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As with anything in the human body, it’s all connected and the feet are a result of both the body’s interaction with the ground and what is going on up the chain in the pelvis.
I will cover:
- How high arches develop
- Consequences of high arches
- Common symptoms & pain
- What can be done to help restore full foot function
TL;DR: High arches prevent the arch from dropping and lowering into the ground in walking/running. This causes a lack of “yielding” into the ground which can result in many compensations. In order to address this, we should re-teach the missing link: Pronation and also likely internal rotation.
How High Arches Develop:
The official diagnosis for abnoramlly high foot arches is Pes Cavus. It is an excessively high medial longitudional arch that is often a result of a tibia that is more externally rotated.
The femur will follow the pelvis. If the pelvis is in an anteriorly-tipped orientation, the femurs will be in internal rotation.
If the pelvis is in a posteriorly-tipped orientation, the femurs will be in external rotation.
If the femur is internally rotated, in an attempt to find stability, the tibia can turn away from it. The presentation of tibial external rotation on a relatively internally rotated femur is often what causes knee valgus, or inwardly collapsing knees.
This type of arch usually develops early in childhood or later in life as a result of a limitation in the lower body (Neumann, 2016).
Consequences of Pes Cavus
The most glaring problem with high arches is that it will be limited in its ability to pronate.
As we strike the ground with our lateral heel, the foot is in a more supinated and rigid state. When we enter mid-stance phase of gait, the arch needs to drop and lower into the ground so that bodyweight may be appropriately placed over the stance-side foot.
This is a “yielding” action in which the arch eccentrically legthens and allows for the Windlass Mechanism to take place, where the arch then springs back up upon late stance in gait to allow for optimal propulsion.
A person with Pes Cavus will have trouble absorbing the repeated impacts of higher intensity activity like running (Wittungham et. al, 2001; Dorsey et. al, 2001). This can lead to poor pressure distribution throughout the lower body and stress-related injury.
Because of these limtations, there is little ability to compensate with more of the forefoot because the foot is simply too rigid. The individual is overloading the lateral border of their foot and could be at higher risk for a lateral ankle sprain.
Considering the overall majority of all ankle sprains occur in lateral ankle ligaments (Doherty et. al, 2014) at the Anterior Tibiofibular, Calcaneofibular, and Anterior Fibular ligaments, this is of particular conern.
We also often see these people with outwardly pointed feet. This is often an attempt for them to help find the inside edge of their foot for pronation.
Common Symptoms & Pain signs:
- Pain under the lateral toes
- Lower limb stress fractures
- Ilitibibial Band Friction Syndrome
- Back pain (Builder & Marr, 1980)
- Foot calluses under the big toe or “pinkie toe”/5th ray
What Can Be Done
In order to help this postural condition, it is important for the individual to regain a sense of pronation.
To do this, we can have them put a towel under their arch and dorsiflex their ankle, which is associated with mid-stance phase of gait.
We can consider releasing the role of the calves. Because supinated is paired usually with plantar flexion (that’s what the calves do), they’re often quite tight in these people.
Releasing the calves will allow them to let go and allow for more pronation/dorsiflexion upon mid-stance.
3. Re-acquire Internal Rotation via Activating Adductors
Those are more “local” fixes, but we should also look up the kinetic chain for a comprehensive approach. If we have determined a lack of internal rotation at the femur & pelvis is present (usually requires a thorough assessment), we can have the individual activate their adductors to allow for them to re-acquire more internal rotation.
4. Rear-Foot Elevated Split Squats with Ipsilateral Load
As for exercises that incorporate both the pelvis, legs, and feet, I am a big proponent of rear-foot elevated split squats with a same-side load. The reason for this is balance.
In order to not “fall” out to the side, the individual will need to shift their weight to their inner foot and pronate more. This is a more advanced progress I would wait to use until they are ready.
5. Footwear Solutions. It’s hard to give blanket recommendations because footwear tends to be very individual, but these shoe qualities should be present. Check out the shoes that are listed under “high arches”.