High Arch Feet - Causes, Symptoms, Diagnosis, and Treatment

Introduction

A high arch foot refers to a raised foot arch (elevated more than normal). The longitudinal arch of the foot is raised, and the condition is seen in children and adults. It is also called pes cavus and is the opposite of flat feet. However, a high-foot arch is less common when compared to flat feet and tends to be more painful. It is mostly seen as a manifestation associated with some underlying neurological process.

What Are the Causes?

• The condition has been recognized in both adults and children.

• Can have unilateral (only one side) or bilateral (both sides) presentations.

• Bilateral cases are often associated with a genetic cause.

• Unilateral cases are mostly due to post-traumatic reasons; if a history of trauma is absent, brain imaging studies are done to rule out neurological causes.

• The main causes of pes cavus are:

1. Neurological Disorders - the neurological conditions associated with pes cavus are:

• Post-stroke (blood supply to the brain is blocked due to rupture of vessels or clot) symptoms.

• Spinal cord lesions.

• Cerebral palsy (neurological disorders that affect motor developmental skills)

• Parkinson's disease (a progressive neurological disorder that results in balance problems, tremors, etc.)

• Leprosy.

• Poliomyelitis.

• Polynueritic syndrome (simultaneous malfunctioning of multiple peripheral nerves)

• Myelomeningocele (a severe form of spina bifida characterized by a fluid-filled sac that contains nerve tissues and is seen to protrude from the baby’s back)

• Spina bifida.

2. Clubfoot - in untreated or inappropriately treated clubfoot

3. Trauma - the traumatic causes include:

• Scar tissue burns.

• Knee dislocation.

• Peroneal nerve injury.

• Vascular lesions.

• Compartment syndrome (characterized by pressure build-up within muscle space that result in pain).

• Tibial fracture.

4. Idiopathic- those cases where the cause is unknown.

• An accurate diagnosis is essential, as the underlying etiology determines the future course of the condition. The condition may worsen progressively if the underlying etiology is neurological or associated with some medical condition. While those cases that are not associated with neurological disorders mostly do not change their appearance.

What Are the Symptoms?

The symptoms include:

• Shortened foot length.

• Pain while walking or standing.

• Bend toes or hammer toes.

• Ankle sprains can develop due to an unstable foot as the heel is tilted inward.

• Calluses (thick hardened skin layers) on the side, ball, or heel of the foot.

• Inward tilting heels.

• Some may experience a foot drop (dragging the foot while taking a step).

• Trouble in finding fitting shoes.

• Arch pain and at times knee pain.

How Is the Condition Diagnosed?

1. Patient History:

• The patient mostly presents with foot pain due to increased stress on one part of the foot due to the deformity.

• The common pain sites are the lateral foot region, the heel, the cuboid region, and the metatarsal head region.

• The patient also complained of painful calluses and non-fitting shoes.

• If a familial history of a similar condition is present, it indicates a genetic cause.

• Unilateral lesions, along with neurological symptoms, indicate spinal lesions.

2. Clinical Examination:

• A thorough orthopedic foot examination is carried out.

• Limb alignment is evaluated.

• Skin is evaluated for callosities.

• The strength and function of lower extremity muscles are evaluated.

• A detailed neurological examination is done.

• A Coleman block test is done to determine the deformity's rigidity by placing a block under the lateral side of the forefeet and heel.

• Palpation is done along the metatarsals to check for stress fractures.

• An important clinical sign is the “peek-a-boo” heel (the heel pad is seen from the front when the patient stands with both feet pointing ahead).

3. Diagnostic Tests:

• X-rays- Plain radiographs are usually the first investigational tests done.

• MRI - MRI (magnetic resonance imaging) of the spinal cord and brain is done in cases where unilateral high arch feet are present with no other obvious causes.

• CT (computed tomography) - CT is done to evaluate the joints.

• Nerve Conduction Tests- These help in determining the speed of nerve conduction and help in determining muscular abnormalities.

What Are the Treatment Options?

1. Non-operative Management:

• Custom Orthotics - inserts placed in the shoes to provide additional cushioning.

• Medications - Some over-the-counter anti-inflammatory medications, like NSAID (non-steroidal anti-inflammatory drugs), relieve swelling and pain.

• Bracing- at times, bracing the foot and ankle is recommended to reduce the symptoms.

2. Operative Management:

• Surgery is indicated in cases where non-surgical options fail to improve stability and relieve pain.

• The surgical procedure is selected based on the individual case.

• In case of underlying neurological pathologies, additional surgical procedures will be needed in the future due to disease progression.

What Is the Differential Diagnosis?

The underlying etiology of pes cavus should be determined to provide optimal treatment for the patient. It is also important to differentiate pes cavus from equinovarous foot, as it requires a different surgical approach.

The differential diagnosis includes:

• Charcot-Marie- tooth disease: it includes a group of genetic disorders that cause peripheral nerve (nerves that transmit signals from the CNS (central nervous system) to the rest of the body) damage.

• Dejerine-Sottas-Neuropathy: It is an early onset demyelinating peripheral neuropathy.

• Congenital Hypomyelinating Neuropathy: It is an uncommon form of inherited peripheral neuropathy that results in poor muscle tone, muscular weakness, absence of reflexes, and hypomyelination.

• Distal Hereditary Motor Neuropathies: a group of disorders characterized by neuropathy.

What Is the Prognosis?

The prognosis of the condition mainly depends on the underlying etiology that led to a high-arched foot. Treatment and prognosis mainly depend on the underlying etiology. Some of these underlying conditions are progressive, while others are non-progressive.

What Are the Complications?

• Prolonged orthotics usage, despite a progressively worsening deformity or a delay in diagnosis of the condition, can lead to a rigid deformity that requires arthrodesis.

• Surgical correction cannot always prevent recurrence in cases where the underlying etiology is a progressive neurological disorder.

• The complications associated with a delicate cavus foot are:

  • Ankle instability.

  • Metatarsal stress fractures.

  • Varus ankle arthrosis.

  • Claw toe deformities.

  • Plantar fasciitis (thickened tissue at the bottom of the foot, resulting in heel pain).

  • Ankle joint arthritis.

Conclusion

A high arch foot means a raised foot arch which is less common when compared to flat feet. It may be present in one or both feet. It can occur due to underlying neurological conditions or trauma or even be idiopathic. Both non-operative and operative treatment options are available. The prognosis of the condition depends mainly on the underlying cause.