Feet with High Arches

Posted October 6th, 2008

Feet with high arches are artistically pleasing and very much desired for their haute couture possibilities, especially for women, but this kind of foot can be an abysmal mechanical disaster for athletes.
The high-arched or cavus foot provides very little protective shock absorption for the foot, ankle, leg, and knee. Often the athlete attached to this good-looking foot suffers from toe deformities that include hammertoe, claw toe, and mallet toe. These will usually lead to painful corn-type lesions and abrasions on the top surface of the toes. These toe deformities will also cause a migration of the protective covering on the bottom of the metatarsal heads called the plantar plate. The exposure of the metatarsal heads can lead to sub-metatarsal bursitis under metatarsals two, three, and four, which can be quite painful during athletics and often the discomfort carries over to non-athletic activities as well.
The cavus foot can also put excess stress on the sesmoids under the first metatarsal. Commonly we will see fractured sesmoids in patients with high-arched feet. The good news is that a fractured or bipartite sesmoid is not always painful, however, when the injured sesmoid is painful, successful treatment regimens can be limited. Conservative treatment is orthotics, but this usually offers marginal positive responses. Trigger point injection therapy may relieve pain, but not for the long term. Combinations of treatments that may include surgery are usually the only successful way to go.
A person with a cavus foot may also suffer from plantar fascitis and painful heel spur syndrome. Arthritis at the metatarsal cuneiform joints is common and often leads to chronic discomfort. The Achilles tendon is not spared in this pretty but problematic foot, and chronic, varied Achilles injury is common because the high inclination angle of the heel bone causes trauma to the Achilles with every step. Often a heel spur will develop at the attachment of the Achilles tendon into the calcaneous. These problems are difficult to successfully treat, and complications and chronic athletic disability is too often seen. We often find a shortening of the muscle group that makes up the calf and attaches to the Achilles tendon. This usually leads to muscle and tendon injury.
The major problem with cavus feet is an increased incidence of ankle twisting and sprains. The high-arched foot looses some capacity to adapt to inconsistent, uneven surfaces and is prone to stumbling and twisting. At first the situation is insidious and the recurring ankle twisting is overlooked, however, this usually leads to a severe ankle sprain incident that may be the cause of an emergency room visit and x-ray exam. Commonly this scenario ends with about three weeks of discomfort and the athlete returns to sports; however there may have been damage to the ligaments that are responsible for stability of the ankle and this athlete will suffer from Ankle Instability Syndrome. The twisting incidences will occur with great frequency but still cause only temporary episodic disabilities. At risk is further injury to the cartilage surfaces of the talus, and this is called the talar dome. Ankle arthritis will eventually occur with all the associated stiffness and ongoing pain.
The high-arched foot often suffers from chronic tendenopathy of the lateral tendons as they pass through the ankle into the foot. It is not uncommon for athletes to have peroneal brevis and longus tendonitis. These tendons course down the outside of the leg and continue through the ankle in back of the lateral malleolus, on the outside of the foot and eventually insert into the foot. The brevis inserts into the base of the fifth metatarsal and the longus wraps under the foot, extends medially, finally inserting into the bottom of the first metatarsal cuneiform joint. It offers the ankle stability and is a major everter of the foot. Evertion is a motion that results in the bottom of the foot moving outward, away from the midline of the body. This motion is an important function for the foot to adapt to uneven surfaces.
All muscles that course down the lower leg will be subject to increased pressures from overuse as they attempt to compensate for loss of adaptabilities created by the high-arched foot. The knee also will suffer, as it will be called upon to act with increased capacity as a shock absorber for the rigidity in the foot.
The high-arched foot is fast and powerful. This foot type works well for sprinters, jumpers, and for athletes in sports that require sudden change in direction. The basketball player with this type of foot will be on the rebound in a flash. The tennis athlete will get across court before you can blink, and can have an awesome serve. This foot type is often attached to record holders of 5K road races.
Care must be taken to choose appropriate footgear to protect this foot’s anatomy and also that of the leg. For the runner, I feel that Asics Kyano might just be the best of the best. Look at New Balance for court sports, except basketball, for which I recommend Nike. A shoe must protect the forefoot with shock-absorbing materials as the metatarsal heads are particularly vulnerable. Rear-foot design must absorb shock at heel strike, but should not be just cushioned, it must also allow limited pronation that will protect the ankle from twisting. Choice is always limited, and I suggest that you always ask for the opinion of a knowledgeable sales person in our reputable sports shops. Not long ago, in my inbox, a high-arched athlete raved about the Salomon Wings. This shoe is now on my suggestion list.

Rob Rinaldi DPM

Robert Rinaldi is a board-certified podiatrist and podiatric surgeon at the Gifford Medical Center in Randolph, VT. He is a fellow and a founding member of the American Academy of Podiatric Sports Medicine, and a podiatric consultant to the Dartmouth College track and cross-country teams. He is a former nationally ranked long-distance runner, having competed in 25 world-class marathons. You can reach him at Gifford Sports Medicine and Surgery Clinics in Randolph, VT, or at the Sharon Health Clinic in Sharon, VT, 802-728-2490 or 802-763-8000 or at rrinaldi@giffordmed.org.