Clinical manifestations of high arched foot According to the degree of arch elevation and whether it is accompanied by other deformities of the foot, high arched foot is usually divided into four types. Simple high arched feet are mainly characterized by fixed plantarflexion deformity of the forefoot, with the first and fifth metatarsal bones evenly weight-bearing. The medial and lateral longitudinal arches of the foot are uniformly elevated, and the heel remains in a neutral position, or there is mild valgus. Inversion type high arched foot This type only has plantarflexion deformity of the first and second metatarsals, which increases the longitudinal arch of the foot. The external longitudinal arch remains normal. The fifth metatarsal is easily elevated to the neutral position without weight bearing, while the first metatarsal cannot be passively dorsiflexed to the neutral position due to fixed plantarflexion, and there is a 20-30° internal rotation deformity. Initially, the hindfoot is mostly normal. The pressure on the first metatarsal head increases significantly during standing and walking. In order to reduce the pressure on the first metatarsal head, the patient tends to adopt an inversion posture for weight bearing, and fixed inversion deformity of the hindfoot occurs in the late stage. The patient has claw-shaped toes, the first metatarsal head protrudes toward the bottom of the foot, the soft tissue of the weight-bearing area of the plantar foot is thickened, and the callus is formed and painful. 3, heel walk type high arched foot Commonly in poliomyelitis, spinal cord expansion. It is mainly caused by the paralysis of calf triceps muscle, characterized by the heel bone in dorsal extension, and the forefoot is fixed in plantarflexion position. 4.Plantarflexion type high arched foot Mostly secondary to congenital clubfoot after surgical treatment. In addition to the fixed plantarflexion deformity of the forefoot, the hindfoot and ankle joint also have obvious plantarflexion deformity. The clinical manifestations of each type of high arched foot are not consistent, but the forefoot has a fixed plantarflexion deformity. The toes are normal in the early stage, but with the development of the disease, there is a gradual regression of the toes, plantarflexion of the interphalangeal joints, hyperextension of the metatarsophalangeal joints, and claw-like toe deformity, and in severe cases, the toes cannot touch the ground. Due to the metatarsophalangeal joint dorsiflexion deformity caused by the metatarsophalangeal joint subluxation, the base of the proximal phalanx is pressed on the dorsal side of the metatarsal head, which will aggravate the metatarsal plantarflexion deformity, leading to thickening of the skin at the weight-bearing place, the formation of callus, or even the formation of ulcers. X-ray examination, should be taken under weight-bearing conditions of the foot positive lateral X-ray film. The distal and proximal articular surfaces of the first cuneiform bone are parallel to each other in a normal foot, while in a high arched foot, due to plantarflexion deformity of the forefoot, which occurs mostly in the first cuneo-metatarsal joint, the equalization of the distal and proximal articular surfaces converge on the metatarsal side.M′eary measured the angle between the talus median and the first metatarsal median, and the arch was normal when the two lines were consecutive. If the angle can be measured, it indicates an elevated arch. Hibbs measured the angle formed by the midshaft of the heel bone and the midshaft of the first metatarsal, with a normal value of 150-175°. This angle is reduced in high arched foot deformities. In addition, orthopantomograms measure the heel spur angle, and a <20° indicates a rearfoot hallux valgus deformity. Differential diagnosis The diagnosis of high arched foot can be made on the basis of gait abnormality, increased longitudinal arch of the foot with claw toe deformity, as well as increased M′eary's angle and decreased Hibbs' angle on X-ray examination. However, high arched feet are often caused by neuromuscular disorders, and further investigations should be performed to find the primary disease or potential causes, such as electromyography, CT or MRI of the skull or spinal cord. Defining the cause of the disease is important in determining the prognosis. High-arch foot treatment measures Non-surgical treatment Early mild high-arch foot can be treated by passively pulling the plantar contracture of the metatarsophalangeal fascia and the shortened intrinsic plantar muscles. In order to alleviate the pressure on the metatarsal heads and make the weight evenly distributed, a 1cm thick felt pad is added at the metatarsal head inside the shoe and 0.3-0.5cm thick on the rear lateral side of the sole to reduce the tendency of inversion of the hindfoot when walking. However, these measures can only alleviate the symptoms, neither correct the high arched foot deformity nor prevent the deformity from aggravating. When the high arched foot has prevented weight-bearing walking, shoe wearing, or progressive aggravation, then surgical treatment is necessary. Surgical methods can be divided into soft tissue release and bony surgery. Generally, the surgical method is selected according to the patient's age, the type and severity of deformity, and the status of the primary disease. In principle, soft tissue surgery is performed first, such as soft tissue release on the plantar side of the foot, tibialis anterior tibialis posterior tendon displacement and toe extensor muscle posterior displacement and so on. If soft tissue surgery fails to correct the deformity, or if older children have fixed high arched foot deformity, bone orthopedic surgery can be chosen. Surgical treatment A traditional method of soft tissue release is to make a longitudinal incision through the posterior aspect of the medial border of the foot to expose the soft tissues of the plantar side of the foot. The metatarsophalangeal fascia, the long metatarsophalangeal ligament, and the short flexor, short flexor digitorum, and little flexor digitorum can be peeled off from the beginning of the calcaneus and pushed to the distal end. For complete release, the divergent ligaments are cut, the metatarsal aspect of the first to third metatarsophalangeal joint capsule is incised, and the dilated portion of the posterior tibial tendon is cut off, along with the fibers stopping at the metatarsal and cuneiform bones. Postoperative immobilization in a series of orthopedic casts was performed for 8 weeks. Bony orthopedic procedures included open osteotomies of the first cuneiform, dorsal tarsal wedge and V-shaped osteotomies, and posteriorly displaced osteotomies of the heel bone. The dorsal tarsal V-shaped osteotomy has more advantages; it does not damage the tarsal epiphysis and is therefore indicated for children older than 6 years of age. It does not shorten the foot and can correct forefoot pronation and pronation deformity. The main points of the operation are: ① take a transverse or longitudinal incision on the dorsum of the foot to reveal the tarsal bone outside the periosteum; ② design a V-shaped osteotomy line at the apex of the arch, which is usually located in the center of the navicular bone, and the medial branch from the navicular bone slanting to the medial cortex of the first cuneiform bone; ③ after completing the osteotomy, the operator pulls the forefoot distally and raises the forefoot up, and at the same time, presses down on the distal break of the osteotomy. If there is internal rotation and adduction deformity, the forefoot can be externally rotated and abducted to pre-correct it. A Kirschner pin is then inserted through the medial aspect of the first metatarsal, stopping at the lateral portion of the heel bone through the osteotomy line. Postoperatively, the foot was immobilized in a calf cast for six weeks. After removing the cast, the Kirschner pin was removed and X-rays were taken to observe the healing of the osteotomy. If the osteotomy has healed, weight-bearing walking can be started gradually.