Every parent wants their child to grow up healthy and beautiful. If the baby places his legs incorrectly, this is a sign of pathology that requires urgent treatment. Hallux valgus can lead to serious complications that will last a person's entire life.
Most orthopedic pathologies can be cured in childhood without consequences, this is due to the growth characteristics of the body in children. Bones and joints recover quickly, so curing hallux valgus in childhood is not difficult. In order not to start the disease and ensure healthy feet in the child, parents need to know how it manifests itself.
Plano valgus deformity of the feet is a disease in which the legs bend inward, while the heels and toes deviate outward, visually forming x-shaped legs. Plano-valgus foot deformity in children is quite common; the disease is associated with weak ligaments and muscles that cannot withstand the load when the child begins to walk.
Valgus feet can be congenital or acquired, the latter being quite rare. The disease can manifest itself during the baby’s first steps, or at a later age (up to 5 years). In most cases, it is possible to diagnose foot valgus early if parents regularly show their baby to an orthopedist.
If a flat valgus foot is detected in a child under the age of 3 years, then it is believed that the disease is associated with developmental pathologies in the womb. The disorders are associated with a weak and underdeveloped ligamentous apparatus, because the legs of a healthy child can withstand loads normally and do not deform.
Planovalgus foot deformity in children over 3 years of age develops for the following reasons:
Regardless of the cause of flat valgus foot, the child must undergo a course of treatment under the supervision of a specialist, otherwise the consequences will be dire.
The disease is accompanied by the following symptoms:
Symptoms may appear during the child’s first steps and disappear by the time he learns to walk, but treatment in this case is still required, the person just can adapt to many things. In other cases, symptoms appear already when the child has been moving normally for a long time, this is also a reason to visit an orthopedist as soon as possible.
Only a doctor can diagnose flat valgus foot deformity, so at the first symptoms of the disease you should consult an orthopedist. The specialist will conduct an external examination, listen to complaints and prescribe several tests.
Diagnosis of hallux valgus deformity
This may be radiography, ultrasound, computed tomography. But in most cases, external signs of the disease are sufficient. By measuring the angle of deviation of the leg from the norm, the doctor can immediately make a diagnosis, identifying the extent of the disease.
The first degree is characterized by an angle of 10-15 degrees; this condition is the most favorable and easily treated. If the deviation from the norm is 15-20 degrees, the second degree is established, in this case it is more difficult to cure the disease. A deviation from the norm of 20-30 degrees requires long-term treatment, and more than 30 degrees may require surgery.
Hallux valgus in children in most cases can be successfully treated with conservative methods, but it is very important that the therapy is carried out by a professional. Treatment is prescribed in a comprehensive manner, including the use of splints and bandages to reduce the load on the foot, various physiotherapeutic methods, massage and physical therapy. The little patient is also prescribed children's orthopedic shoes.
Flat valgus feet in children are treated with the following physiotherapy methods:
In advanced cases of the disease, when conservative treatment is ineffective, planovalgus feet are treated with surgical methods. The surgery will help restore normal foot function and prevent further complications.
Massage for flatfoot in children is very effective in the initial stages of the disease, and is an excellent addition to therapy in more advanced cases. A relaxing massage will help relieve your child of leg pain, improve blood circulation in the tissues, and help strengthen muscles and ligaments.
In order for massage for hallux valgus to be as effective as possible, it must be carried out in compliance with the following recommendations:
In most cases, babies do not tolerate the first massage sessions well, the reasons for this are obvious. Therapeutic massage can be quite painful even for an adult; in addition, it is performed by a stranger for a baby.
If a child has hallux valgus, not only the legs are massaged, but a full back massage is required. This allows you to strengthen the muscles and prevent curvature of the spine. It is important to understand that the entire musculoskeletal system in the human body is interconnected, and even minor deformations can have serious consequences.
Flat valgus position of the foot is effectively treated with the help of gymnastics, which is especially useful to do immediately after the massage. It is worth clarifying that a massage course usually consists of 10 procedures, but gymnastics should continue until the child recovers, and after the end of treatment, for prevention.
Examples of exercises used to treat hallux valgus in adults and children:
Parents need to understand that physical therapy with such a diagnosis should become a daily procedure, just like bathing and brushing teeth. It is recommended to do exercises in the morning; first, the mother can do a light massage, stroke and rub her legs to improve blood circulation in them. After which you can start doing gymnastics.
Orthopedic shoes for children with hallux valgus are prescribed without fail. The doctor prescribes a special model that will fix the foot and ankle joint well, preventing them from deforming.
Orthopedic shoes reduce the load on the spine, knee and hip joints, and are also a good prevention of flat feet. Thanks to the fixing shoes, the leg stops deforming and continues to develop correctly.
As a rule, you need to wear orthopedic boots or sandals practically all day, with the exception of the moment when physical therapy exercises are performed. If a child categorically refuses to wear orthopedic shoes, they may be chosen incorrectly, and parents need to choose a different model.
You can refuse to wear special shoes only after consulting a doctor, since improper treatment will lead to serious complications in the future.
The older the child, the more difficult it is to cure planovalgus deformity. If at the age of up to 3 years you can get rid of pathology with the help of shoes, braces, exercises and massage, then at an older age such treatment may simply be ineffective. The situation is especially difficult in children over 10 years of age, in which case x-shaped legs can remain for life.
Nowadays, low-traumatic operations are performed in which doctors straighten the child’s legs. After just a couple of days, the baby can move independently, and after a few weeks he returns to normal life.
If hallux valgus is not treated in childhood, the disease provokes a number of pathologies:
Hallux valgus is harmless only in childhood, as long as it can be treated conservatively. If you consult a doctor in a timely manner, the prognosis is always favorable; you can quickly and effectively straighten your legs and teach your child to walk correctly.
In adulthood, there can be no question of any conservative treatment, since the formation of bones and joints has ended. In this case, to get rid of crooked legs, a number of expensive operations will have to be performed, otherwise the patient will remain disabled for life.
To prevent the occurrence of hallux valgus in your baby, it is recommended to follow the following tips:
If the child had x-shaped legs and underwent treatment, it is necessary to observe preventive measures with special diligence in order to prevent the development of flat feet and postural disorders.
Many people ask questions: why does foot deformity occur, what are the types, what is the treatment? The main reason is wearing incorrectly selected and uncomfortable shoes; if this factor is not eliminated in time, it can cause quite unpleasant and dangerous consequences. That is why it is important to know why the foot may become deformed and how to properly treat it.
The main types of changes in the shape of the foot, often found in medicine, include:
Hallux valgus is characterized by the turning of the first toe to the inside of the foot. Not only does the unsightly appearance of the foot bring discomfort to a person, but also changes in all the structures of the foot occur, which, in turn, can cause pain.
Along with such deformation, other pathologies may develop. These include deforming arthrosis of the joints, chronic bursitis, and flat feet. As noted above, the main reason for changes in the shape of the foot is the wrong shoes. This same cause of hallux valgus is the most common.
Other reasons can also be mentioned:
The basis of hallux valgus is a congenital weakness of bone and connective tissue, which causes flat feet.
Diagnosing hallux valgus is not difficult, especially based on external signs. This is an inward curvature of the thumb. Let us analyze the symptoms in more detail according to the stages of development of the disease:
Stage 1 – The appearance of discomfort and mild pain when walking, fatigue, discomfort when wearing shoes, the appearance of calluses and corns.
Stage 2 – Change in the shape of the thumb joint, the appearance of a “bump” at its base, redness of the skin in this place, swelling, pain syndrome.
Stage 3 – There is a process of inflammation in the joint, pain, swelling, corns.
Stage 4 – Usually the disease does not reach this stage, since the person still consults a doctor. If time is lost and a person does not have time to seek the help of a doctor, he is bothered by severe pain in the area of the big toe, which causes limited mobility of the foot. At the same time, it becomes difficult for a person to move. You can also note the formation of a large lump at the base of the finger, calluses, corns, and keratinized skin.
Only a doctor can make a diagnosis and prescribe treatment for hallux valgus. All methods of treating hallux valgus are divided into conservative and surgical.
Conservative treatment of the disease is as follows:
Orthopedic shoes are selected strictly on an individual basis. Loose and soft orthopedic shoes will help prevent further development of the deformity, and daily exercises for hallux valgus will consolidate the result.
In recent years, a magnetic patch has proven itself well in the treatment of the disease, which has a pronounced anti-inflammatory and analgesic effect, and helps stimulate blood circulation in the muscles of the foot. This treatment method is no worse than, for example, laser treatment.
Surgery for hallux valgus is prescribed when all conservative methods are ineffective. An operation to remove a bunion is performed if a severe deformity is diagnosed, which makes it difficult for a person to put on and wear shoes. Rehabilitation after surgery includes limiting the load on the foot and wearing special shoes.
Varus deformity of the foot appears already in a newborn child, if the nature of its appearance is congenital. But there is also an acquired form of the disease, when external causes contribute to its development.
The deformity is similar to clubfoot, but there are still differences. Before we talk about them, let's look at why this disease occurs.
The causes may be the following pathologies existing in the human body:
The development of varus foot placement occurs very slowly. That is why the diagnosis of the disease is observed already at the late (middle) stage, when the baby’s limbs become O-shaped.
The earliest sign of the disease is faster wear on the outside of the shoe sole when the heel wears unevenly. You can also note a type of disease called equinovarus deformity, which is accompanied by the fact that the child does not step on the entire foot, but only on the toe.
You should not neglect the treatment of such a disease, as you can end up with curvature of the spine, which requires more complex treatment. In general, the pathology can be treated conservatively, but there are cases when the only solution is surgery.
For this pathology, antivarus orthopedic shoes are recommended, which fix the rear part of the foot and abduct the anterior part. The feet, tightly fixed with fasteners, will not “loose”, which is the source of preventing deformation. No less important is gymnastics for the feet, which helps strengthen the ligaments and muscles of the feet. The doctor also prescribes physiotherapeutic procedures, massage of the feet and legs.
Surgical correction of foot deformities, including varus, is prescribed if other treatment methods have failed.
Not only varus and valgus feet are common deformities. Thus, flat feet ranks one of the first places according to statistics in the field of medicine.
With flat feet, the shape of the foot changes, the longitudinal and transverse arches drop. Depending on which arch is lowered, transverse and longitudinal flat feet are distinguished.
Symptoms of both forms of pathology are:
The most common acquired form of the disease occurs due to congenital connective tissue deficiency. Another source of foot pathology is wearing the wrong shoes: too tight or too big. It is also worth noting other factors that provoke the development of the disease. These include excess weight, systematic stress on the feet, physiological aging, which reduces muscle strength.
Treatment for flat feet consists primarily of strengthening the muscles that support the arches of the feet. This can be achieved through gymnastics. Walking on uneven surfaces is equally beneficial.
Your doctor will tell you how to do a massage for flat feet. But it is worth noting: this method of treating the disease has a beneficial effect on the muscles, relieving fatigue. At the same time, massage helps improve metabolism in the body, as well as blood circulation.
Orthopedic shoes are required, which are chosen according to certain rules:
There is another deformity of the foot bones that has become common lately – clubfoot.
You can suspect it in a child based on the following signs:
Very often, the first signs of such a disease can be detected immediately, in the first days after the birth of a child. Thus, there is a complete turn of the feet with the sole upward, which can only be corrected by surgery.
The congenital form of the disease is caused by the incorrect position of the fetus in the womb. There is also an acquired form of the disease, which is possible after improper fusion of bones due to injury, burns, or impaired bone growth. Also, acquired clubfoot can occur due to an inflammatory disease when wearing the wrong shoes.
Treatment of pathology in a child under two years of age involves the use of only conservative methods (massage, gymnastics). At older ages, treatment methods are as follows:
If you consult a doctor in time when the first signs (symptoms) occur, you can avoid consequences that can be dangerous to a person’s overall health.
Hallux valgus in a child is a condition in which a decrease in the height of the arches of the foot and an X-shaped curvature of its axis gradually develops. In this case, the heel along with the toes turns outward, the baby develops noticeable clumsiness and fatigue. What to do if you find similar changes in your child’s feet? First of all, you should seek advice from an orthopedic doctor, and also understand the reasons that led to the development of hallux valgus.
By this term, orthopedists understand a condition of a child’s foot in which the distance between the ankles is 4-5 cm. The baby’s knees should be brought together and straightened. With this pathology, the heel and toes deviate outward, and the inner arch collapses inward. The child's legs become like the letter "X". If not only the axis changes, but also a decrease in its arches is noted, the orthopedist makes a diagnosis of “plano-valgus deformity of the feet.” Why is this situation developing?
Hallux valgus in children can be either congenital or acquired. In this case, congenital pathology is considered a consequence of intrauterine disorders at the stage of development of the lower extremities and can be caused by a wide variety of factors. In this situation, it is possible to detect a flatvalgus foot in a baby already in the first months of life.
The acquired deformity becomes noticeable much later - with the child’s first steps. These deviations may be associated with insufficient development of the ligamentous apparatus and various disorders of the musculoskeletal system. It has been noted that foot valgus most often occurs in weakened children with severe muscle weakness. The disease can also be caused by the following conditions:
The cause of foot valgus can also be incorrectly selected shoes for the first steps. Wearing soft and poorly supportive shoes can be a direct cause of hallux valgus. The development of the lower extremities is also adversely affected by putting the baby on his feet too early and using walking aids (walkers).
Whatever the reason that caused the formation of a planovalgus foot, the outcome is the same. Muscles and ligaments weaken and stretch over time, losing their ability to hold the foot in the correct position.
Advice: when choosing shoes for your first steps, consult a specialist!
The first symptoms of hallux valgus appear at the moment when the baby tries to take his first steps. When observing the child’s gait, it becomes clear that the baby steps only on the inner edge, and not on the entire leg, as it should be normally. If left untreated, the feet become X-shaped. The child gets tired quickly, complains of pain in the legs and discomfort when moving. Swelling may develop in the evening and at night. Hallux valgus is also characterized by the fact that boots are always worn down only on the inside of the sole.
In addition to foot valgus, there are other types of X-shaped deformities of the lower extremities. The curvature can touch the femoral neck with its congenital dislocation or dysplasia. “X” shaped legs may also be curved at the shins. All these diseases are usually combined with each other and are a consequence of the same changes occurring in the ligamentous apparatus of the lower extremities.
Advice: If you notice foot deformities in your child, consult a doctor!
The flat-valgus position of the feet is well determined by radiographic examination. The picture is taken in three projections. The x-ray clearly shows the incorrect position of the legs - and this gives every reason to make a diagnosis. In addition, computed tomography is performed - a method that allows you to calculate all the necessary morphological parameters of curved feet. And finally, the doctor must perform podometry, during which the load on different parts of the hallux valgus is assessed.
Some types of deformities require additional examination. An ultrasound examination is performed to determine the condition of the hip joint. In addition, every child diagnosed with hallux valgus should consult a neurologist to rule out diseases of the nervous system. In some cases, the disease develops not only due to insufficiency of the ligamentous apparatus, but also due to certain pathological conditions of the brain and spinal cord.
A change in the arch of a child's foot inevitably leads to the formation of an X-shaped curvature of the legs. It is also impossible to avoid incorrect position of the pelvis, and as a result, postural disorders in older age. In many cases, foot valgus leads to the development of flat feet - a source of constant pain and fatigue in the legs. To avoid the occurrence of such complications, you should not delay visiting a doctor at the first symptoms of the disease.
The goal of treating hallux valgus is to restore the normal shape of the leg and return it to full function. In the early stages of the disease, priority is given to conservative therapy. Following all the recommendations of the attending physician will make it possible to avoid the development of serious complications and do without surgical intervention.
Methods of conservative therapy used to treat valgus:
The selection of orthopedic shoes should be carried out by a doctor after a thorough examination of the patient. The chosen shoes should be comfortable enough so that the child does not refuse to wear them. A wide nose is required; heel – no higher than 4 cm.
If the flat-valgus position of the feet is complicated by the development of flat feet, shoes are selected according to a different principle. In this case, boots and sandals should have a fairly rigid back and tight instep support. Don’t forget about special orthopedic insoles, which are made to order individually for each child.
Advice: do not purchase orthopedic shoes without a doctor’s prescription!
Among the physiotherapeutic procedures, the following procedures have proven themselves to be effective:
Don’t forget about massage – both general and special for hallux valgus. A good effect has been seen from swimming in a pool or open water. Exercise therapy (therapeutic gymnastics) can be carried out both in specialized groups and at home. It is only important to follow all the rules for doing the exercises and not to overexert yourself during training.
Hallux valgus is a condition that is much easier to treat in the early stages of the disease. One of the effective methods of increasing the tone of the ligamentous apparatus is considered to be therapeutic exercises. Experts recommend performing the entire set of exercises in the morning or dividing the workout into several stages throughout the day.
All these exercises give very noticeable results in the treatment of hallux valgus and can be used both at home and during a walk in the park or outside the city. The main thing is not to force your child to study without his desire. Turn training into an exciting game - and your baby will be happy to take part in it.
Surgical treatment of hallux valgus is performed quite rarely and only in cases where it has not been possible to obtain an effect from conservative therapy for a long time. The method of surgical correction is determined individually and depends on the severity of the disease, the patient’s age and the presence of concomitant pathology. Valgus flatfoot is not a death sentence, and orthopedists are actively using newer techniques to correct the pathology.
This condition is medically called Hallus Valgus. Hallux valgus deformity occurs predominantly in women. Not so long ago it was believed that the cause of this pathology lay in improperly selected shoes. At the moment, experts deny this claim. Uncomfortable shoes undoubtedly worsen the course of the disease, but are not its source. Presumably, the formation of valgus of the first finger is influenced by hereditary predisposition, as well as insufficiency of the ligamentous apparatus.
As the disease develops, the thumb deviates outward. In this case, chronic arthrosis is formed with joint deformation and the growth of osteophytes (bone protrusions). This is what patients notice as a kind of “bump” at the very base of the finger. Over time, pain appears. Habitual shoes become too small, and the patient has to choose shoes a size larger, or even switch to soft slippers.
Is it possible to cope with this disease? At the initial stages, experts advise the use of orthopedic interdigital pads and special insoles-instep supports. If there is no effect, surgical treatment is recommended to eliminate the deformity of the first finger. A specific technique is selected after a complete examination of the patient and consultation with the attending physician.
Foot valgus is a disease that requires enormous patience from the patient. Treatment takes a long time, and parents of children do not always have the strength to complete the job. It is important to remember that only following all the doctor’s recommendations and daily activities with the child will give a chance of recovery from this disease.
"Road Clinical Hospital
at the Voronezh-1 station of JSC Russian Railways
THREE sections of the foot - fore, middle, rear.
Diseases associated with finger pathology, primarily bursitis and arthritis (rheumatoid, gouty and post-traumatic) of the joints of the first finger (“bumps”, colloquially ).
Deformations of the fingers , as a consequence of the transverse flatness of the feet, represent a number of pathologies (“bones”, colloquially ):
The diagnosis is made after examination and examination, standard x-rays are used in frontal and lateral projections, additional methods are computed tomography and magnetic resonance imaging ( examples of calculations of deformation angles ).
Treatment of diseases (deformities) of the feet is carried out by a combination of surgical methods and conservative therapy, depending on the stage.
Methods of conservative treatment:
Open (cut) operations:
Example of a radiograph of the right foot before and after open surgery (SCARF osteotomy) on the first and fifth metatarsals:
Minimally invasive (percutaneous) surgeries (MIS) are performed using bone burs through punctures or mini-incisions, often in the early stages of deformities or in combination with open techniques.
Such operations can reduce the healing and rehabilitation time; below are the diagrams and radiographs of minimally invasive osteotomies.
This type of surgical intervention is performed using modern power equipment, cutters, drills, burs, fixation using Baruk screws (BOLD), staples, knitting needles ( see below ).
The special design of intracortical screws is created to completely immerse the head threads into the bone and allows them not to be removed after fusion. All implants are made of high-quality titanium alloys that do not cause allergic reactions. Many cosmetic techniques involve percutaneous-intraosseous fixation with a Kirschner wire, which is removed within 3 to 6 weeks.
X-ray during and after surgery - fracture healing
Metatarsalgia - pain in the forefoot and plantar hyperkeratosis (callus) occur due to excess pressure on the metatarsal heads. This occurs due to an imbalance in the balance between the fulcrum points of the foot when transferring body weight. Most often, the pathology affects the small rays, mainly the long 2nd metatarsal bone. The essence of the surgical treatment method is to shorten and raise the heads of the metatarsal bones; fixation is performed with self-tapping screws ( examples below ).
The first metatarsophalangeal joint (MFJ) deserves special attention in surgery of the 1st ray of the foot. Considering the biomechanical features of upright posture, the pushing function of 1 finger, movements in this joint are extremely important. Let's consider the main pathologies and methods for their correction.
Gouty and rheumatoid arthritis, regardless of deformation, affect the PPJ with complete or partial loss of the function of rolling the foot
Egyptian / Square / Greek
Osteoarthritis (arthrosis) of the first PFJ , the consequence of which is Hallux Rigidus Limitus (rigid 1 toe - a pathology limiting the normal range of motion) also develops depending on the type of foot ( see above ), the long 1 metatarsal bone and 1 toe are predisposing factors. At the initial stages of the disease, corrective osteotomies remain a relevant method of surgical treatment.
A sharp narrowing of the joint space is a sign of limited movement.
Resection of exostoses (bone outgrowths) and osteotomy are mandatory.
In the later stages of the disease, the following treatment methods are applicable:
Rehabilitation after the above operations on the forefoot begins after the first dressing ( the appearance of the foot before and after ).
Shoes used after surgery allow you to unload the forefoot and begin walking in the first days after correction ( Baruk shoes ).
Morton's neuroma is another disease of the forefoot and is characterized by pain, burning in the intermetatarsal and interdigital spaces, discomfort, tingling, numbness, and sometimes a sensation of a new growth.
Due to pinching of the nerve between the heads of the metatarsal bones, resulting from transverse spreading of the foot or other reasons, there are several methods of conservative treatment: wearing orthopedic shoes, physical therapy, the use of corticosteroids, local anesthetics. If ineffective, an operation can be performed - excision of the perineural fibrosis and a section of the dorsal digital nerve, dissection of the intermetatarsal ligament, and osteotomy of the 3rd or 4th metatarsal bones is also possible.
Planovalgus foot deformity is a flattening, mainly of the longitudinal arch of the foot (the middle section is rolled inward), abduction-pronation position of the forefoot and valgus position of the hindfoot, i.e. heel and toes point outward ( see below ).
Causes : previous trauma, inflammatory, neuromuscular and congenital diseases. But most often it is hyperelasticity syndrome (Ehlers-Danlos Syndrome) and weakness of the tendon-muscular system. Treatment of the initial stages (1 and 2) can be conservative: after examination (plantography) and determining the degree of flat feet, correction is possible with individual insoles and wearing orthopedic shoes.
For flat feet (grade 3 and 4), surgical intervention is indicated.
Subtalar arthroeresis ( arthroereisis - from the Greek “artros” and “ereido” - to strengthen, support the joints ) - the operation consists of placing a special implant through a mini incision in the sinustarsi, blocking the “sliding” of the talus bone from the heel.
Such operations have an age limit (up to 35-40 years according to various authors) and the best results are observed in childhood and adolescence, when endorthesis can work until growth is completed (17-18 years). In adult patients, implant removal is mandatory 1-1.5 years after installation. It is worth noting that while the implant is in the sinus, the foot remembers the given correction, and after its removal it retains its shape. After surgery no hard bandages are applied; full movement and stepping on the leg is possible already on days 5-7; stitches are removed on days 10-12.
There are two main types of implants, the first is a “pistol” type, with a titanium alloy core coated with high-strength polyethylene.
The second is a “screw-in” type, with threads, made of a similar alloy. In both cases, the appropriate implant size is selected for each foot. The operation lasts from 20 minutes to half an hour. Examples of postoperative images (see below).
For tibialis posterior tendon dysfunction (PTTI), the above-described technique of subtalar arthroeresis is also used in combination with tendon plasty. After the diagnosis is made, an operation is performed: through a 3-5 cm incision at the level of the scaphoid bone, a corrugated suture is placed on the scaphoid, or transposition of the flexor digitorum longus tendon with tension on the scaphoid. What should patients do whose age no longer allows the use of such methods? There is a solution: a number of surgical interventions have been developed aimed at maintaining the longitudinal arch by creating immobility in the joints of the medial column of the midfoot.
Midfoot arthrodeses:
§ The Lapidus operation (PW Lapidus ) consists of a proximal corrective osteotomy of the 1st metatarsal bone in combination with arthrodesis of the first metatarsocuneiform joint in case of its hypermobility.
§ Talonavicular arthrodesis, and their combinations.
Currently, modern clinics use the most stable designs that reduce the fusion time, such as, for example, IO - FIX - a compression system of bonded screws ( see above ).
Mini plates with angular stability for fixation of small joints.
Equinovarus foot deformity (pescavus - hollow foot) is an abnormal position of the foot, in which the inner side of the foot is raised and bent inward, the outer side is lowered down, the toes and heel are deviated inward, and is the opposite of planovalgus.
The causes , as a rule, are the consequences of a congenital disease, clubfoot suffered in childhood; post-traumatic changes - damage to the sciatic, peroneal nerves, purulent destructive processes in the foot, consequences of dislocations and fractures at the level of the ankle joint or other joints of the foot.
Treatment consists of a whole complex of sequential surgical and conservative techniques. These are interventions on the bones and joints of the posterior part: medializing corrective osteotomies of the calcaneus , arthrodesis of the joints associated with the calcaneus, the so-called two and three-joint arthrodeses (see below).
In the postoperative period, semi-rigid or rigid plastic bandages or orthoses are required, immobilization periods vary from 4 to 8 weeks, support on the foot is prohibited for a period of 6 to 12 weeks, depending on the degree of complexity of the operation.
Rehabilitation after surgical interventions for pathologies of the middle and hindfoot includes standard measures: physiotherapy, physical therapy, massage. A mandatory addition is kinesio taping.
Haglund's disease ( osteochondropathy of the calcaneal tubercle or apophysitis ), is characterized by pain, swelling, induration, deformation and roughness at the level of the calcaneal tubercle, near the insertion of the Achilles tendon ( retrocalcaneal bursitis or enthesitis ). The reasons for the appearance are not fully understood; the most likely occurrence of deformity in adulthood is associated with injuries and overexertion (repeated microtrauma).
If conservative therapy has no effect, surgical treatment is used - resection of the heel tubercle and removal of bone and soft tissue growths; correction can be performed either openly through an incision or endoscopically - through punctures ( bursoscopy ).
Heel spur ( plantar fasciitis or insertionitis ) is an inflammatory and degenerative change in the plantar aponeurosis at the site of its attachment to the heel bone, which often results in the appearance of bone outgrowths ( osteophytes ) in this area, accompanied by acute pain.
Extracorporeal shock wave therapy, a non-invasive outpatient method, is recognized as the best treatment method ( see above ).
Cases of a chronic advanced process are not uncommon, in which fasciotomy - a minimally invasive method, often performed endoscopically (under video control), dissecting the plantar aponeurosis in the area of attachment to the heel bone by 1/3. The purpose of the intervention is to relieve tension in the fascia and, as a result, the disappearance of pain.
The ankle (tibia-talus) joint - connecting the foot (talus) and the lower leg (tibia and tibia), belongs to the category of large joints, complex in structure and block-shaped in shape. Let's touch on some pathologies associated with deformities and methods for their correction.
Instability of the ankle joint is a pathology in most cases external and caused by injury. Chronic subluxation of the foot medially. The examination reveals a rupture or failure of the external ligamentous structures of the ankle joint.
Surgical method for ligamentous apparatus restoration:
In the postoperative period, the limb is immobilized for 3 weeks, then patients undergo a standard rehabilitation course, professional athletes begin active training with loads after 3 months.
Osteoarthritis of the ankle joint (crusarthrosis) is a degenerative-dystrophic disease that affects all structures of the joint and periarticular tissues, causing its deformation and, as a consequence, limitation of movements and pain. The cause may be a previous injury, the presence of a chronic disease, or a violation of the biomechanics of walking due to other reasons.
In the initial stages, conservative treatment methods are justified; in later stages, arthroscopic lavage of the joint is applicable; in advanced forms of arthrosis, only radical surgical treatment is possible:
Endoprosthetics - resection of damaged cartilaginous surfaces and replacement of friction pairs with metal ones with a polyethylene liner.
X-ray and appearance of the ankle joint endoprosthesis
This type of surgery is gaining momentum in Russia, in contrast to hip and knee replacements, which have been used for many years. This complex, expensive and high-tech type of medical care is available only in specialized orthopedic departments of modern clinics.
Arthrodesis of the ankle joint is its surgical immobilization with the installation of the foot in the average physiological position. Mobility in the joint becomes impossible, but after the operation the pain stops. Compensation for the range of motion occurs due to other joints of the foot. This does not lead to significant impairment of limb function.
X-ray difference between normal (A) and osteoarthritis (B)
Various methods of osteosynthesis and many metal structures for its implementation have been developed. After processing the cartilaginous surfaces and, often, osteotomy of the fibula, the articular surfaces are brought together and fixed:
The long process of fusion takes from 3 months to six months, during which time the patient is forced not to step or to dose the operated limb and use crutches.
Diabetic foot is a complex of anatomical and functional changes that develop against the background of diabetic neuropathy, micro- and macroangiopathy, contributing to increased trauma and infection of the soft tissues of the foot, the development of a purulent-necrotic process and, in advanced cases, leading to amputation.
Diabetic foot syndrome is a collective concept that unites a group of late complications of diabetes mellitus in which pathological changes in the patient’s feet develop in the form of purulent-necrotic processes, ulcers and osteoarticular lesions that occur against the background of specific changes in peripheral nerves, blood vessels, skin and soft tissues, bones and joints (appearance on the diagram and clinical example).
Treatment of this syndrome should always be comprehensive; conservative methods include: unloading the foot, treatment of angio- and neuropathy, local treatment of ulcers, antibacterial therapy in cases of associated infection. The latest methods include: extracorporeal shock wave therapy, the use of growth factors and stem cells, and the plasma jet method. Surgical methods: angioplasty and stenting of the arteries of the lower extremities, endarterectomy, autovenous bypass, bone osteotomies as a method of relieving the load from an ulcerative defect of the plantar surface, economical resections, necrectomies and amputations.
Charcot's foot (Jean-Martin Charcot) is a destructive, diabetic, non-infectious neuroosteoarthropathy of the foot, accompanied by neurological deficits, leading to anatomical destruction of bones and ligaments, deformation of the foot and the development of ulcerative defects.
Due to its rarity, few surgeons have experience treating this disease. Depending on the stage of the process, the type of therapy is selected. Surgical treatment - resection of melted bones of the foot and metal osteosynthesis (arthrodesis of destroyed joints).
Considering all parts of the foot and the associated ankle joint, one can underestimate the completeness of each pathology taken individually. Before choosing a treatment method, an individual approach to each patient is required, a full examination, assessment of the statics and dynamics of walking.
Currently, it is no secret to anyone how great the impact of foot disease and deformation is on the appearance of pain and related problems in the knees, hips, back and shoulders. Therefore, your feet simply need to be examined, diagnosed and treated!
The text and illustrations are intended solely to inform about diseases and their treatment options. Do not forget: self-medication can harm your health.
National Health Institution "Road Clinical Hospital at Voronezh-1 station of JSC Russian Railways"