Written by: John Baker and Lily Hoog-Fry

What is a High Arch?

A 'high arch' occurs when the medial longitudinal arch of the foot is noticeably elevated, pulling up away from the floor. In some cases, these higher arches are a symptom of underlying neurological pathologies or conditions that disrupt the central nervous system's ability to smoothly coordinate the dynamic rhythm between the ankle and foot, impacting crucial muscle alignment and timing. However, this characteristic foot structure can also result from non-pathological misalignments in the ankle and foot. These often stem from muscle weakness or strength imbalances, which can be influenced by factors like poor posture, inefficient movement patterns, past injuries, worn-out footwear, or shoes with inadequate support that encourage the ankle to roll laterally (4)(9).

Why Do High Arches Matter?

Regardless of its origin, a foot with a high arch becomes abnormally stiff, supinated (inverted), and excessively curved. This rigid structure undesirably lifts the metatarsal bones from the ground, causing them to bunch up and significantly reducing the entire foot’s ability to tolerate load and its natural resiliency (4)(12).

When the medial arch is too high, it forces a compensatory shift in our entire body weight, pushing it anteriorly and laterally onto our feet. This compromises our capacity to properly distribute load across the first three metatarsals and the vital medial and transverse arches. Such weight shifts decrease the surface area of the bottom of your foot that is in effective contact with the ground, consequently increasing stress on both the ground structures and their supporting components. Over time, this can lead to painful overuse injuries due to repetitive microtrauma (3)(9)(10). This shifting can also reduce the effective recruitment of ankle musculature, negatively impact our movement patterns, heighten susceptibility to lateral ankle sprains, and potentially lead to chronic ankle instability (1)(5)(6)(7)(11).

What Can You Do About It?

When someone develops a cavus foot, another name for a high arch, the approach to care typically focuses on two key areas:

1. Decreasing the tension on the structures that are pulling the foot into supination/inversion, and
2. Increasing the strength of the muscles that work to pull the foot into pronation/eversion.

How to Loosen Up:

To understand which structures need attention, we can effectively divide the lower leg into its medial (inside) and lateral (outside) halves. The medial half is where we'll find the tight elements that require loosening, while the lateral side contains the weaker muscles that need strengthening.
When addressing the medial side of your lower leg, our focus will be on four key muscles:

1. Tibialis Posterior
2. Flexor Digitorum Longus
3. Flexor Hallucis Longus, and
4. Soleus

While the soleus attaches bilaterally, its bias towards the medial side of the common gastroc-soleus tendon (the Achilles Tendon) means that when tight, it can contribute to pulling the foot into an inverted/supinated position. The other three muscles are unique to the medial side of the lower leg, with their tendons crossing the ankle and attaching at various points throughout the foot. Consequently, when tight, they all actively pull the foot into inversion/supination.

Here are some exercises designed to release tension throughout your foot, helping to relieve common high arch pain.

• Myofascial Release with Ball: This is an excellent tool for effectively loosening up tight tissues! You can utilize any firm, round object, though a lacrosse ball is a widely accessible and common choice.
• Sit in a chair with your feet flat on the ground, holding the ball.
• Place the ball on your shin, starting near your knee. 
• Roll the ball medially (inward) until it moves off the shin bone and onto the softer muscle tissue.
• Use both of your hands like a vice grip, pinning the ball firmly to your leg (one hand on the ball on the inside of the leg, the other hand on the outside of the leg).
• Now, with the ball firmly pressed into the inside of your leg, gently invert/evert your foot 3 times, then dorsiflex/plantar flex 3 times.
• Move the ball approximately 2 inches lower on the leg and repeat the sequence.
• Continue this sequence until you reach the ankle (the end of the lower leg), then switch to the other leg.

• Inverter Stretch: This stretch is particularly effective for lengthening tight connective tissue.
• First, gather a small item like a hand towel or sock.
• Next, find a suitable surface to stretch your calf on, such as a stair.
• Position your foot to comfortably stretch your calf muscles. Then, slide the hand towel or sock (or similar item) under the outside of your foot – it can range from very thin to about 1 inch thick – specifically where your 3rd, 4th, and 5th toes connect to the ball of the foot.
• This careful placement should put your foot into slight eversion (effectively lowering your arch), and you should feel the stretch intensely localized to the medial/inside of the lower leg, targeting the same area where the tight muscles are situated.
• Hold the stretch for 30 seconds and then switch sides, repeating 4 times per side for a total of 2 minutes per side.

How to Strengthen Your Shins:

As discussed earlier, our strength-building efforts will focus on targeting the muscles located on the outside of the lower leg for crucial additional support: specifically the peroneus longus, brevis, and tertius (not everyone has the tertius!).

While these are not the only muscles in the lateral lower leg, they are the ones that critically need to become stronger to help pull the high arch of your foot down. Therefore, they will be emphasized in our approach to effectively mitigate foot pain.

Here are some strength training exercises you can perform to address your specific needs and build more natural arch support.

• Banded Ankle Eversions: This is a highly effective way to work our target peroneal muscles in an isolated manner.
• Find a light resistance band (this can be either a large circular band or a smaller circular band).
• Sit down with your legs extended in front of you, ensuring your heels maintain contact with the ground.
• Wrap the band around both feet in the midfoot/forefoot region. If you are using a big circular band, you may need to double it up to achieve appropriate tension.
• Using one foot as an anchor, begin to evert the other foot for 10-15 repetitions. Initially, utilize a slow and controlled concentric and eccentric movement to ensure you properly engage the correct muscles.
• Repeat for 3 sets per leg, progressively increasing volume or intensity as your strength improves.

• Big Toe Calf Raises: This exercise offers an excellent method to incorporate training the peroneal muscles within a closed-chain setting, enhancing functional strength.
• For this specific drill, placing a coin or a piece of paper underneath the foot, precisely on the ground where the big toe and foot connect (at the 1st metatarsal head), can be very beneficial.
• With your feet flat on the ground, lightly hold onto something for support. Your initial lack of stability might be surprising!
• Consciously shift your weight around and take note of how that alters the sensation of weight on your feet and how the ground feels underneath you. Aim to settle into a position where your weight feels evenly centered across the soles of your feet (recalling the "tripod foot" concept mentioned in previous articles).
• With a slow and controlled contraction, focus intently on pushing through the 1st Metacarpal Phalangeal Joint (where the big toe meets the foot). This specific cue will initiate the raising of your heel off the ground. This deliberate focus helps bias the peroneus longus muscle and significantly restricts your ability to compensate by shifting tension elsewhere.
• Slowly lower your heel back to the ground, critically never allowing your weight to shift off the 1st MTP joint. Maintain consistent pressure there, keeping the arch down and the muscular tension precisely where you want it.
• Begin with just a handful of high-quality calf raises at a time, performing them scattered throughout the day (the number of reps is less important than the QUALITY of each movement). Scale up slowly as needed and as your technique and strength improve.

Why Should You Care?

While having an arch that is too high isn’t immediately classified as a severe healthcare condition, it can unfortunately lead to degenerative and debilitating consequences in the long term. Who genuinely enjoys chronic ankle pain and repetitive sprains? Even worse, it has the potential to significantly decrease your athletic performance and could eventually force you to stop training altogether due to an increased risk of both traumatic and stress-related injuries. I don’t know about you, but I personally want to remain healthy because of my feet, not despite my feet.
 
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