The person with the high arched foot can be a difficult foot type to treat.  Many times patients will come into the office with literally a bag full of orthotics and arch supports they have tried that did not help with the pain.

There are a couple of foot motions of the foot, pronation and supination, which we have to discuss before we can start talking about the problems with the high arch foot.  Pronation is the motion of flattening out of the arch as the foot rotates toward the floor. Pronation is important because it allows the foot to absorb shock. In addition, pronation allows all the bones of the mid-foot to unlock and become like a “bag of bones”.  Being a loose “bag of bones” enables the foot to adapt to uneven surfaces (uphill, downhill, rocky surface, etc.). Supination is the opposite of pronation. In supination the foot rotates up from the floor. Supination re-locks the bones of the mid-foot and transforms the foot into a rigid lever arm to provide an efficient push-off and propel the body forward.

As you might expect, people with a high arch foot have the opposite problem as those that have flat feet.  The people with flat feet are over-pronators.  They do not supinate the foot at the end of the step.  Therefore the people with flat feet are unable to lock the bones of the foot to form a firm efficient lever arm for push-off.  However, people with the high arch foot do not pronate.  The foot remains in a locked supinated position throughout the step.  This causes several problems.  First of all if the person with the high arch foot is unable to pronate their foot, their foot is a poor shock absorber.  Thus the impact of walking and running is not absorbed in the foot it is transmitted back up the leg to cause pain in the knee, hip and low back.  In addition the person with the high arch foot tends to overload the bones on the outside of the foot.  This can lead to pain on the outside of the foot and in extreme cases this can lead to very painful stress fractures of the bones on the outside of the foot.  The person with the high arch foot may also be more prone to ankle sprains particularly if they are athletic.

Why does someone develop a relatively stiff, high arched foot.  The high arch can develop form spasm in the muscles which are responsible for supinating the foot.  If these muscles are tight they do not relax when they are supposed to allow the arch to flatten out and pronate.  Some people are born with their heel bone, the calcaneus, in an upward position.  This causes all the bones of the mid-foot to be in a supinated type of position.  Arthritis of the bones of the mid-foot will also make it difficult for the bones to unlock and thus the foot remains in the supinated, high arch position.

The treatment for someone with a high arch centers around providing shock absorption for the foot and distributing the load away from the outside of the foot.  The key to accomplishing this is to make sure that the arch support actually matches the height of the high arch.  This will allow the inside part of the foot to carry some of the load and absorb some of the impact of walking or running.  If the bones on the outside of the foot are overloaded we will usually add some cushioning on the arch support.  For some people we also add a slight wedge on the outside edge of the arch support to prevent the ankle from rolling over, externally rotating, to prevent ankle sprains.

The problems associated with the high arch foot are much different than the problems associated with flat feet.  This is one reason why an off-the-shelf arch supports seldom help the person with the high arch.  The person with the high arch needs a custom arch support made from an accurate impression of the foot.

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