What is it?
There is a spectrum of foot shape between flatfeet and high arches. Classically high arches are seen as more attractive but if they are on the high end of the spectrum they can cause problems with foot pain and recurrent ankle sprains. Particularly high arches can be a sign of a nerve disorder and particularly worrying is a new, quickly progressing high arch on one side which can be a sign of problems in the back. I look out for these issues and can manage and refer them to appropriate specialist colleagues if needed.
What causes it?
Most high arches are on the spectrum of normal and are family related. In some cases they may be due to a genetic abnormality such as charcot-marie-tooth disorder or a problem in the spine. I carefully assess the deformities and assess whether there could be any underlying causes and manage the foot accordingly.
How can I treat it?
Many familial high arches can predispose you to tendon problems or recurrent ankle sprains. Depending on how much the problem is affecting you, we can come up with a treatment plan that best suits you. I usually start with insoles to support your foot which can be surprisingly light and fit into most shoes and a programme of physiotherapy to strengthen the muscles and ligaments around the ankle. The majority of the work is based on balance and making your ankles more resistant to falling foul of sprains.
What does surgery involve?
Surgery is very dependent on exactly what the problem is. If the problem is recurrent ankle sprains or tendon problems, I usually deal with these using keyhole camera surgery or mini open techniques. To stop the problem reoccurring I will usually add a percutaneous heel shift which does slow down recovery but is important to stop the problem coming back.
If there is weakness in bending your ankle up, which is more common in the nerve related high arches, I move one of the tendons into a better position. I have developed a new technique for this which I also use for “dropfoot” which is very stable and has had good results so far.
Aftercare is dependent on the procedures performed. For keyhole surgery alone, you have a bandage and a boot and start therapy at 2 weeks, progressing to jogging at 8 weeks and return to sports at 3-4 months. If further procedures such as a heel shift are appropriate, you will be non weight bearing in a cast for 2 weeks followed by a boot for 4 weeks returning to jogging at 3-4 months and sports at 6-8 months.
Risks and complications
There are risks to all surgery and conservative measures should be tried when possible. If surgery is an option, we will discuss all of the pros and cons and the risks that are specific to you in detail. Specific risks of this procedure are-
The main risk of this procedure is recurrence due to not addressing the underlying problems. I do my best to work with you to find a solution that works for you but still gives you the best chance of a full recovery. If the ankle is still unstable following this type of surgery, I use a mini open internal bracing technique which is slightly more aggressive but gives phenomenal ankle stability.
If surgery is an option for you we will discuss all the options in detail so you can make the decision which is best for you.