High arched feet are far less common than flat feet. Also known as a cavus foot type, high arches cause a number of different problems that require different treatment than those associated with flat feet. The cause of high arches is typically genetic, with high arches being passed down to children. High arches are also seen in a number of genetic diseases, and neuromuscular conditions. Nerve injury and trauma to various tendons can also lead to the development of high arches later in life. The actual deformity can occur at several different levels in the foot, with some feet being high-arched due to a higher drop in the long metatarsal bones, and others due to a very high position of the bones in the middle of the feet.

High arched feet can cause numerous problems. Hammertoes, or contraction of the toes upward at the toe joint closest to the toe base, are often seen in high arched feet. This is primarily due to weakness of the muscles working on the top of the foot, which allows the muscles working on the bottom to pull the toes down near their tips, resulting in a higher prominence of the toe further back. Hammertoes can develop corns on the skin due to the prominence of the bone under the top of the toe, which irritates the skin and forces it to thicken. These corns can become painful, and even the simple prominence of the toe itself on the top of the shoe can cause pain, notwithstanding the corn. Pain in the ball of the foot can develop by the heightened prominence of the bones under this area, which can lead to painful calluses. High arched feet are also at risk for developing frequent ankle sprains, as the foot is positioned more inward than a normal arched or flat foot, leading to rolling in of the ankle more easily. Perhaps the most common and limiting problem high arched feet experience is a lack of shock absorption. The foot deals with shock created by walking and running by flattening the foot outward slightly. High arched feet cannot perform this motion well, and therefore the stress and shock created by walking is transmitted directly into the middle of the foot. This can lead to the development of pain and inflammation on the top of the arch, as well as strain to a tissue in the arch called the plantar fascia. Long periods of walking can especially aggravate the foot.

High arched feet need to have the excessive shock of walking absorbed in order to prevent arch pain. This is accomplished by using shoe inserts with shock absorbing properties, as well as shoes that have a high degree of cushioning. Composite foam or thick silicone gel materials are the lining of choice for shock absorbing inserts, although some cases require the use of custom made shoe inserts to more effectively deliver shock away from the foot. Athletic shoes provide the best capability of shock absorption from the shoe perspective, while flats and heels provide the least amount of absorption. In some severe cases, surgical reconstruction is needed to reduce pain and discomfort, although these procedures are technically demanding and not commonly performed.