing individual symptoms for years without anyone looking at what’s driving all of them. A proper evaluation takes the whole picture into account. Book an appointment at our Coon Rapids or Golden Valley office.
Call 763-421-7300 | Book online
Serving Coon Rapids, Golden Valley, Maple Grove, Ham Lake, Andover, Champlin, Blaine, Plymouth, Wayzata, Minnetonka, St. Louis Park, Edina, and all Twin Cities communities.