Flat feet & high arches. Diagnostics & therapy
Treatment and recognition of foot's malalignments.
An examination and treatment of a flatfoot or cavus is always necessary if the deformity affects any aches and pain.
What kind of treatment is best suited for a malalignment always depends in each case on the extent of deformation and the symptoms that occur. Mild cases can often be treated well by training the muscles of the foot and shoe insoles. Only in severe cases, surgery is needed at all.
Diagnostics, treatment & therapy of fleet feet & high arches.
Diagnostics. How are flat feet or high arches diagnosed?
Clinical assessment of flat feet or high arches.
The first important criterion is the position of the foot when fully weight-bearing. Inwards tilting of the heel indicates the presence of a flat foot, outwards tilting of the heel the presence of high arches. If the longitudinal arch is well developed when standing on the toes, this is usually a harmless natural variation of the norm and not clinically significant. In comparison, there is evidence of a functional deficit in the tibialis posterior tendon when the patient raises their heels and the longitudinal arch does not lift up normally or symptoms prevent the patient from standing on the toes. A flat foot is normally very flexible. Restrictions in mobility can arise from abnormal bony bridges between the small bones of the foot or from arthritis in the lower ankle joint. The extent to which the patient can lift up the outer edge of the foot is the crucial factor for patients with high arches. If this is no longer possible, the evidence suggests damage to the peroneal tendons stabilising the outer edge of the foot and the advanced stage of the disease. Ankle stability is also assessed, in particular the stability of the outer ligaments. High arches are normally more stiff as a whole.
X-rays. Considering the positioning of the bones
The position of the bones is demonstrated in x-rays of the foot in 3 planes and the ankle when weight-bearing, as well as in special axis views of the heel. These images can identify atypical bone formations, incorrect positions of bone and degenerative changes in the individual joints. It is necessary to take images when weight-bearing to decide which treatment strategy is the best.
Magnetic resonance imaging (MRI).
Magnetic resonance imaging (MRI) helps to evaluate the tendons, ligaments and cartilage. The presence and extent of damage to the tibialis posterior tendon in flat feet or the peroneal tendons in high arches can be confidently evaluated using MRI scans. Information on the cartilage, especially in the lower ankle joint, is important when planning treatment strategies.
Other causes of flat feet & high arches.
Neurological diseases can result in the development of high arches in particular. If further clarification is needed, it is wise to undergo additional specialist neurological evaluation. When something is not clear or a hybrid form of the disease is present, dynamic pressure distribution analysis can provide further information on the causes and treatment methods available.
Therapy. How are flat feet & high arches treated?
Conservative treatment of flat feet & high arches.
Minor forms of flat feet and high arches can be well treated with insoles. Flat feet insoles are used to support the longitudinal arch and activate the foot muscles that hold the longitudinal arch. High arches insoles are raised at the outer edge of the foot and tilt the foot away from its abnormal position.
Surgery. Surgical treatment options for flat feet
Surgery using a spacer.
When structural damage is present, treatment strategies involve the targeted correction of individual components. The placement of a "spacer" between the heel (calcaneus) and the ankle bone (talus) can correct malpositioning in young patients. All tendons must function normally before this treatment method can be carried out. The spacer is removed again after 2-3 years.
Surgically removing tarsal coalition.
If present, abnormal bridging (tarsal coalition) between the individual small bones of the foot is removed surgically. Some symptoms may remain though as the affected joints have never moved normally until they were operated on. In such cases, surgical stiffening of the affected joints in a normal position is indicated in the long run to treat symptoms permanently
Functional disorders of the tibialis posterior tendon.
The surgical correction of flat feet in adults can be broken down into several components. On the one hand, the abnormal position has to be corrected. On the other hand, the surgery aims to normalise the tibialis posterior tendon´s function once again. To achieve this, one of the many tendons that flexes the toes is sutured onto the tibialis posterior tendon to strengthen the tendon. The bony malpositioning is corrected when the heel´s position is corrected. Depending on the degree of malpositioning, it may be necessary to transplant a piece of bone from the rim of the pelvis. Extra surgical steps may also be indicated, such as correcting the position of the midfoot or lengthening the Achilles´s tendon, depending once again on the individual position of bones.
Flat foot can cause complete stiffening of the lower ankle joint.
Pronounced malpositioning, particularly a torn tibialis posterior tendon, can cause irreversible damage to the lower ankle joint in the long term. Once this has occurred, stiffening of the lower ankle joint can no longer be avoided. The treatment strategy is extremely complex. It aims to permanently maintain the function of the foot and to prevent stiffening of the lower ankle joint.
It is important here to respond before it is too late and not be inactive and take pain killers over several months in the hope that " it will get better".
Surgery. Surgical treatment options for high arches
How are high arches treated?
The surgical correction of high arches corrects the position of the hindfoot at the heel. If necessary, the outer ligaments are reinforced and the pull of muscles strengthened by changing the position of individual tendons on the outer edge of the foot. In some cases it may be necessary to lengthen individual tendons or correct the position of other bones. This depends on the patient´s individual malpositioning.
Post-operative rehabilitation for flat feet & high arches.
Getting back to every day life again.
It takes 6 weeks for the surgical correction of bone to heal. The foot must remain non weight bearing during this period. After 6 weeks, weight bearing can be increased in stages. The foot can normally fully weight bear after 10 - 12 weeks. The foot is protected by a solid below-knee walker (supportive orthosis for the lower leg) over a period of 3 months. The additional use of insoles is important for the first year following the operation. It can take up to almost one year before the patient is able to play sport in cases of complex malpositioning.
Flat feet & high arches
Tests are indicated when malpositioning is extremely pronounced, new, has gotten worse etc.
Experts for foot disorders: Specialised clinics and hospitals for diagnostics, treatment and therapy of flat feet & high arches at a glance.