Pain guide · Foot pain
High arches (pes cavus) are feet whose inner arch stays high when you stand, often with the heel tipped slightly inwards. About 1 in 10 people have them. Often it's just the shape of your feet and needs no treatment, but high arches can concentrate pressure under the heel and the ball of the foot, come with clawed toes, and in some studies go with ankle sprains.
A high arch that is new, getting higher or only on one side, or that comes with weakness, numbness or tripping, needs a GP check, because it can be the first sign of a nerve condition such as Charcot-Marie-Tooth disease. For painful high arches, custom insoles are the one treatment tested in a trial, with a modest effect. This guide explains the checks, what the evidence shows for insoles and shoes, and a plan of stretches, ankle strength and balance with 3D demos.
Exercise is for pain that has been checked or is clearly mild and settling.
A high arch (pes cavus) is an inner arch that stays high when you stand, so a footprint shows little or none of the middle of the foot. The commonest type, the cavovarus foot, has the heel tipped inwards, the bone behind the big toe angled down, and often clawed toes.
One population study, a footprint survey of 1,846 people aged 16 to 65 in India, found high arches in about 10%. In 277 footballers aged 10 to 40, 30% had high arches, more often at higher levels of play.
The two main groups are high arches with no clear cause, called idiopathic, and high arches from a nerve or muscle condition. NHS clinicians describe a high arch as often just a normal variant of foot shape that doesn't normally need treatment.
NHS Lothian's orthopaedic guidance for GPs says a high arch may be the first sign of a developing nerve condition, so any developing high arch should be investigated, particularly if it's only on one side. It asks GPs to refer every one-sided high arch with no known cause.
The NHS lists the signs of Charcot-Marie-Tooth disease: very highly arched feet that can make the ankle unstable (or very flat feet), curled toes, weakness in the feet, ankles and legs, difficulty lifting the foot and a high-stepping walk, numbness, cold feet, thinning of the lower legs and tiredness. Symptoms usually start between 5 and 15, and young children may seem unusually clumsy.
In 148 children with high-arched, heel-in feet on both sides and no known diagnosis, 78% turned out to have Charcot-Marie-Tooth disease, rising to 91% with a family history. In 70 children referred to neurologists, weakness, an unsteady walk, a family history, loss of feeling, muscle thinning and absent ankle reflexes pointed to it. Nerve conduction tests, electromyography (EMG) and genetic tests confirm it.
In one study, 60% of 40 people with high arches (with or without a nerve cause) had foot pain, against 23% of 30 people with normal arches. Pressure under the heel and the front of the foot was higher, and it went with the pain. The usual sore spots are under the ball of the foot, under the heel, and painful hard skin, and clawed toes and corns are common.
A heel-in high arch puts more load on the outside of the ankle. NHS clinicians say people with high arches may be more likely to have ankle sprains; a review found a heel-in high arch was one of the few foot shapes linked with outer ankle sprains; a study of 277 footballers found high arches among the risk factors for foot and ankle injury; and in a surgical series of 10 people with heel-in high arches and no nerve condition, all had long-standing ankle instability.
But in 116 people having surgery for an unstable ankle, a subtle high arch on X-ray was no commoner than in 105 people without ankle problems. So a high arch may add to the risk, but the evidence is mixed, and the ankle guides cover sprains themselves.
A high arch is diagnosed by looking at the foot standing and walking, and nerve tests look for a cause. X-ray judgements of a subtle high arch are unreliable: in the study above, two observers rated 18% and 29% of people without ankle problems as having one. An X-ray report of a cavus foot doesn't by itself mean a problem.
Without a nerve cause, NHS clinicians treat a high arch as a variant of normal foot shape. With a nerve condition, the arch can increase as muscle weakness worsens, though in some it stays stable. Charcot-Marie-Tooth disease is progressive, but most people keep walking, though older people may need a walking aid. In the Framingham population study, a high-arched foot posture wasn't linked with the foot disorders measured.
In 449 navy special forces trainees, high arches were one of several risk factors for overuse injuries, and in a survey of 20 high-arched and 20 low-arched runners, the high-arched group reported more ankle, bone and outer-side injuries. But in 927 novice runners in neutral shoes, very high-arched feet had no significant extra injury risk, and a review of 21 cohorts found the evidence on foot posture was mostly about flat feet.
In one trial, 154 adults with painful high arches on both sides (133 with no clear cause and 21 with a nerve or muscle condition, 16 of them Charcot-Marie-Tooth disease) wore custom-made foot orthoses or flat sham insoles for 3 months. On a 100-point foot pain scale, pain improved by 8.3 points more with the orthoses in the trial's own analysis (95% confidence interval 1.2 to 15.3), and by 10.9 points more (3.2 to 18.6) in the Cochrane review's analysis of the same data. Foot function improved by 9.5 points more in the trial's analysis and by 11.0 points more in the review's.
Pain scores improved by 74% with the orthoses but also by 43% with the sham insoles, and 27% against 15% reached normal pain levels, a difference that could have been chance. Side effects such as more foot pain, ankle instability and skin irritation were about as common: 9% against 15%. A second Cochrane review worked out that about 5 people need custom orthoses for 1 to benefit.
The improvement wasn't linked to changes in pressure under the foot, and people with the worst pain improved most, so the researchers raised the possibility of a strong placebo effect. The orthoses cost US$87 against US$2 for the shams. Off-the-shelf insoles haven't been tested for pain in high arches, and no trial has followed people beyond 3 months.
Cushioned footwear with room for the foot is the usual advice to spread pressure, and NHS clinicians list footwear changes among the main treatments. In 22 adults with high arches, two cushioned running shoes lowered peak pressure under the foot while running, but nobody measured pain.
Choosing running shoes by arch type doesn't prevent injuries. US Army recruits given cushioned shoes for high arches had the same injury risk as recruits all given one stability shoe, and a Cochrane review of three military trials (7,203 people) found that prescribing running shoes by foot posture probably makes little or no difference (moderate certainty).
The Cochrane review found no trials of stretching, strengthening, balance work or surgery for high arches, and lists them as treatments still needing testing. It describes the usual care without surgery as orthoses and cushioned shoes plus stretching tight muscles, strengthening weak ones, care of hard skin and balance work, and NHS clinicians include physiotherapy among the main treatments. The plan on this page follows that logic, with doses borrowed from ankle trials.
These trials were in people who had sprained an ankle, not specifically in people with high arches. After an ankle sprain, an 8-week home balance programme with a balance board, three sessions a week of up to 30 minutes, cut repeat sprains from 33% to 22% in 522 athletes. In 39 people with unstable ankles, 6 weeks of band and heel-raise strength training, or of hop and balance training, three times a week, improved strength, balance and hopping.
In a trial of 60 children with Charcot-Marie-Tooth disease, 6 months of progressive strength training for the muscles that lift the foot (three times a week, at 50% to 70% of their maximum) was safe and slowed the loss of strength: they were stronger than a sham-training group 2 years later. A 2023 review of 6 trials rated this the only finding of moderate quality for exercise in the condition. The NHS calls physiotherapy one of the most important treatments, while warning that overdoing exercise can make symptoms worse.
Some things haven't helped. Night splints didn't improve ankle movement in two trials in 26 people with the condition, and botulinum toxin injections every 6 months didn't stop the arch increasing in 10 children over 2 years.
Most people with painful high arches are managed without surgery, with insoles, an ankle brace, footwear changes and physiotherapy. Surgery is for severe or progressing deformity: releasing tight tissue and moving tendons, cutting and realigning bones, or fusing joints. NHS Lothian asks GPs to refer one-sided high arches with no known cause, and people who haven't improved after at least 3 months of physiotherapy or podiatry. There are no trials of surgery for high arches, and recovery can be long: the NHS describes 12 weeks in plaster and up to 10 months to recover after a fusion for Charcot-Marie-Tooth disease.
This guide borrows the foot pain guide's rule: pain you would call mild to moderate, no more than about 5 out of 10, that settles within an hour, with no more swelling or stiffness the next morning. After a fresh ankle sprain, follow the ankle sprain guide's rule instead. The 5 out of 10 figure is an editorial starting point, not a tested rule.
With a nerve condition such as Charcot-Marie-Tooth disease, work at a moderate level, build up slowly and follow your physiotherapist's plan: the NHS warns that overdoing it can make symptoms worse, while a supervised programme at 50% to 70% of maximum was safe in children. Stop for new weakness, numbness or tripping, and get it checked (our suggestion).
Start at the first stage. Each move opens a full guide with a 3D demo.
Ease pressure under the heel and the ball of the foot with cushioned shoes and, if your feet hurt, custom insoles from a podiatrist. Stretch the calf and the sole: a tight plantar fascia and Achilles tendon are among the things linked with high arches. If a nerve condition is suspected or known, get it assessed first and follow your physiotherapist's plan. Doses are editorial unless marked.
3D demoWall calf stretch (gastrocnemius)Beginner · A wall3 holds of 30 s each leg, daily · Editorial; no trial in high arches
Easier: Seated calf stretch with a towel · Harder: Toes-tucked kneeling (toe squat)
3D demoSoleus wall stretchBeginner · A wall3 holds of 30 s each leg, daily · The bent-knee calf stretch; editorial
Easier: Seated calf stretch with a towel · Harder: Toes-tucked kneeling (toe squat)
3D demoPlantar fascia stretch (seated)Beginner · A bench or box3 to 5 holds of 10 to 30 s, 2 to 3 times a day · The move's dose, from heel pain trials. Ease off if the big toe joint is stiff or painful
Harder: Toes-tucked kneeling (toe squat)
3D demoTowel toe curlBeginner · Other / check instructions + A bench or boxIf your toes claw: until the toes tire, or for 1 minute, 5 times, 3 days a week · An NHS podiatry leaflet's dose for bent toes
Harder: Short foot + toe splay
3D demoFoot roll (ball or roller)Beginner · A massage ball1 to 2 min per foot · For comfort; the move's editorial dose. Use gentle pressure if your feet are numb, and check your skin afterwards
Harder: Calf foam rolling
Move on when: Walking is comfortable in your shoes and insoles.
Strengthen the muscles on the outside of the ankle and the shin that resist rolling over, and train balance. The band and heel-raise doses come from an ankle instability trial; the others are editorial.
3D demoIsometric ankle eversion against a wallBeginner · A wall + A bench or box8 to 12 holds of about 6 s each foot · An easier start, from the move's own instructions
Harder: Band ankle eversion
3D demoBand ankle eversionBeginner · A band + A bench or box3 sets of 10, 3 to 5 s a repetition, rising to 4 sets of 10, with a heavier band every 2 weeks · The trial's progression
Easier: Isometric ankle eversion against a wall · Harder: Pogo hops
3D demoTibialis raiseBeginner · No equipment2 to 3 sets of 10 to 15 · Editorial. Strength training for the muscles that lift the foot was safe in children with Charcot-Marie-Tooth disease
Harder: Single-leg tibialis raise
3D demoSlow calf raiseBeginner · A wall2 sets of 10, building to 2 sets of 15 · The start of the trial's heel-raise progression, on both feet
Easier: Seated bent-knee calf raise (soleus raise) · Harder: Standing dumbbell calf raise
3D demoSingle-leg standBeginner · A wallBuild to 30 s without support, then with the eyes closed · Standing on one leg with the eyes open, then closed, is in the trial's balance programme
Easier: Tandem stance and heel-to-toe walk · Harder: Single-leg reach matrix
Move on when: You can stand on one leg for 30 seconds with your eyes closed without touching down.
Keep balance work going three times a week, as in the trial that cut repeat sprains, and consider an ankle brace for court and field sports if your ankle keeps rolling (the chronic ankle instability guide covers braces).
3D demoSingle-leg calf raise from a stepIntermediate · A step + A wall3 sets of 10, building to 4 sets of 15 · The rest of the trial's heel-raise progression, on a step with a hand on a rail
Easier: Slow calf raise · Harder: Single-leg pogo hops
3D demoSingle-leg reach matrixIntermediate · No equipment3 rounds of 5 reaches each direction · The move's dose; hop-and-reach work is in the trial's balance programme
Easier: Standing crossed-leg side reach · Harder: Single-leg Romanian deadlift
3D demoBalance board standBeginner · Other / check instructionsSeveral holds of 20 to 30 s · The move's editorial dose. The sprain-prevention trial used a balance board, three sessions a week of up to 30 min for 8 weeks
Easier: Single-leg stand
3D demoSingle-leg hop and stickIntermediate · No equipment3 sets of 5 hops each direction, holding each landing for 2 s · The move's dose. Start with small hops in one direction
Easier: Standing broad jump with stuck landing · Harder: Alternate-leg bounding
3D demoHeel walkBeginner · No equipment2 to 3 lengths of a room · Editorial: endurance for the muscles that lift the foot
Easier: Tibialis raise · Harder: Eccentric heel drop
Move on when: This is maintenance: keep balance work going three times a week if your ankles roll, and see a GP if the arch or your strength changes.
Choose cushioned shoes with enough depth and room for your foot, and go by comfort rather than buying a shoe sold for high arches. If your feet hurt, ask a podiatrist about custom insoles: they're the one treatment tested in a trial for painful high arches.
Keep up balance training three times a week, and consider an ankle brace for court and field sports; NHS clinicians list ankle braces among the treatments for high arches. The chronic ankle instability guide covers braces and the full sprain programme.
Plan exercise with your physiotherapist and pace yourself. Check and clean your feet regularly, because there's a risk of injury and infection if they're numb. Insoles, shoes that support the ankle, and ankle or leg braces are among the aids the NHS lists for Charcot-Marie-Tooth disease.
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| Habit or position | Why it matters | Instead |
|---|---|---|
| Thin, flat, unpadded shoes for long days on your feet | High arches concentrate pressure under the heel and the ball of the foot, and that pressure went with pain. | Cushioned, roomy shoes, and custom insoles if your feet hurt. |
| Buying high-arch running shoes to prevent injury | Choosing running shoes by arch type didn't reduce injuries in large military trials. | Comfortable shoes that fit, changed gradually. |
| Ignoring an ankle that keeps rolling | High arches may add to the risk of sprains, and balance training cuts repeat sprains. | Balance work three times a week, and a brace for sport.Try: Single-leg stand |
| Relying on night splints or casts to stretch the arch | Night splints didn't improve ankle movement in trials in Charcot-Marie-Tooth disease. | Daytime calf stretches.Try: Wall calf stretch (gastrocnemius) |
| Exercising to exhaustion with a nerve condition | The NHS warns that overexertion can make symptoms worse. | A planned, moderate programme with a physiotherapist. |
| Waiting it out when one foot's arch is changing | A developing or one-sided high arch needs investigating for a nerve cause. | See a GP. |
A 15-minute barefoot routine for stronger toes, arches, calves and ankles, finishing with balance. You need only a towel, a wall and a resistance band.
15 minBeginner11 movesA wall, Other / check instructionsBalance practice in 10 minutes: tandem stance, single-leg stands, marches, heel walks, tree pose and floor transfers.
10 minBeginner7 movesA wall, A bench or boxSeven stretches for after a run: calves, soleus, quads, hip flexors, hamstrings and glutes.
10 minBeginner7 movesA wallFeet whose inner arch stays high when you stand (pes cavus), often with the heel tipped slightly inwards. About 1 in 10 people have them.
Often they're just your foot shape and need no treatment. But they can concentrate pressure under the heel and the ball of the foot: in one study, 60% of people with high arches had foot pain, against 23% with normal arches.
If the arch is new, getting higher or only on one side, or if you have weakness, tripping, difficulty lifting the front of your foot, numbness, curled toes or a family history of Charcot-Marie-Tooth disease. NHS clinicians investigate any developing high arch, especially a one-sided one.
Yes, it's the commonest nerve cause: in 148 children with high-arched, heel-in feet on both sides, 78% had it. Other signs are weakness, clumsiness, foot drop, numbness and curled toes, usually starting between the ages of 5 and 15.
Custom foot orthoses are the one tested treatment. In a trial of 154 adults, they eased foot pain more than flat sham insoles over 3 months, though the sham insoles helped many people too and the difference was modest. Off-the-shelf insoles haven't been tested; a podiatrist can advise.
Cushioned, roomy shoes with enough depth for your foot are the usual advice. Choosing running shoes by arch type didn't reduce injuries in large military trials, so go by comfort.
The evidence is mixed. A heel-in high arch has been linked with outer ankle sprains in some studies, but in another, subtle high arches were no commoner in people with unstable ankles. Either way, balance training cuts repeat sprains.
No exercise has been tested specifically in high arches. Calf and sole stretches, strengthening the muscles on the outside of the ankle and the shin, and balance work are sensible, low-risk choices. In children with Charcot-Marie-Tooth disease, strengthening the muscles that lift the foot was safe and slowed the loss of strength.
The shape usually doesn't change, but the symptoms can: most people are managed with insoles, an ankle brace, footwear and physiotherapy. Surgery is for severe or progressing deformity.
They can contribute: pain under the heel and the front of the foot is the commonest complaint, with higher pressure under both. The plantar fasciitis and ball of foot pain guides cover those.
Often it's just their family's foot shape. See a GP if the arch is new, getting higher or only in one foot, or if your child is unusually clumsy, trips a lot or has trouble lifting their feet.
Exercise education, not a diagnosis or treatment plan. It is written from the guidelines and studies listed above; review by a clinician is pending. If your pain follows an injury, is severe, is getting worse, or comes with any warning sign listed on this page, get it assessed. Health disclaimer.
