About Flat and High Arch

As its name describes, flat foot (also known as posterior tibial tendon dysfunction or PTTD) is when the arches of your feet are very low. This can cause pain when standing for long periods of time and can even make your feet tire easily. Cavus foot is the exact opposite of flat foot. It’s a condition where the arches of your feet are higher than normal. It’s also known as high foot arches, subtle cavus foot or pes cavus. Like flat foot, high arches can cause a number of issues, including pain when standing or walking. It’s one of the major culprits behind arch pain.

Normally individuals with cavus foot are born with the condition. Flat foot may be hereditary, or it can be acquired as an adult. Adult-acquired flat foot is usually a result of overuse or injury to the posterior tibial tendon, which is a structure that helps form the arch of the foot. However, flat foot can also be an effect of obesity, diabetes or hypertension.

If you suspect you have high arches or flat foot, consult your doctor to determine if you need treatment. Some patients do not experience pain, so treatment may not be necessary. However, if you have pain in your feet or lower back, your doctor may suggest shoe insoles or orthotics.

Cavus Foot (High-Arched Foot)

Cavus foot is a condition in which the foot has a very high arch. Because of this high arch, an excessive amount of weight is placed on the ball and heel of the foot when walking or standing. Cavus foot can lead to a variety of signs and symptoms, such as pain and instability. It can develop at any age and can occur in one or both feet.

Cavus foot is often caused by a neurologic disorder or other medical condition, such as cerebral palsy, Charcot-Marie-Tooth disease, spina bifida, polio, muscular dystrophy or stroke. In other cases of cavus foot, the high arch may represent an inherited structural abnormality. An accurate diagnosis is important because the underlying cause of cavus foot largely determines its future course. If the high arch is due to a neurologic disorder or other medical condition, it is likely to progressively worsen. On the other hand, cases of cavus foot that do not result from neurologic disorders usually do not change in appearance.

The arch of a cavus foot will appear high even when standing. In addition, one or more of the following symptoms may be present:

The arch of a cavus foot will appear high even when standing. In addition, one or more of the following symptoms may be present:

• Hammertoes (bent toes) or claw toes (toes clenched like a fist)
• Calluses on the ball, side or heel of the foot
• Pain when standing or walking
• An unstable foot due to the heel tilting inward, which can lead to ankle sprains

Some people with cavus foot may also experience foot drop, a weakness of the muscles in the foot and ankle that results in dragging the foot when taking a step. Foot drop is usually a sign of an underlying neurologic condition.

Diagnosis of cavus foot includes a review of the patient’s family history. The foot and ankle surgeon examines the foot, looking for a high arch and possible calluses, hammertoes and claw toes. The foot is tested for muscle strength, and the patient’s walking pattern and coordination are observed. If a neurologic condition appears to be present, the entire limb may be examined. The surgeon may also study the pattern of wear on the patient's shoes. X-rays are sometimes ordered to further assess the condition. In addition, the surgeon may refer the patient to a neurologist for a complete neurologic evaluation.

Nonsurgical Treatment

Nonsurgical treatment of cavus foot may include one or more of the following options:

Orthotic devices. Custom orthotic devices that fit into the shoe can be beneficial because they provide stability and cushioning to the foot.

Shoe modifications. High-topped shoes support the ankle, and shoes with heels a little wider on the bottom add stability. Bracing. The surgeon may recommend a brace to help keep the foot and ankle stable.

Bracing is also useful in managing foot drop.

When Is Surgery Needed? If nonsurgical treatment fails to adequately relieve pain and improve stability, surgery may be needed to decrease pain, increase stability and compensate for weakness in the foot. The surgeon will choose the best surgical procedure or combination of procedures based on the patient’s individual case. In some cases where an underlying neurologic problem exists, surgery may be needed again in the future due to the progression of the disorder.

If you look at an adult foot from the inside, you'll usually notice an upward curve in the middle. This is called an arch. Tendons -- tight bands that attach at the heel and foot bones -- form the arch. Several tendons in your foot and lower leg work together to form the arches in your foot. When the tendons all pull the proper amount, then your foot forms a moderate, normal arch. When tendons do not pull together properly, there is little or no arch. This is called flat foot or fallen arch.

Flat feet in adults can arise from a variety of causes. Here are the most common:

• An abnormality that is present from birth
• Stretched or torn tendons
• Damage or inflammation of the posterior tibial tendon (PTT), which connects from your lower leg, along your ankle, to the middle of the arch
• Broken or dislocated bones
• Some health conditions, such as rheumatoid arthritis
• Nerve problems
• Other factors that can increase your risk include: Obesity Diabetes Aging Pregnancy

Symptoms of Flat Feet and Fallen Arches

Many people have flat feet -- and notice no problems and require no treatment. But others may experience the following symptoms:

• Feet tire easily
• Painful or achy feet, especially in the areas of the arches and heels
• The inside bottoms of your feet become swollen
• Foot movement, such as standing on your toes, is difficult
• Back and leg pain

Your doctor examines your feet to determine two things:

• Whether you have flat feet
• The cause(s) An exam may include these steps:
• Checking your health history for evidence of illnesses or injuries that could be linked to flat feet or fallen arches
• Looking at the soles of your shoes for unusual wear patterns
• Observing the feet and legs as you stand and do simple movements, such as raising up on your toes
• Testing the strength of muscles and tendons, including other tendons in the feet and legs, such as the
• Achilles tendon or the posterior tibial tendon
• Taking X-rays or an MRI of your feet

Treatment for Flat Feet and Fallen Arches Treatment for flat feet and fallen arches depends on the severity and cause of the problem. If flat feet cause no pain or other difficulties, then treatment is probably not needed. In other cases, your doctor may suggest one or more of these treatments:

• Rest and ice to relieve pain and reduce swelling
• Stretching exercises
• Pain relief medications, such as nonsteroidal anti-inflammatories
• Physical therapy
• Orthotic devices, shoe modifications, braces, or casts
• Injected medications to reduce inflammation, such as corticosteroids If pain or foot damage is severe, your doctor may recommend surgery. Procedures may include the following:
• Fusing foot or ankle bones together (arthrodesis)
• Removing bones or bony growths -- also called spurs (excision)
• Cutting or changing the shape of the bone (osteotomy)
• Cleaning the tendons' protective coverings (synovectomy)
• Adding tendon from other parts of your body to tendons in your foot to help balance the pull of the tendons and form an arch (tendon transfer)
• Grafting bone to your foot to make the arch rise more naturally (lateral column lengthening)