Exploring Treatment Options for High Arches and Ankle Injuries

Ankle injury

At the age of 25, I had never experienced discomfort from high arches despite engaging in various intense sports such as basketball, badminton, and rock climbing without any issues.
However, after a right ankle sprain, I developed compensatory problems in my left foot.
I received PRP injections and shockwave therapy, which improved my condition by about 50%, but further progress has been slow.
A doctor later suggested that I check my foot pressure to see if there were any underlying foot issues, which led to the discovery of my high arches.
I found that my left foot has an even higher arch compared to my right foot (completely rigid), along with a collapsed transverse arch, functional leg length discrepancy due to high arches, knock knees, pelvic tilt, and scoliosis.
I was already aware of these issues outside of the arches, but they had not caused me pain before.

After using custom orthotics and undergoing stretching and physical therapy for six months, I have only maintained my condition without improvement.
Currently, my symptoms include pain in the heels and dorsum of both feet, pain on the lateral side of the metatarsals, joint pain around the cuboid bone, and calf pain.
I had no symptoms prior to the sprain, but now it seems that all doctors and physical therapists attribute my issues to high arches, mostly recommending orthotics, which only prevent further deterioration.
I have seen online that some traditional Chinese medicine practitioners offer osteopathic treatments and small needle knife techniques to relieve muscle spasms, and some physical therapists have exercise therapy methods that I would like to try.
I am hesitant about surgery and would like to know if there are any experienced traditional Chinese medicine practitioners or physical therapists in Taiwan who specialize in treating high arches.

Niming, 20~29 year old female. Ask Date: 2023/12/16

Dr. Lü Bingcheng reply Traditional Chinese Medicine

Since I do not provide medical services related to acupuncture needles and high-arched feet, to my knowledge, Dr.
Li Chang-hsien from the Traditional Chinese Medicine Department at Puzi Hospital offers needle knife therapy.
I suggest you contact the Traditional Chinese Medicine Department at Puzi Hospital for more information.

Reply Date: 2023/12/16

More Info

When dealing with high arches (pes cavus) and associated ankle injuries, it's essential to understand the underlying mechanics of the foot and how they can affect the entire kinetic chain, including the knees, hips, and spine. High arches can lead to various complications, including instability, pain, and compensatory injuries in other areas of the body, as you've experienced.

Understanding High Arches and Their Impact
High arches can cause excessive supination (rolling outward) of the foot, which may lead to increased stress on the lateral structures of the ankle and foot. This can result in conditions such as ankle sprains, plantar fasciitis, and metatarsalgia. The compensatory mechanisms that occur due to high arches can also lead to issues like knee pain, hip misalignment, and even spinal problems, as you have noted with your pelvis and spine.

Treatment Options
1. Orthotics and Footwear:
Custom orthotics can be beneficial in providing support and cushioning for high arches. They can help redistribute pressure across the foot and improve alignment. It's crucial to work with a specialist who understands the nuances of foot mechanics, as generic insoles may not address your specific needs.

2. Physical Therapy:
Engaging in a structured physical therapy program can be highly beneficial. A physical therapist can design a rehabilitation program that focuses on strengthening the muscles of the foot and ankle, improving flexibility, and correcting any biomechanical issues. Exercises that target the intrinsic muscles of the foot, as well as the calves and hips, can help stabilize the ankle and improve overall function.

3. Manual Therapy:
Techniques such as myofascial release, joint mobilization, and soft tissue manipulation can help alleviate pain and improve mobility. Some practitioners may use techniques like dry needling or acupuncture to address muscle tightness and pain.

4. Extracorporeal Shock Wave Therapy (ESWT):
Since you've already tried PRP and shockwave therapy with some success, continuing with ESWT may provide additional benefits, especially for chronic pain conditions.

5. Alternative Therapies:
Exploring traditional Chinese medicine (TCM) approaches, such as acupuncture or herbal remedies, may provide relief. Some practitioners specialize in treating musculoskeletal issues and can offer a holistic approach to your condition.

6. Surgical Options:
While you prefer to avoid surgery, it's worth noting that in severe cases where conservative treatments fail, surgical intervention may be necessary to correct structural issues. This could involve procedures to realign the bones or tendons in the foot and ankle.

Seeking Qualified Professionals
In Taiwan, there are many qualified practitioners who specialize in treating high arches and related conditions. Look for physical therapists with experience in sports medicine or orthopedic rehabilitation. Additionally, consider consulting with a podiatrist or orthopedic surgeon who has a focus on foot mechanics and can provide insights into both conservative and surgical options.

Conclusion
Your situation is complex, and it may take time to find the right combination of treatments that work for you. It's essential to maintain open communication with your healthcare providers and to advocate for yourself in seeking the best care possible. Remember that recovery from injuries, especially with underlying conditions like high arches, can be a gradual process, and patience is key.

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