High arch is causing my foot problems. What is the solution?
What are the problems related to high arches?
The foot is functioning like a tripod. When the arch is high, there is an association with a tilted heel making the foot unstable. Patients often feel unstable especially with walking on uneven grounds. Weight-bearing areas of the foot are also shifted to the outside border of the foot leading to pain and callus formation. With a severe deformity, the peroneal tendons can become overloaded or ruptured. A longstanding deformity can lead to a recurrent ankle sprain and ankle arthritis.
Why do I have high arches?
When there is no identifiable cause, the condition is called "idiopathic cavovarus deformity". In this group of patients, there is a congenital variation in the shape of the foot towards the higher arch and deformities are usually milder.
The most common cause of a severe form of high arches is a neurologic condition called "Charcot-Marry-Tooth Disease" or CMT. The CMT is a genetic disorder with multiple subtypes with various patterns and severities of foot deformity. Patients who were born with clubfoot deformity may also have difficulties related to high arches as adults despite being treated as a baby.
What is the treatment for high arches?
Each patient with high arches should be individually treated. The treatment spectrum ranges from nonsurgical treatments to surgical reconstructions. A mild degree of deformity may respond well to custom insoles, padding of callus, and ankle brace. Insoles with high arch support should be avoided as they further overload the outer border of the foot. Physical therapy may be helpful in some cases by improving strength in the peroneal muscles and gait training.
Is there a surgical correction for high arches?
There are numerous surgical options to correct high arches. Both components of dynamic and static structures must be considered. In general, the goal is to recreate a balanced foot tripod with balanced soft tissue. Each patient will benefit from different surgical techniques and combinations depending on the type of deformity, severity, and underlying disease in the muscles and tendons. A patient with a mild deformity may need only a minimally invasive surgery with early weight-bearing, while another with a severe CMT disease may need more extensive bone realignments and tendon transfers.
What are the benefits and risks of surgical correction of high arches?
Surgical correction of high arches is aimed to improve balance, improve stability, improve walking gait, decrease pain, decrease callosities, and decrease ulceration. Risks of surgery include wound infection, nerve damage, stiffness, nonunion, and hardware-related symptoms.
What is the recovery after a surgical correction for high arches?
As there is a spectrum of severities in the degree of deformity, there is also a difference in the surgical correction and recovery. Patients requiring only minimally invasive surgery may be able to start weight-bearing right away and may reach full recovery in 3-4 months. For most severe deformities, a hospital stay is required followed by delayed weight-bearing and full recovery by 6-12 months.
Author: Phinit Phisitkul, MD