What Are High Arches (Pes Cavus), and Do They Cause Problems?
Pes cavus means the arch of your foot is higher than normal. This pushes too much weight onto the ball and heel, reducing shock absorption and making the outer edge of the foot take more load than it should. Over time, high arches can lead to ankle instability, pain in the feet and legs, and changes in posture further up the body.
Key takeaways
- High arch feet concentrate pressure on the heel and ball, leaving the midfoot unsupported.
- Lateral foot loading and supination can cause recurring ankle sprains, metatarsal pain, and claw toes.
- Problems often travel upward. Knee, hip, or lower back pain may be linked to a cavus foot you have never had assessed.
- A standing, weight-bearing image shows your foot under real load, something a lying-down scan cannot replicate.
- Pes cavus is a structural finding, not a diagnosis on its own. The right imaging helps identify what needs attention.
What exactly is pes cavus?
Pes cavus is the medical term for a foot with an unusually high arch. Instead of the sole making broad contact with the ground, a cavus foot touches down mainly at the heel and the ball, with little or no contact through the midfoot. This creates a rigid, less flexible structure that does not absorb shock well when you walk or run.
You can often spot it yourself. When you stand on a wet surface and look at your footprint, a high-arched foot leaves only a thin strip, or no strip at all, along the outer edge. In more pronounced cases the foot may look almost "C-shaped" from the side.
High arches sit at the opposite end of the spectrum from flat feet. Where a flat foot overpronates (rolls inward), a cavus foot tends to supinate (roll outward). Both can cause problems, but in different ways.
What are the signs of high arches causing problems?
Many people with high arches have no symptoms at all. Problems tend to appear when the foot cannot cope with the load you put through it, especially during exercise or long periods on your feet.
If outer ankle pain is a recurring issue, it is worth reading about peroneal tendonitis on the outer ankle, which is closely linked to how a cavus foot distributes load.
What causes high arches?
A high arch develops when the muscles and tendons that shape the foot are out of balance. This can happen for several reasons.
Understanding muscle imbalance and loading is helpful here. When some muscles in the foot and lower leg overpower others, the arch height and heel position shift. Over time, this can become a fixed structural change.
Can high arches cause pain in the knees, hips, or back?
Yes, they can. Your body works as a connected chain from your feet to your head. When the foot supinates, the shin rotates outward slightly, the knee tracks differently, and the hip and pelvis may tilt to compensate. Pain often appears well above the foot, and if nobody looks at the foot, the real cause can be missed.
This is a common story: someone has ongoing outer knee pain or lower back stiffness, investigations focus only on the painful area, and the high-arched, rigid foot that started the chain reaction is never examined properly. Understanding how leg alignment is assessed from the ground up can make a real difference.
How is a high arch assessed with standing imaging?
A standard X-ray or MRI is usually taken while you lie down. When you are lying flat, gravity no longer loads your foot, your muscles relax, and your arch may look less pronounced than it actually is. That means the image does not show how your foot truly behaves when you stand and walk.
Standing EOS imaging at ScanAlign captures your feet, legs, hips, and spine in a single upright image while you bear your full body weight. This reveals the real arch height, the angle of the heel (hindfoot varus), and how the rest of the skeleton lines up above. It uses about 90% less radiation than a standard X-ray, around ten times less.
What it shows: True arch height under load, heel tilt, forefoot position, and full leg-to-spine alignment in one capture.
Why it matters: You see how your body actually compensates when weight-bearing. This is the information clinicians need to plan orthotics, physiotherapy, or surgery accurately.
What it shows: Bone structure and joint spaces with gravity removed. The arch often appears lower than it really is.
What it misses: Load-dependent alignment changes. The knock-on effects through the knee, hip, and spine are invisible because the muscles are relaxed.
When MRI is the better tool: EOS shows bones, joints, and alignment beautifully. If your clinician suspects soft-tissue damage, nerve compression, or a tendon tear, MRI is usually the right choice. The two scans answer different questions and often complement each other.
What helps manage pes cavus?
Treatment depends on the severity, the underlying cause, and what symptoms you have. ScanAlign is a diagnostic imaging clinic, so we do not provide treatment ourselves, but accurate imaging is the foundation of any good plan. Common approaches that clinicians may recommend include:
- Cushioned, supportive footwear. Shoes with extra cushioning under the heel and ball help offset the reduced shock absorption of a rigid, high-arched foot.
- Custom orthotics. Insoles designed from your specific alignment data can redistribute pressure more evenly across the sole.
- Physiotherapy. Strengthening the peroneal muscles on the outer lower leg and stretching the plantar fascia and calf can improve stability.
- Ankle bracing. For recurrent sprains, a lightweight brace can add support during activity.
- Surgical assessment. In more severe or progressive cases, an orthopaedic surgeon may consider procedures to rebalance the foot. Precise standing imaging is essential for surgical planning.
If you have high arches and unexplained foot, ankle, or leg pain, a standing alignment scan can show what is happening under real load.
Book a free video consultationFrequently asked questions about high arches
Yes. Pes cavus is simply the medical term for high arches. It describes a foot where the arch is higher than the typical range, concentrating pressure on the heel and ball of the foot.
They can. A rigid, supinating foot changes how load travels through the ankle, knee, and hip. Compensations at any level can produce pain well above the foot itself.
No. ScanAlign is a private, self-pay clinic. You can refer yourself directly through a free video consultation. No GP letter is required.
An EOS scan uses about 90% less radiation than a standard X-ray, around ten times less. This makes it one of the lowest-dose skeletal imaging options available.
It depends on the cause. If high arches are linked to a neurological condition, they may worsen gradually. If the cause is inherited or structural without an underlying disease, the arch shape tends to remain stable, though symptoms can change with activity levels.
The Coleman block test is a clinical examination where you stand with the outer edge of your foot on a small block, letting the first metatarsal drop off the edge. It helps a clinician work out whether the heel tilt is driven by the forefoot or the hindfoot, which guides treatment decisions.
Orthotics do not change the bone structure, but they can redistribute pressure, cushion high-load areas, and improve stability. Many people with pes cavus find well-fitted orthotics reduce pain significantly.
When you lie down, gravity is removed and your muscles relax. The arch may flatten slightly, masking the true severity. A standing image captures the foot under real body weight, showing actual arch height, heel angle, and the alignment of the entire leg above.
You can arrange a foot and leg alignment scan starting with a free video consultation. A clinician will explain the options and any costs before you commit.
If you develop sudden numbness, weakness in the foot or leg, or any loss of bladder or bowel control, seek urgent medical attention. Contact your GP, call 111, or go to A&E. These symptoms need prompt assessment, not an imaging booking.
See your alignment standing up
A free video consultation lets you discuss your symptoms and find out whether a standing alignment scan could help.
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- NHS. "Foot pain." nhs.uk. Accessed 2024. Overview of common foot conditions including high arches.
- Burns J, Crosbie J, Hunt A, Ouvrier R. "The effect of pes cavus on foot pain and disability." Clinical Biomechanics. 2005;20(9):877-882.
- American Academy of Orthopaedic Surgeons (AAOS). "Cavus Foot." OrthoInfo. Patient information on diagnosis and management of pes cavus.
Written by Abbas Dhami (Specialist Diagnostic Radiographer)
This page is general information and not a diagnosis.
ScanAlign is the trading name of CoreMed Solutions Ltd and operates under The Harley Street Hospital's CQC licence.