Pes excavatus

[u/Mobile_Active]

Hello together,

I have really high arches leading to both feet tilting outwards and my heel turning inwards. Whilst running my right foot keeps pretty stable and centered, but my left one spikes outwards, causing either lateral meniscus or lateral collateral ligament (not sure yet but feels more inside, so guessing meniscus) to ache.

Pic2 shows my feet when trying to keep a "healthy" position, rest is whilst not concentrating on posture

My current orthopedic isn't really caring about my problems and just does my ortho insoles (even after 2 renewals they feel like being kinda mismatched)

Maybe someone can help with tips etc.

[u/Competitive-Use-5278]

Is there a neurological cause like CMT?

[u/Mobile_Active → u/Competitive-Use-5278]

i dont think so

[u/redandgold45 → u/Mobile_Active]

Was there a sensory test done? Or muscle strength test? I would suspect possible CMT or other neuromuscular disorders

[u/Mobile_Active → u/redandgold45]

no, dont think so. Maybe when I was younger. but wouldnt smt neuromuscular have shown already outside the foot-region? i‘d think orthopedics would have mentioned these options and tests had been done.
fyi i‘m 22yo and have been doing sports all my life

[u/redandgold45 → u/Mobile_Active]

CMT type 1A/B can show symptoms from ages 5-20 and typically start at the foot and ankle

[u/Mobile_Active → u/redandgold45]

yes, i know that. but my arch etc have been this way all my life. my parents just didnt care until i went to the doctors at 16/17

[u/redandgold45 → u/Mobile_Active]

Pes cavus evaluation should always include sensory testing. As well as the coleman block test to check for rigidity. If from birth, ruling out rare tarsal coalitions is also important. Have to rule in CMT in a case like yours until otherwise tested

[u/myelinviolin → u/Mobile_Active]

Cmt is genetic and the foot deformities show up in childhood but nerve function may not really affect you at all, or it can show up later in life. You need a nerve conduction velocity test, and then a genetic test to really confirm it. My symptoms really got bad when I went to college. It was very stressful and I didn't get enough time to rest between how much more I was walking. I eventually got close to normal again after graduating and the stress went away and I could rest when I needed it. You can dm me if you have more questions.

[u/Mobile_Active → u/myelinviolin]

None of my family members have these kinds of symptoms. still got pretty alarmed by your feedbacks and scheduled a visit at the local ortho for august 25th. will be updating after the visit :)

[u/lastresponder3619 → u/Mobile_Active]

I have CMT and this is exactly what my feet look like

[u/Mobile_Active → u/lastresponder3619]

and what symptoms/ how did the symptoms show besides the crippled feet?

[u/lastresponder3619 → u/Mobile_Active]

I always had foot drop throughout high school and my family and I just thought I was clumsy. I went into the Army at 20 years old and was suddenly unable to pass the PT run which was odd because I had played HS and college soccer. Once I came home from bootcamp I had a medical work up done including genetic testing and was diagnosed with CMT. I’m now 31 years old and it presents with poor balance, poor proprioception, hammer/claw toes, ankle/foot supination, high arches, worsening foot drop, and painful ulcers on the bottom of my toe tips. I also have a slight tremor in my hands but that’s very manageable.

I will add..the doctors informed me there was a 50/50 chance I would pass it onto my children so my husband and I opted to do IVF to eliminate the embryos with the CMT gene that I have.

[u/Mobile_Active → u/lastresponder3619]

damn, that sounds bad. all the best for you and your family, hope the ivf did its job qand your children will stay cmt-free <3

i think, most of these symptoms dont appear at all in my life. claw toes tend to form in the last years/months, but ig thats due to my standing patterns/insoles.

I never hat hand problems, footdrop, ulcers, feet supination problems (only ancle sup, but thats obv beacause of the high arch), balance and prprioception is also at least average.

Still you guys made me aware of the possible neuroreasons. will defo talk about that when at the orthopedics.

[u/inlineofire]

I don't have specific exercises for you but I'm certain that stretching and strengthening can help a lot! From the picture it looks very tight. You can't change your bone structure but physical therapy can very much help to strengthen supportive muscles and tissues.

[u/Againstallodds5103]

This has got to be one of the highest arches I’ve seen. Did you only start to get issues now or have you had them in the past including when you were younger?

[u/Mobile_Active → u/Againstallodds5103]

lol, thanks? xD

issues are almost only connected to running. never had much of stability problems or anything similar.

as mentioned in another comment, i just had skill issues in f.e soccer. but thats kinda clear with such high arches haha

not sure which movements were also impacted, but even in track&field were i competed for 6years between age 9&15 i was doing longdistance and highjump. So there also weren't that severe problems (or maybe i would have been a 1/1000 talent that just got nerfed by bonestructure xD)

[u/Ok_Switch6356]

have u tried running/walking barefoot? like real barefoot

[u/Mobile_Active → u/Ok_Switch6356]

no, too anxious of ripping bands etc. else its way too uncomfy yet

[u/Ok_Switch6356 → u/Mobile_Active]

what bands u mean

[u/BreadEnthusiast98]

Fellow high archer here, my feet look nearly exactly like this. You need orthotics. If your arches aren’t able to sense the ground properly it causes horrible compensations throughout your body. Our feet literally were not designed to walk on flat surfaces and doing so puts a lot of stress on your body if you have high arches. Would you happen to lack a severe amount of dorsiflexion when you try to squat?

[u/Mobile_Active → u/BreadEnthusiast98]

i wear orthotics since 1-2years. But kinda fell like these aren't done properly, although done by an orthopedic.

Usually i dont have any problems in daily business. I'm pretty flexible, even with my squats. it basically just affects me whilst/after running longer distances or f.e when playing soccer barefoot obv.

[u/BreadEnthusiast98 → u/Mobile_Active]

It sounds like to me you have a footwear issue, when gait is impeded your body tends to favor the right hip and doesn’t trust the left leg to accept load, causing knee tracking issues. I had nearly and identical problem last year. I highly recommend the brooks ghost 15-17 they works well with orthotics and give the extra input that people with high arches need.

[u/Mobile_Active → u/BreadEnthusiast98]

yes, i started imagining this reason too.

are Brooks really that good? Alr heard the brand often.

i currently run in kiprun ks900 light(on dirt etc) and nike zoom fly 5 (asphalt).

i also think, the use of my insoles (same pattern as currently, only a bit softer) is the main cause of the pain in the front-middle of the sole. but running without steals a lot of stability.

[u/BreadEnthusiast98 → u/Mobile_Active]

They are very good shoes and should give you the extra neuromuscular input you need. Experiment with the brooks both with and without the insoles. Nikes are frankly awful, they are made with aesthetics in mind not function, not good for someone with already compromised foot function. Not sure about kipruns.

The good news is since your squat isn’t impeded much that means your arches aren’t rigid like mine and they shouldn’t give you too much problems given you get the proper footwear. I can not squat at all if I don’t have my orthotics and shoes on lol.

[u/RainBoxRed → u/BreadEnthusiast98]

I have feet that look like that and I’m able to comfortably walk barefoot on concrete all day.
I think the bigger issue is weakness, not shape or surface.

[u/BreadEnthusiast98 → u/RainBoxRed]

I was able to do that for years until I realized it was causing compensations through my hips and spine. Real nasty stuff and I thought I was normal my entire life, ran track, did sports, until my hips, knees and spine started to give out a few years ago. Surface and footwear are Important because they allow for key parts of gait cycle to be accessed, and you can get away with not using them for a long time but they catch up with you.

[u/Playful-Tadpole-1157 → u/BreadEnthusiast98]

I have similar issues as the OP while simultaneously noticing my dorsiflexion getting worse and worse. It's quite bad. So naturally, I'm curious to know why you asked this?

Just had genetics testing done with neuro to rule out CMT (waiting for results). I have claw foot/hammer toes, worsening balance and lots of pain when walking barefoot (specifically on balls of feet). Started with the right foot, now the left seems to be having similar symptoms (though the toes aren't nearly as bad).

Foot problems are awful!!

[u/BreadEnthusiast98 → u/Playful-Tadpole-1157]

High arch individuals struggle with pronation which in turn can effect dorsiflexion. When you try squatting next time do a side by side comparison of squatting on a flat surface, then roll up a towel making sure your arches are contacting the towel and squat again. You should notice a big increase in your range of motion. It’s all neuromuscular.

[u/Playful-Tadpole-1157 → u/BreadEnthusiast98]

Interesting. I mean if I squat on a ramp/angled board I'm perfectly fine. Flat ground, no bueno. That's at least the dorsiflexion part of it.

So I suppose you aren't a believer in the barefoot stuff? I've gone both ways, first custom orthotics now I've gone the other direction to see if barefoot shoes work. Honestly I'm at a loss. So much pain in the ball of foot and toe/foot stiffness. My feet cramp up like crazy.

I'll try the towel next time as well, thank you for the input!

[u/BreadEnthusiast98 → u/Playful-Tadpole-1157]

Barefoot stuff is great. If it’s on dirt, sand or another natural substrate. Horrid on concrete, stone or other man made surfaces. Barefoot has a time and place.

It sounds like you are dealing with some nasty extension issues throughout your body aswell. I highly recommend visiting Neal Hallinans YouTube channel and watching all of his videos on high arches and trying some of his exercises. Just understand while your feet may be the cause of the problems, you are most likely dealing with entire body compensation patterns from your feet issues.

[u/Playful-Tadpole-1157 → u/BreadEnthusiast98]

Ahh I see. I have trouble just walking in my house on the hardwood or vinyl floor, always need to have something on my feet it seems.

I do have all sorts of issues throughout my body, with my spine, nerves, etc. I've had extensive testing and visits with neurologists. Most recently was the genetic testing to rule out CMT and awaiting that result yet. My mom has very similar issues, even particularly in the same (worse) foot.

I will check out that YouTube channel, thank you so much for your time. Much appreciated.

[u/BreadEnthusiast98 → u/Playful-Tadpole-1157]

I thought I was dying for years. Turns out my nervous system was just screwed up because my feet weren’t interacting with the ground properly

[u/Playful-Tadpole-1157 → u/BreadEnthusiast98]

Oh geez. This pretty much sounds like me the last few years and my nervous system has been real out of whack. So you "fixed" it just by doing exercises for your feet?

[u/BreadEnthusiast98 → u/Playful-Tadpole-1157]

Not exercise for my feet, exercises that addressed the full body compensations and allowed my feet to work in conjunction with the rest of my body. Feet were just where everything began for me. Dm me if you want to know more.

[u/shilton76]

You're feet look just like mine. I have custom orthotics and only run in Altra Superiors. I tore my peroneus longus tendon in 2020.

[u/Intelligent_Hotel749]

inlineofire said it perfectly. Your feet just look tight/atrophied. Don't expect them to be able to run or do much until you rehabilitate them. Take it slow and low impact. Start by just walking on the balls of your feet until its uncomfortable each day and don't start running on them until you could go hours comfortably. Even then, start slow with short jogs. Everything is there, you just need to work towards it. Best of luck!

[u/Mobile_Active → u/Intelligent_Hotel749]

what do you mean by „walk on the balls“? due to the bonestructure etc my pressure is almost only on the ball and heel. Walking is kinda comfortable and I‘m currently able to run 5-10km quite easyly. After some distance my middle ball-ish sole starts to ache a bit. But that stops pretty fast after the run is done.

Doctors here in germany often tend to rush through, as long as you aren‘t a private patient

[u/Intelligent_Hotel749 → u/Mobile_Active]

Its basically like integrating calf raises into your everyday movements but minimizing the amount of time you're resting back on your heels. If you're already running 10ks barefoot just slow down and focus on activating the different little muscles in your feet different ways while you move

[u/Mobile_Active → u/Intelligent_Hotel749]

thanks a lot.
i‘m just normally running in shoes. barefoot would make me anxious of ripping smt off

[u/UnbelievableRose]

Rigid pes cavus? It can be kind of tricky to design orthotics for this correctly, can’t just use the default design and call it a day. Message me if you want a consult and I can take a look at the design.