Hollow foot (high arch)

In summary: hollow foot is an excessively high arch: weight is concentrated on the heel and the ball of the foot instead of being distributed, leading to calluses, overloads, and a tendency for sprains. With gait analysis and custom insoles, it is offloaded and well controlled.

Hollow foot (or cavus) is less noticeable than flat foot, but it causes just as much discomfort, if not more: since the midfoot hardly touches the ground, all the work is done by the heel and the forefoot, which end up protesting.

Treatment does not aim to “lower the arch,” but to distribute support better. A properly designed insole based on gait analysis usually radically changes comfort when walking and playing sports.

Hollow foot and sports

The hollow foot tends to be somewhat rigid, and this is noticeable in sports. A flexible foot adapts to the terrain and distributes the impact of each stride; the hollow foot, however, absorbs impact poorly and concentrates the work on the heel and the ball of the foot. Therefore, those who run or jump with a hollow foot accumulate overloads more easily: pain in the heel, the ball of the foot, or the Achilles tendon.

Additionally, the heel tends to tilt inward, and on uneven terrain this translates into a higher risk of recurrent ankle sprains.

None of this means that you cannot play sports with a hollow foot — quite the opposite. It means it is advisable to prepare it: footwear with good cushioning, insoles designed for the specific sport, and a review of technique and loads. This is the usual approach of sports podiatry, with gait analysis as the starting point.

A foot that overloads the ball of the foot and the toes

Since the midfoot hardly touches the ground, the forefoot assumes more pressure than it should. Over time, this can lead to pain under the ball of the foot — metatarsalgia — and calluses that always reappear in the same spots.

The toes also pay the consequences: in the hollow foot, it is common for them to gradually bend into claw toes, adding friction with the shoe to the pressure problem. Therefore, when assessing a hollow foot, we always look at the whole picture: heel, ball of the foot, toes, and ankle. Treating only one part is usually insufficient.

Why we sometimes request a broader assessment

In the vast majority of cases, hollow foot is simply the shape of the foot, often shared with other family members, and it is well managed with simple measures. However, there is one situation that deserves more attention: when the hollow foot appears in adulthood or progresses rapidly.

In these cases, it is advisable to rule out a neurological or muscular cause behind it, and therefore we may request additional tests or coordinate with other specialists. It is not the usual scenario, but including it in the assessment is precisely what allows you to be at ease.