High Arch

What is a High Arch?

A high arch is a foot deformity characterized by excessive longitudinal arching of the foot. Along with this, the position of the forefoot and hindfoot is altered, and the toes may show deformities, such as the development of claw toes.

A distinction is made in high arch deformities between bunions (pes excavatus), mainly characterized by the altered inclination of the forefoot and claw toes, and heel hocks (pes calcaneus excavatus), in which the focus is primarily on the heel deformity.

High arch often develops during childhood/adolescence and often causes symptoms in adulthood.

Causes and Symptoms

The development of high arch occurs due to a disbalance in the muscles that attach to the foot. This imbalance can have various causes. It often occurs as a result of neurological disease. Due to the damage to nerves, the muscles can no longer be adequately controlled, and the described changes occur. Neurological disorders can be genetic, i.e., hereditary, such as hereditary motor and sensory neuropathy (HMSN) but can also occur spontaneously or be related to inflammatory diseases.

In addition, the high arch can be congenital, brought on by accident, or "idiopathic," meaning it occurs without a known cause.

Symptoms often do not appear until adulthood. Then, for example, pain occurs at the ball and outer edge of the foot. In these areas, an increased formation of calluses or calvus is often observed. Other indicative signs of the disease are frequent "ankle twisting," general ankle joint instability, and claw toes. The interaction of these symptoms can lead to arthrosis (=chronic joint wear accompanied by pain) or fractures of the metatarsal bones.

High Arch Diagnosis: Do I Have High Arch?

To diagnose a high arch, the distance of the inner edge of the foot to the ground is measured. This is enlarged in pes excavatus compared to healthy individuals. In addition, other orthopedic tests may be performed to support the diagnosis: for example, affected individuals are insecure when standing on one leg. The treating physician will also order a neurological examination, meaning that the nerves and their quality will be examined.

Overall, the diagnosis combines visual diagnosis and orthopedic measurements and tests.

High Arch Treatment

The treatment of high arch is based on several criteria. First, a decision is made as to which treatment method is right depending on the patient's age, the triggering cause, and the symptoms. The treatment can range from bandages, orthopedic shoe insoles, and customized orthopedic shoes to correction by surgery. Usually, it is advised to start treatment as early as possible to prevent severe late effects that impair the normal function of the foot.

Conservative Therapy

Conservative therapy usually consists of 2 components: orthopedic insoles and physiotherapy. This therapy can be applied to mild forms of high arch and is designed to relieve pain and symptoms and slow down the progression of the disease.

The orthopedic insoles are custom-made and thus individually adapted to the foot and the patient's complaints. They are designed to correct the position of the foot and treat pain. However, insoles may no longer be sufficient in the advanced stages of the disease, so special shoes or splints are used.

With the help of physiotherapeutic guidance, stretching exercises should be carried out regularly to ensure stability and mobility in the entire foot, especially in the ankle joint. Physiotherapy provides that the imbalanced interaction of the muscles is brought back into balance.

High Arch Surgery

Surgical correction is considered when fatigue fractures occur due to a massive load of the outer foot, the ankle joint is too unstable, resulting in frequent twisting of the ankle, or conservative therapies fail, and the complaints persist despite this.

During the operation, the position of the foot bones is changed. The metatarsal bones are first worked on with a saw and brought into the correct position in relation to each other. The adjustments aim to keep wear and pressure on the joints in the foot as low as possible.

Transfer of the tendons can also be carried out. This is a procedure where the tendons of the muscles attached to the foot are removed from their original position and redirected so that the high arch does not reform after the surgery.

Other surgical treatments may also become necessary depending on the severity of the condition, such as replacing the external ligaments. In addition, arthrodesis may also be considered if the deformity progresses very severely.

Course and Prognosis

The course and progress of the disease can vary greatly, depending on the severity and the therapy used. In general, the development of high arch progresses steadily if no treatment is initiated. However, if the diagnosis is made early and therapy is initiated quickly, the progression of the disease can often be prevented, thus positively influencing its course.

Sources

• Wirth, C.J. und Zichner, L. (2002) „Orthopädie und orthopädische Chirurgie: Fuß“, 1. Auflage, Georg Thieme Verlag KG, Stuttgart
• www.orthopaedie.insel.ch/fileadmin/Orthopaedie/PDF/Patienteninformation_Fuss_-_Der_Hohlfuss.pdf
• www.oza-m.de/fachbereiche/fuss-sprunggelenk/hohlfuss/
• www.pschyrembel.de/Pes%20cavus/K0GQB