Waterfall from middle of gutter, almost no flow from downspout (photos). I just had the gutters cleaned. What should I do next?

We had our gutters cleaned recently, but during rain the gutter is overflowing from the middle of the run. Very little water appears to be coming out of the downspout. I've attached photos showing the overflow and the area near the foundation. Does this look more like a clogged downspout/underground drain, or a gutter pitch/sag issue? Any suggestions on what to check next? Unfortunately I don't have a ladder tall enough to get up there and look.