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. The foot is 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.
Flat Feet Symptoms
Causes: how does a flat foot/high arch occur?
Causes of a flat foot
Having a flat foot is a normal transitional stage during childhood development. It has two causes. On the one hand, children have thicker padding under the soles of their feet in comparison to adults. On the other hand, the muscles that raise the foot arch aren’t as strong yet. In rare cases, the foot does not rise up to age 6 years.
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 of the flat foot. 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. This can be traced back to a dysfunction of the posterior tibial tendon. This tendon normally raises the longitudinal arch of the foot, ensuring a stable gait. Wear frequently occurs in this tendon.
Causes of a high arch
High arches are present from birth in most cases, but paralysis of the leg muscles can also cause deformity. Additional potential causes include disorders of the central nervous system or spinal cord.
Symptoms: potential symptoms
Mild flat feet or high arches don’t have any symptoms in the majority of cases 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’ll 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.
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 can’t stand on your tiptoes any more, 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. The disorder has already progressed far in this case.
In a clinical examination, we’ll 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 from one another. It lets us precisely identify atypical bone formations, incorrect positioning of your bones from one another and signs of wear of 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.
Flat Feet Treatment & Surgery
Most deformities can be treated easily and effectively
The treatment that’s best for you depends on the extent of the deformation and your symptoms. 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: correction of the deformity using shoe inserts
Milder flat feet and high arches can be treated effectively using inserts.
Inserts 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 inserts 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 also remove this through surgery. But if you’ve never had normal movement in the affected joints in your life so far, 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 symptoms 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.