This is a topic that I really love, because it’s one that I’ve had to deal with personally over the years. I have high arches, and as a result have had to make several shoe gear modifications throughout my life in order to accommodate for everything from plantar fasciitis to extensor and peroneal tendonitis.
Before I get into it, I want to quickly go over some terminology. Confused patients will sometimes come to me telling me that they supinate. This probably isn’t what they mean, because everyone supinates. It’s the natural motion of the foot/ankle to invert, plantarflex, and internally rotate. In more basic terms, it’s what the foot does as it pushes off the ground. The foot becomes more rigid and the arch raises and locks to create a springboard that effectively propels the body forward. What these patients probably mean to say is that they over-supinate, or have high arches that don’t pronate or flatten properly. In the most severe cases this may mean a foot that is rigid with an inverted heel, resulting in frequent ankle sprains or instability. In less severe cases, it may just cause increased pressure because less of the foot ends up contacting the ground because of the lack of normal flexibility in the foot.
The heel on the left is inverted. This is a component of supination. When the heel is stuck in this position throughout standing and gait, as is seen in severe high arches, it creates strain on the bone and soft tissue.
High arches can make it even trickier to find shoes than being an overpronator with flat feet. One reason is that shoe companies are much better at marketing to people with flat feet, as this is more commonly diagnosed and more common in general. If you’ve read my previous post on overpronation, then you’ll understand that pronation is quite normal, but I think that it’s misdiagnosed as a problem much more frequently than it actually is. Hence the increased marketing and the mass of patients that come to me telling me that they have flat feet.
So where does that leave people with high arches, and are high arches really that bad? High arches aren’t necessarily bad, but they can leave runners prone to certain injuries if they aren’t careful. The main problems occur in people who have high arches and an inability to pronate properly. Pronation is a necessary part of the gait cycle that functions as shock absorption, alleviating the forces of impact on the foot and the rest of the lower extremity. This is most evident when the foot lands during running or walking. The foot becomes more flexible and the arch gets lower to help absorb the forces of impact. When the foot is unable to do this, as is the case in more severe high arches, it's subjected to increased impact forces on the heel and metatarsals, as these are the primary points of contact for the foot. The result is the potential for plantar fasciitis, generalized heel pain, or even heel/calcaneus or ball of the foot/metatarsal stress fractures.
Because of the high arches, all of the pressure ends up on the heel and metatarsal heads.
Additionally, this foot type may also place increased stress on certain tendons such as the peroneal tendons on the outside of the foot and ankle as they try to compensate for the foot position, or the extensor tendons on the top of the foot from pressure from the laces.
That was the bad news. The good news is that at least some of these issues can be controlled with gait or shoe gear modifications. As far as gait goes, the important thing to avoid is over-striding. This occurs when you land with an extended, straight knee, resulting in a jarring impact that actually slows you down and adds increased impact forces to the heel, knee, and hip. Add this to the poor shock absorption of the high arched foot and you get even more impact and the potential for injury. The best way to avoid this is to work on your cadence, or strides per minute. I talked about this in the heel drop post, but increasing your stride rate to over 180 spm can help decrease over striding and reduce impact forces. It might also be wise to avoid barefoot running shoes and possibly even a forefoot strike without the proper amount of padding. The people who do best with barefoot running are the flexible individuals with feet that can pronate and supinate normally. The inability to do one of these, especially the inability to pronate, can lead to more impact and injuries.
For shoe gear modifications I want to go over some specific issues and how you might deal with them using shoes. To start, the shoe itself needs to have adequate cushion to help with shock absorption. How much cushioning depends on how rigid your foot is and how much you can tolerate while still achieving comfort. It also should not have too much heel posting or correction in the heel. To that end, a motion control shoe is a poor choice, as these are for over pronators and often have heel counters that will make a high arched type foot much worse and prone to even more ankle sprains. In general, this leaves you with two good choices; either a well cushioned neutral shoe that allows for some pronation, or a mild stability shoe.
It might seem backwards to have a stability shoe that is meant to limit pronation, but I’ve had alot of success using mild stability shoes. They offer good cushioning in general but also have arch fill that, if it matches your high arch, can provide increased surface area for contact and therefore disperse the forces of landing. My advice is to try on a variety of these neutral or stability shoes to find one that matches your arch height when standing but that does not push into your arch to the point that it forces you to roll your ankle. For instance, one of my favorite pairs of running shoes is a stability shoe. I’ve run in this stability shoe for years, and it helped me get rid of a bad case of peroneal tendonitis that I was getting from my poorly padded neutral shoes (shame on me). Now I use a mix of the two types but tend to prefer a small amount of stability because it seems to lessen the workload on my tendons and bones. Maximalist shoes, such as the Hoka and similarly well padded shoes can also be a great choice. This type of shoe can be neutral or stability and provides tremendous cushioning without excess weight.
If your heel is narrow and commonly sloshes around in the shoe, as is common with high arches because of the position of the heel bone, then look for a shoe with excessive padding throughout the sides of the heel portion. If this isn’t enough, try using the top two holes for lacing to keep the heel pushed back, or purchase a silicone heel cup to add bulk in the heel to prevent slipping.
Use the top hole to prevent heel slipping
If you are having pain on the top of your foot from your foot rubbing on the tongue or laces, I’ve found that the best approach is to add silicone or foam padding under the tongue and use an alternate gap lacing technique such as can be seen here. Additionally, you should use flat laces as these will irritate your foot less, or try thicker running specific socks.
As always, if you are experiencing significant pain or deformity, seek medical advice. There are certainly instances when physical therapy, orthotics, or even surgery is needed, and there should be some sports specific podiatrists or orthopedic doctors in your area that can help. Let me know if you have any specific questions related to the topic or other topics that you want me to cover.