Flat foot

Flat foot and high arch

Two common conditions of the foot are flat feet and high arches, which are more often than not, nothing to worry about. Having either of these conditions does not usually cause any problems in your everyday life, nor should they stop you from being able to carry out sporting activities. Though they are rarely a sign of something more serious, if your feet begin to feel stiff, painful, or if you start to experience problems then you may need to seek treatment.

In cases where the condition suddenly occurs and you did not have it before, or it only affects one of your feet, or if you are noticing issues with your balance and ability to walk, it is definitely best to get your feet examined by an expert.

Our foot surgeons at Schoen Clinic have many years of experience in treating flat feet and high arches. If you do begin to notice something untoward, we can assure you that your feet are in safe hands with us.

What do we understand by flat foot/high arch?

The terms flat foot and high arch are initially used to describe the external appearance of the foot in a neutral way.

In the case of a flat foot, the longitudinal arch of the foot will appear to have sunk. This can lead to a tilting of the heel or forefoot towards the instep therefore, the foot will appear to be more or less solidly on the ground.

A high arch can be recognised by a high instep and high longitudinal arch, which can lead to a tilting of the heel towards the outstep. The high arch increases the likelihood of the ankle joint twisting. In extreme cases the midfoot is twisted, meaning that you can only roll it over the outstep.

Potential symptoms of flat foot/high arch

In the majority of cases, mild flat feet or high arches don’t have any symptoms and do not require further treatment. Increasing pain in the inner ankle in combination with a flat foot may indicate excessive strain of the posterior tibial tendon. If the heel keeps tipping down towards the outstep, additional pain may occur in this region. In the case of a high arch, you will mainly feel pain on the outer edge of your foot. You might frequently roll over your ankle and have more skin calluses on the outer edge.

Causes: How does a flat foot occur?

Having a flat foot is a normal transitional stage during childhood development.
  • Children have thicker padding under the soles of their feet in comparison to adults.
  • The most common cause of flat foot in children and young adults are loose capsular ligaments, connected with muscular weakness
  • If the foot has poor mobility, atypical connections between the individual tarsal bones may be the cause
  • In rare cases, the individual bones are incorrectly positioned from each other
  • Sometimes, beyond the age of 40 years, a flat foot will increasingly develop or an already present flat foot will significantly worsen

Causes: How does a high arch occur?

  • High arches are present from birth in most cases
  • Paralysis of the leg muscles can also cause deformity
  • Other potential causes include disorders of the central nervous system or spinal cord

Diagnosis: Examination of the foot deformity

If the deformity is causing you pain and symptoms, clinical examination will be required. In this examination, our specialists will first check the positioning of your foot under full strain. Your heel tipping towards the outstep is an indication of a flat foot; if it tips inwards, this indicates a high arch. If the longitudinal arch rises well when tiptoeing, the deformity is generally harmless. If the longitudinal arch no longer rises as normal or if you cannot stand on your tiptoes anymore, this is a sign of a dysfunction of the posterior tibial tendon.

If you can no longer lift the outer edge of your foot due to a high arch, the peroneal tendon, which stabilises the outer edge of your foot, may be damaged. In this case, it is likely that the disorder has already progressed further.

In a clinical examination, we will also check the stability of your ankle joint, particularly the outer ligaments. Imaging procedures, such as X-ray examinations, will then be carried out for a precise diagnosis.

X-ray images show the positioning of the bones

We first take X-ray images of your foot in three planes. We also create images of your ankle joint under stress, as well as special axis images of your heel. This all shows us the positioning of your bones in relation to one another. It lets us precisely identify atypical bone formations, incorrect positioning of your bones from one another and signs of wear on individual joints. The X-ray images under stress show the extent to which correction is necessary.

MRI for assessing tendons, ligaments and cartilage

We can safely assess whether and to what extent the posterior tibial tendon in the case of a flat foot, or the peroneal tendon in the case of a high arch, has been damaged using Magnetic Resonance Imaging (MRI). Information on the cartilage, particularly in the upper ankle joint, is important for planning the best possible treatment strategy.

Additional examination in case of uncertainty

High arches can often be the consequence of neurological disorders. If any uncertainty exists, additional specialist neurological assessment can be beneficial. We can also analyse the pressure distribution on your foot during movement using a dynamic pressure measurement system. This provides additional evidence of the causes.

Most deformities can be treated easily and effectively

The treatment for your foot deformity that’s best for you depends on the extent of the deformation and your complaints. Mild cases can typically be treated effectively using shoe inserts and by carrying out foot muscle training exercises. Surgical intervention is only required in severe cases.

Conservative treatment: Correcting the condition with shoe insoles & orthotics

Milder flat feet and high arches can be treated effectively using specific insoles.

Insoles that support the longitudinal arch of the foot are used for flat feet. This activates the foot muscles that hold up the longitudinal arch.

The insoles for a high arch are higher at the outer edge of the foot and therefore tilt the foot away from the deformity. The more flexible the foot, the better the chances of success.

Surgical treatment for a flat foot

With young patients, we can correct the deformity using a “spacer” between the heel bone and the ankle bone. After two to three years, this is then removed. All tendons need to be functioning normally for this procedure.

If there is a bony bridge between individual tarsal bones, we can remove this through surgery. However, if you have never had normal movement in the affected joints you may still have symptoms. If a normal joint has not formed at all, under certain circumstances, your symptoms may only be alleviated through fusion of the joint.

Through flat foot surgery, our specialists correct the deformity and also restore normal functionality of the posterior tibial tendon by suturing one of the many tendons that bend the toes, strengthening the posterior tibial tendon. We repair the bone deformity through positional correction in the heel bone. Additional surgical steps, such as a positional correction in the midfoot, or an extension of the Achilles tendon, may be required according to each individual deformity.

If the deformity has been present for many years, the lower ankle joint may be irreversibly damaged. If arthritis has already occurred in the lower ankle joint, the deformity and complaints can only be treated through reinforcement of the lower ankle joint. In this case, the goal is to initiate treatment early so reinforcement surgery is not required.

Surgical treatment for a high arch

When operating on a high arch, we correct the hind foot deformity on the heel bone. If necessary, the outer tendons are strengthened and muscle tension increased by redirecting individual tendons to the outer edge of the foot. According to each individual deformity, it may be necessary to extend individual tendons or carry out additional bony positional corrections.

Flat foot: Our specialists

Our foot specialists offer you rapid diagnosis and personalised solutions for the treatment of your flat feet.

Dr Roger Wolman

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant - Rheumatology

Consultant - Sports & Exercise Medicine

Consultant Rheumatology and Sport & Exercise Medicine
MD (Res) FRCP FFSEM
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Mr Ali Abbasian

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant Orthopaedic Surgeon - Foot & Ankle

Consultant Orthopaedic Surgeon 
MBBS FRCS(Tr&Orth)
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Mr Kumar Kunasingam

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant Orthopaedic Surgeon - Foot & Ankle

Consultant Orthopaedic Surgeon
BSc(Hons) MBBS(Eng) MRCS(Eng) FRCS(Tr&Orth) DipSEM DipOrth
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Mr Stefan Weitzel

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant Orthopaedic Surgeon - Foot & Ankle

Consultant Orthopaedic Surgeon
MD FRCS(Eng) FRCS(Tr&Orth)
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Dr Philip Batty

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant - Sports & Exercise Medicine

Consultant Sport and Exercise Physician
MB ChB, MRCGP, FFSEM
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Prof Mike Loosemore MBE

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant - Sports & Exercise Medicine

Consultant in Sport and Exercise Medicine
MBBS MSc PhD FFSEM(UK)
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Dr Julian Widdowson

Schoen Clinic Orthopaedic and Spinal Hospital London

Consultant - Sports & Exercise Medicine

Consultant Sport Exercise Medicine Physician
MBBS MRCGP DCH DRCOG MScSEM FFSEM
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Flat foot: Our specialised hospital

Our specialised Orthopaedic and Spinal hospital is based in the heart of London. With a full diagnostics and imaging suite, surgical theatres and private bedrooms with ensuite bathrooms, we are able to offer a rapid diagnosis, treatment and recovery programme all under one roof.

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Authors, 09.06.2020