Flat feet (pes planus) and high arches (pes cavus) sit at opposite ends of the same spectrum, and each creates its own functional limitations. Flat feet tend to roll inward too much, straining the arch and surrounding joints, while high arches are too rigid to absorb shock, concentrating pressure on the heel and ball of the foot. Both are manageable — usually without surgery — once they're properly identified.
A healthy foot goes through a specific sequence with every step: it absorbs impact, flattens slightly to adapt to the ground, then firms back up to push off efficiently. Flat feet and high arches disrupt that sequence in different directions, which is why the two conditions cause such different symptoms and require different approaches to treatment.
What are flat feet, and how do they limit movement?
Flat feet occur when the arch collapses toward the ground, either because it never fully developed or because supporting structures — most often the posterior tibial tendon — have weakened over time. With flat feet, your foot rolls inward too much as you walk (a pattern called overpronation), which can allow your ankles, knees, and hips to fall out of proper alignment.
Common causes include posterior tibial tendon dysfunction, prior ankle injuries, prolonged standing, excess body weight, or underlying neuromuscular conditions. Functionally, flat feet are associated with:
- Fatigue during walking or standing, since the arch isn't doing its share of the shock-absorbing work
- Weak push-off strength when walking or running
- Achy, tired feet by the end of the day
- Balance difficulty on uneven surfaces
- Increased stress transmitted up into the knees and hips
Because the arch bears extra strain, flat feet are also a common contributor to plantar fasciitis and other heel pain.
What are high arches, and how do they limit movement?
High arches are the opposite problem: the arch stays too rigid and doesn't flatten enough to absorb impact or adapt to the ground. With less of the foot in contact with the ground, weight concentrates heavily under the heel and the ball of the foot. High arches are frequently genetic, but can also result from neurological conditions or nerve trauma.
Functional limitations of high arches include:
- Poor shock absorption, which transmits more impact through the foot and up the leg
- Pain concentrated under the heel or ball of the foot
- Instability and a higher risk of ankle sprains, since a rigid, highly arched foot has less natural give
- Difficulty finding shoes that fit and support the foot properly
How are flat feet and high arches diagnosed?
Both conditions are usually identified through a physical exam that looks at arch shape while standing and sitting, gait analysis to see how the foot moves through each step, and a check of shoe wear patterns, which often reveal uneven pressure distribution. Imaging is occasionally used to evaluate the bones and tendons more closely, especially if a tendon problem or prior injury is suspected.
How are they treated?
Despite being opposite problems, both conditions typically respond well to the same categories of conservative care, tailored to the specific type of arch:
- Supportive footwear with the right amount of structure for your arch type — motion-control shoes for flat feet, cushioned shoes with flexible soles for high arches
- Custom orthotics to redistribute pressure and correct alignment — see our custom orthotics options
- Calf and foot stretching to maintain flexibility and reduce compensatory strain
- Strengthening exercises for the muscles that support the arch and improve stability
- Physical therapy for gait retraining when biomechanics are contributing to pain elsewhere in the body
Surgery is only considered in rare, severe cases — for example, significant posterior tibial tendon damage or a structural deformity that hasn't responded to conservative treatment — and is always a last resort after nonsurgical options have been tried.
When should you see a podiatrist?
Not every flat foot or high arch causes problems, and many people go their whole lives without needing treatment. See a podiatrist if foot pain, ankle instability, or knee and hip discomfort starts interfering with your daily activities, or if you notice your arch changing shape over time, which can signal tendon involvement. You can request an appointment at either of our Northern Utah offices for a full biomechanical evaluation.
Medically reviewed by the physicians at Wasatch Foot & Ankle Institute. Our board-certified, fellowship-trained podiatrists provide foot and ankle care in Farmington and South Ogden, Utah. This article is for general education and is not a substitute for an in-person evaluation.