The foot is one of the main parts of the body's support. Its area is about 1% of the entire body surface. However, it bears the main load, equal to the mass of the human body. The foot performs several functions: shock-absorbing, supporting, balancing. Under the influence of certain factors, its arch is subject to deformation, and a disease such as flat feet develops. As a result, the sole loses its shock-absorbing properties, which is accompanied by unpleasant complications.
The human foot consists of 26 bones. They are connected to each other by joints and ligaments, the movement of which is controlled by tendons and muscles. In a healthy person, the foot has 2 arches: transverse and longitudinal. They are located in the area of the base of the toes and the inner edge of the sole. When walking, a person does not fully rest on the foot. As a rule, three points are involved: the heel bone, the area at the base of the little finger and the big toe. If the ligaments and muscles of the foot weaken, its shape begins to change. It gradually becomes flat. When walking, a person is forced to rest his sole on the surface. As a result, shock-absorbing properties deteriorate and flat feet develop. A photo of the leg deformity is presented in this article.
The arches function like springs or levers, providing comfortable movement with minimal consequences for the body. Damage to this link entails disruption of the entire system. The body, as we know, is a single whole. Any changes in the operation of one system necessarily affect the functioning of the other. Flat feet can lead to damage to the hip and knee joints and spinal deformation. If the foot cannot cope with its functions, they move to structures located above. The spine, knee and hip joints are not adapted to such a load, so they quickly fail.
The foot has two arches. Therefore, it is quite reasonable to distinguish between the forms of the disease - longitudinal and transverse flatfoot. The symptoms and treatment of each are discussed below. There is also a mixed (combined) version of the disease.
Classification of the disease by type also provides for the separation of acquired and congenital flat feet. The first case is extremely rare and is the result of abnormal fetal development. Acquired flat feet can appear at any age. It, in turn, is divided into several subspecies:
What signs should you pay attention to in order to prevent flat feet in time? Symptoms of this disease appear gradually. Its very first sign is considered to be severe pain in the legs at the end of a working day. By evening, the soles and legs swell and cramps appear. It becomes difficult for women to walk in heels. Due to the enlargement of the foot, you have to give up your old shoes and buy new ones, but in a larger size. Gradually, the pain syndrome spreads higher, moving to the knee and hip joints. Such signs characterize not only flat feet. Symptoms of a similar nature are observed with varicose veins. But treatment for this disease requires something completely different.
To reassure yourself, you can do a simple test at home. To do this, lubricate the soles of your feet with a dye (for example, brilliant green or iodine). Then leave an imprint on a piece of paper so that the load on your feet is even. After this, draw a line parallel to the plantar notch from the heel to the toes. Place a perpendicular line at the deepest part to the outer edge of the foot. If the imprint of the narrow part of the sole occupies at least half of the first line drawn perpendicularly, you have flat feet. A photo of an example circuit is presented below.
Flat feet is a serious disease characterized by foot deformity. In ordinary life, no one pays attention to this defect. It is worth knowing the characteristics of the disease in order to take timely measures to correct it. The causes of the disease can be both external and internal. Considering the rhythm of life of a modern person and the disdainful attitude towards one’s own wardrobe, sometimes flat feet have a mixed etiology. Even everyone's favorite sneakers can cause foot deformation. Why? The sole of the sneakers is equipped with excellent shock absorption. They take on the entire load, fixing the heel. As a result, the muscles relax, creating all the conditions for the development of a problem such as flat feet. What flat feet are and how they arise is now clear.
Returning to the internal causes of the disease, it is worth noting a number of provoking factors. First of all, this is the presence of concomitant ailments. Among them, rheumatoid arthritis takes pride of place. It affects not only the cartilage, but also the ligaments that are responsible for supporting the foot. Injuries and mechanical damage to the leg also contribute to the development of foot defects.
Exposure to external factors can be easily prevented if you take care of your own health and carefully choose your shoes. The exogenous causes of flat feet include the following:
With this form of the disease, an increase in the length of the foot occurs against the background of lowering of the longitudinal arch. As a result, the sole is in complete contact with the floor. The main sign of deformation is a reduction in the gap between the inner edge of the foot and the floor surface itself. Patients with this diagnosis develop clubfoot over time.
There are three degrees of longitudinal flatfoot:
With this form of the disease, the length of the foot decreases, the big toe deviates, and the middle toe becomes deformed. It takes on a hammer-like appearance. A small lump appears at the base of the first finger.
There are three degrees of transverse flatfoot. Their differences are due to the angle of deviation of the big toe.
Mixed flatfoot is considered separately. We have already discussed what longitudinal and transverse flatfoot are, and this pathology is accompanied by symptoms that are characteristic of both types. The manifestation of signs of a mixed form is distinguished by a greater degree of their severity.
The foot of a child under five years of age is a fragile structure that is in the process of formation. Therefore, parents have a great responsibility. They must prevent the disease, recognize it in a timely manner and begin treatment.
Children rarely talk about health problems. Even if they try to hint, parents do not pay attention to them. Children lead an active lifestyle and are in constant motion, which is usually accompanied by fatigue. But there are certain points that parents should pay attention to:
If your child’s gait has changed or he or she begins to move less, you should consult an orthopedic doctor. An experienced specialist can recognize flat feet at an early stage. The symptoms and treatment of this disease in children are practically no different from those in adults. Its only feature is the reversibility of the pathological process. The gradual maturation of the child is accompanied by a natural recovery from the disease. The foot is formed before the age of 13. During this period, it is necessary to focus on physical activity (running, walking). As a result, the muscles will begin to develop harmoniously, and the foot will acquire the correct shape.
Flat feet in adults and children can be determined based on the clinical symptoms of the disease. To assess the extent of the pathological process, a serious examination of the patient is required. It includes several points. This:
Based on the examination results, the orthopedic surgeon can confirm the diagnosis and make recommendations for treatment.
Do people with flat feet join the army? This question worries many young men who have reached adulthood. If a conscript is diagnosed with a 1st or 2nd degree foot deformity, he is required to serve in the armed forces. In case of longitudinal or transverse flatfoot of the 3rd degree, the young man is exempt from the army. He is given a military ID with a “limited fit” stamp.
Many people do not pay attention to flat feet and ignore the first symptoms. In fact, this is a rather serious and rapidly developing pathology that is practically untreatable. It can be completely cured only in childhood, when the foot is not yet fully formed. In adults, therapy is aimed at slowing the development of the disease and preventing complications. Treatment of the pathological process is complex. The patient's muscles are strengthened, pain is eliminated, and progressive longitudinal/transverse flatfoot is stopped. The symptoms and treatment of these types of disease are practically the same. Now let's look in more detail at modern methods of therapy.
Medicines in combination with physical therapy help eliminate pain. Patients are prescribed systemic analgesics (Ibuprofen, Aspirin), as well as ointments for topical use (Dolgit, Voltaren).
The basis of therapy is therapeutic exercises. A set of exercises is selected by an orthopedist taking into account the stage of the disease and the patient’s age. A foot massage has a good healing effect. Regular procedures help normalize blood circulation and increase muscle tone. Unfortunately, all of the above treatment methods are effective only at the initial stage of the disease. For severe foot deformities, only one option helps - surgery.
Treatment of this disease in children requires a different approach. Most often, young patients are diagnosed with longitudinal flatfoot (all parents should know that such deformity cannot be ignored). The pathology is highly treatable if detected early. The child's bones, ligaments and muscles are susceptible to conservative therapy. Exercise therapy and massage have a positive therapeutic effect. If a child has congenital flat feet, they begin to be treated from the very first days of life. For this purpose, special bandages and splints are used.
The human body works as a whole. There are not only anatomical, but also functional connections between all organs. With flat feet, a shift in the center of gravity occurs. To maintain balance, a person is forced to constantly deviate in the opposite direction. Over time, the deformation increases, and the back becomes noticeably rounded. Poor posture and flat feet have similar causes of development. This is weakness of connective tissue, muscles, and obesity. In a healthy person, the arch of the foot acts as a shock absorber. With flat feet it is lost. As a result, increased stress is placed on the spinal column and knees. This leads to even more severe curvature of posture, scoliosis.
Foot deformity can provoke the development of other specific complications, including:
In children with this diagnosis, the shock absorption of the foot is also impaired. As a result, the vibration of the body when moving is transmitted to the legs and spine. Constant irritation of the joints leads to inflammation, and arthrosis develops. The effect of flat feet on the spine is reflected in its curvature. The child constantly suffers from pain in his legs and head, his ability to work and his performance at school decreases.
To prevent the development of flat feet, it should be periodically prevented. First of all, doctors recommend paying attention to shoes. Today, in almost every store you can buy special orthopedic shoes and insoles. The range of similar children's products is amazing in its diversity. Do not forget that shoes and insoles cannot correct foot deformation. They only prevent its development.
To strengthen muscles, it is useful to do contrast baths. It is necessary to alternately dip your feet in basins with cold and hot water. In addition, regular consumption of vitamins in their natural form (A, E, C, D) and microelements (including copper, selenium, calcium) helps strengthen muscles.
Prevention of flat feet in children can begin with increasing physical activity. Martial arts, skiing and horse riding are considered beneficial. In summer you can walk barefoot on mown grass and pebbles. Such daily walks have a positive effect on the motor skills of the small muscles of the foot.
Ekaterina Ruchkina March 29, 2012
Flat feet is a pathology of the structure of the top, associated with the flattening of one or both of its arches (longitudinal and transverse).
When walking upright, the human foot acts as a shock absorber, which springs and reduces the load on the spine and joints of the lower extremities. Therefore, healthy feet have arches - an “instep”. When walking, such a foot has play to flatten under load and restore its shape when the center of gravity is transferred to the other leg.
In a person suffering from flat feet, the feet do not perform their shock-absorbing function or do not perform it fully. Then the load and vibrations when walking are distributed between the joints of the legs, pelvis and spine. Naturally, this leads to excessive wear of bones and joints, the development of diseases, for example, arthrosis, osteochondrosis, and so on.
It is very rare to talk about congenital flat feet. In the vast majority of cases, it develops after birth and is associated with weakness of the ligaments and pathologies of the bones - the apparatus that should give the foot a healthy shape.
Acquired flat feet can develop at an early age or occur in an adult. Types of acquired flat feet:
Based on the most affected arch of the foot, longitudinal and transverse flat feet are distinguished:
Flat feet are usually detected in children during an orthopedic examination. But the patient himself may notice signs of developing pathology. They will be:
Also, by the wear and tear of shoes, you can judge possible flat feet:
But the final diagnosis, of course, is made by the doctor. After the examination, the doctor may conduct a study using a podoscope (a device that, like a scanner, takes prints of the feet of a standing person). X-rays of both feet in a standing position, in two projections - frontal and lateral, help to definitively confirm the presence of flat feet and establish its degree.
Most often, flat feet begin to develop at an early age during the formation of important characteristics and training of the musculoskeletal system. A variety of reasons can lead to weakening of the ligaments that support a child's foot.
Above, we mentioned only rickets, but unhealthy diet, infections, overload during exercise or dancing, and wearing uncomfortable shoes are also dangerous. Even very caring parents cannot 100% exclude all causes that can lead to flat feet (for example, as a result of illness, when the child lies for a long time - the ligaments can weaken).
Therefore, it is so important to periodically visit an orthopedist who can notice the first symptoms of this pathology. In addition, the child should only wear shoes that fit and meet orthopedic standards (with arch support, low heels, and so on). It is necessary to balance the baby’s menu so that his nutrition is complete. Not only excess weight and physical inactivity are dangerous, but also excessive zeal in practicing, for example, ballet. Also, doctors are against the child getting up on his feet too early and trying to walk.
In addition to the means of preventing this pathology described in the previous paragraph, it is worth paying special attention to sets of exercises that will help prevent flat feet not only in children, but also in adults.
There are many similar exercises. But we can briefly describe the main principles of such training:
If it was not possible to prevent flattening of the foot, then it is important to begin treatment as early as possible. Patients must understand that health will never be fully restored - they will always have to take measures to relieve complications.
Pain in ligaments and joints is relieved by taking medications and physical therapy. A massage may be prescribed. The doctor prescribes the patient to wear orthopedic shoes with certain characteristics. Every day the patient must perform a set of therapeutic exercises, which will be shown to him by a specialist. You have to give up some activities and loads.
Only an integrated approach and constant attention can transfer flat feet from the category of acute problems to the category of potential health threats.
Flat feet is a deformation of the foot in which the arches of this area are lowered, which leads to a decrease in physical properties and complete loss of functions, in particular spring and shock-absorbing functions. Any of the arches of the foot can become deformed, and the type of disease depends on this, that is, longitudinal and transverse flat feet are distinguished.
Doctors distinguish between acquired and congenital diseases, and today almost 50% of all adults suffer from this disease. What is transverse flatfoot and why does this disease appear in humans? These are the questions that arise in people who are faced with this disease for the first time and are looking for the most effective method of treatment.
Most often, flat feet are diagnosed in women, but also a huge number of representatives of the stronger half of humanity experience difficulties and discomfort from this disease.
The types of flat feet are defined at a scientific level, and you must know what the disease looks like, which will give you the opportunity to consult a doctor in a timely manner for an accurate diagnosis and treatment.
The disease has a pronounced nature, that is, you can independently identify the disease, and how to determine flat feet at home, you will find out below.
With the disease, the appearance of the foot almost completely changes, both along the inner and outer edges.
It should immediately be noted that longitudinal transverse flatfoot, if treatment is refused, can cause the appearance and development of diseases such as arthritis, arthrosis of the joints (hip and knee).
Severe pain in the back and spine, as well as general malaise, may also occur.
Your doctor can tell you in more detail how to check for flat feet, so it is recommended that when the first signs of the disease appear, you consult a professional, which will allow you to make an accurate diagnosis in a timely manner.
When diagnosing, the type of flatfoot is necessarily determined, which makes it possible to choose a method for treating transverse flatfoot in adults. Your doctor will tell you in detail how to treat transverse flatfoot, but you need to understand that the foot is a natural shock absorber that protects the body from shaking that occurs when moving.
This organ is also necessary for maintaining balance, and it is the two arches of the foot that fully perform these functions. If the ligamentous muscles weaken, which not only causes a change in the appearance of the foot, but also the appearance of pathologies, and before starting treatment it is necessary to determine what type and degree of flatfoot is found in a person.
Before using the help of a doctor, you need to find out how to determine transverse or longitudinal flatfoot, and be sure to determine the degree of the disease. A particularly common type is the transverse type of the disease, and transverse flatfoot can be determined even while at home.
In this condition, the foot shortens, external changes in the inclination of the big toe appear, and the middle finger bends as much as possible, that is, external signs will be as obvious as possible. This means that it is not so difficult to recognize flat feet, but after this you need to immediately consult a doctor for treatment recommendations.
By contacting a doctor who will decide for himself how to check for flat feet, you can be sure that a visual examination of the foot will be carried out. An x-ray will be taken in two different projections, and the method of plantography and podometry is also used for diagnosis, which give the most accurate result.
The doctor will pay attention to the angles of deviation of the foot, features of shoe wear, and muscle reactions to physical activity. Only an accurate diagnosis will reveal the type of disease and its stage, which will make it possible to select the most effective course of treatment.
Many people have a question: how do you know if you have flat feet? This question can be easily answered if you:
Discomfort can even spread to the spine, making movement and life quite painful. Each stage of flat feet can provoke the development of the next stage, which is more negative and painful. How to check whether you have flat feet or whether your shoes are simply uncomfortable to wear?
The disease develops quite quickly, and you will feel discomfort even when wearing soft slippers. In addition, you will see protruding bone and deformed toes, which entails a complete change in the appearance of the foot.
At the initial manifestations of the disease, a person will quickly get tired when walking, which will negatively affect all areas of activity. Pain will appear in the area of the feet and lower leg muscles, which will lead to the inability to maintain a sports lifestyle, in particular to the inability to run.
Various physical activities will be difficult, and in the modern world a person cannot do without them, so the disease can negatively affect life. Of course, external changes in the foot will not make it possible to wear beautiful shoes, which is especially difficult for women, regardless of age, since they always want to look attractive.
To identify the disease while at home, you need to take a piece of paper and spread a thick cream on your foot, then make an imprint. If there are indentations on the inside of the print, the disease will most likely be diagnosed by a doctor.
You can also check by smearing your foot with a quick-rinsing dye, but only if you are not allergic to the components of the paint. After you check yourself or a loved one for flat feet at home, you will need to determine the extent of the disease, but only a doctor can do this.
According to many people, this disease is not dangerous, but this is absolutely not the case. If you or a loved one has been diagnosed with flat feet of degree 3 or 2, then it is mandatory to undergo a course of treatment.
Lack of proper treatment can lead to serious negative consequences, which can not only worsen the quality of life, but also lead to disability and pose a danger to life.
Treatment consists of an integrated approach, which includes pain relief, as well as strengthening the muscle tone of the foot. The sooner treatment is started, the faster you can achieve a positive result in the shortest possible time.
During treatment, it is mandatory to wear orthopedic shoes, which is also required for the prevention of flat feet.
When diagnosing the disease at the initial stage, you can use orthopedic insoles, which give almost the same positive results as wearing orthopedic shoes.
Such insoles can even be used with high-heeled shoes, which is especially important for women who want to look beautiful and attractive in any situation. This question is very relevant, because it is women who most often experience flat feet, in particular, almost 50% of women suffer from the disease described.
The symptoms of transverse flatfoot, which have been discovered, are expressed not only in changes in the foot, but also in painful sensations. To relieve pain, it is recommended to use painkillers, which can be selected by a doctor individually.
The treatment complex includes physical exercises that should be performed on a regular basis. Such exercises are aimed at strengthening muscles and improving their tone, which is important in the process of improving health.
Recently, foot massage has been actively recommended, which has been proven to be an effective method.
You can ask your orthopedic doctor for complete information about the symptoms and treatment of flat feet, and it is this specialist who should be contacted if initial signs or suspicions of this disease appear.
Massage is quite effective in the treatment process, and both a specialist and the patient can perform it independently. In the second case, you can significantly save time and money, which is important in the modern world for everyone.
When massaging, you should do the following:
The duration of the entire process should be about 20 minutes daily, which will allow you to get a positive result. Treatment can be carried out on an outpatient basis, that is, the patient will not need to disrupt or change his life schedule, and the presence of the disease and the process of your healing will not be noticeable to the people around you.
After the course of treatment is completed, you will be able to carry out preventive procedures regularly or even on an ongoing basis, which will eliminate the occurrence of complications and relapse of the disease.
If the symptoms in adults are not severe, then it is quite possible to try treating the disease at home using folk methods. This choice should not be used to treat children, that is, for children with flat feet, you need to strictly follow the recommendations of a doctor who will correctly diagnose the disease and also individually select an effective treatment that gives a positive result.
The ideal is to carry out water procedures that do not take a lot of time and will only bring pleasant sensations. Please note the possibility of using a decoction of oak bark, in which 100 grams of dry matter is poured into 0.5 liters of boiling water to boil for thirty minutes.
Then you need to strain the broth and cool it to a temperature comfortable for a person, and you can steam your legs for any amount of time, which will make the procedure quite pleasant and relaxing.
Salt baths are welcome, and it is better to give preference to iodized or sea salt, which can more favorably influence a person’s overall health. One spoon of salt is added per liter of water, after which the broth is boiled and cooled to a comfortable temperature.
It is also possible to use infusions with sage, chamomile and pine needles to combat the disease, it is important that the degree of flat feet does not affect the choice of decoction, you just need to take into account the possibility that the patient is allergic to certain substances included in the infusion.
Such infusions help not only relieve pain and eliminate discomfort, but also eliminate the inflammatory processes that occur in the human body during the development of this disease.
In addition, such baths can improve the general health of a person who has been diagnosed with one degree or another of flat feet. Of course, traditional medicine cannot completely get rid of the problem, but it can have the most positive effect on health, which means that in case of such a disease it is imperative to consult an orthopedic doctor.
Today, measures to prevent flat feet allow a person not only to avoid the development of the disease, but also to prevent its reappearance after a course of treatment.
In case of such a disease, it is imperative to take a competent approach to choosing shoes, and you need to learn how to choose shoes from the beginning, which will help you make the right decision and thereby make your life as easy and comfortable as possible, even in the presence of the disease.
Treatment for transverse flatfoot at home is quite common, and the correct approach to this issue will help get rid of the problem and significantly improve your health.
If you have already been checked for flat feet and doctors have identified the disease, you should first undergo a course of treatment, and only then engage in preventive procedures. In particular, you need to understand how to choose shoes for the comfort of your feet, you need to regularly walk barefoot, control the level of physical activity, and do gymnastics.
You can use orthopedic insoles for transverse flatfoot as an effective means for treating and preventing the disease. A set of exercises to prevent flat feet will be recommended by your attending physician on an individual basis based on the person’s current state of health, as well as other indicators.
Among the main exercises for the prevention of flat feet are:
This complex can be used not only in the process of prevention, but also during the treatment of the disease, so if you are prone to this problem, it is recommended to regularly engage in these exercises.
After treatment for grade 2 flatfoot and grade 3 flatfoot, preventive measures should be carried out regularly, which will avoid complications and the return of the disease. In principle, prevention methods are similar to treatment methods, so even if you are not prone to developing this disease, preventive measures will not harm, but rather improve your health.
The sooner you detect a disease and begin its proper treatment, the better results you can achieve in the minimum amount of time.
Flat feet is a foot deformity characterized by flattening of the arches. There are transverse and longitudinal flat feet; a combination of both of these forms with each other and with other foot deformities is possible.
Rice. 1. The relationship of the bones of the foot is normal (left) and with transverse flatfoot (right).
Rice. 2. The relationship of the bones of the foot is normal (above) and with longitudinal flatfoot (below).
Flat feet can be congenital or acquired. The latter can be static, traumatic, paralytic. Static flatfoot is one of the most common orthopedic diseases and is often bilateral; occurs due to excessive loads on the musculo-ligamentous apparatus of the foot. It is often an occupational disease among people whose work involves standing for long periods of time (postmen, hairdressers, conductors, counter workers, etc.). Predisposing factors: poor footwear, weakness of the foot ligaments and leg muscles, various diseases with poor circulation in the extremities - thrombophlebitis, endarteritis. Transverse flatfoot can develop as an independent deformity or in combination with longitudinal flatfoot and hallux valgus (see).
With severe degrees of flatfoot, the gait changes significantly, becoming awkward and constrained. A person walks with his legs wide apart and his feet turned out, his legs slightly bent at the knee and hip joints, and he swings his arms vigorously. In the evening, swelling of the foot may appear, disappearing overnight. An early sign of flat feet is aching pain in the foot, leg muscles, thigh, and lower back. Later, the foot becomes deformed - it lengthens, widens in the middle part, the longitudinal arch completely disappears, the heel deviates outward.
Rice. 3. Flat foot appearance. Rice. 4. Foot prints of normal (left) and flat (right).
The diagnosis of flat feet in severe cases is not difficult and can be made during a routine examination (Fig. 3). More accurate and objective data on the degree of flatfoot are obtained using special research methods. Imprints or outlines of the plantar surface of the feet are made (plantography). A normal foot gives an impression on paper of the heel, a narrow strip along the outer edge of the foot and its forefoot. With severe flat feet, the sole is completely imprinted (Fig. 4). Characteristics of the degree of flatfoot in digital indicators are given by podometry (see).
Rice. 5. Gymnastic exercises for flat feet.
Rice. 6. Inserting an insole-support.
Prevention of flat feet consists in ensuring high functional endurance of the musculo-ligamentous apparatus of the foot, which is achieved through a set of special and general strengthening physical exercises and rational selection of shoes. When standing for a long time, it is recommended to place your feet parallel and periodically stand on the outer edges of the foot. Shoes must strictly correspond to the size of the foot. Tight and excessively loose shoes are equally detrimental to the spring properties of the foot. The rational heel height is 3-4 cm.
Treatment of flat feet depends on the stage of the disease and clinical manifestations. Prescribe daily warm baths up to the knees, massage of the muscles of the foot and lower leg, and gymnastics. Gymnastic exercises should be regular, 5-6 minutes each, preferably several times during the day.
Gymnastics begins with walking barefoot with emphasis on the entire foot, then walking on tiptoes, squatting and walking on the outer edge of the foot. The exercises are completed with hops and jumps on the fingers (Fig. 5). Exercises are carried out with stretching the toes of the feet with the fingers resting on a stationary object, bending the toes of the foot pressed to the floor, grasping and lifting small objects from the floor with the fingers. It is recommended to walk barefoot on uneven ground, sand, climb a smooth pole, run, jump, and play football. A special insole is placed in the shoes - an instep support (Fig. 6), which raises the lowered longitudinal arch. The transverse arch can be raised by gluing to the insole, respectively the heads of the II-III metatarsal bones, a strip of soft rubber 2.5 cm long, 2 cm wide and 0.8 cm thick (in the middle part). For severe flat feet, special orthopedic shoes are recommended (see .). In severe cases of flat feet with persistent foot deformity, especially with traumatic flat feet, operations are performed on the ligaments and bones of the foot.
Flat feet (pes planus) is a deformity accompanied by flattening of the arches of the feet. When the longitudinal arch is flattened, they speak of longitudinal flatfoot (Fig. 1); when the transverse arch is flattened, it is called transverse (Fig. 2). Often, longitudinal flatfoot is combined with abduction of the forefoot, elevation of the outer edge, pronation of the heel, that is, valgus of the foot (pes plano-valgus). With a pronounced abduction of the forefoot they speak of pes plano-valgo-abductus.
There are five types of flat foot: congenital, rachitic, paralytic, traumatic, static.
Congenital flat feet are relatively rare. It is caused by malformations of the embryo, amniotic bands, underdevelopment or absence of the fibula, as well as other developmental defects.
Rachitic flatfoot is observed with rickets as a result of softness of the bones and their reduced resistance, as well as a general weakening of the muscular-ligamentous apparatus. The foot becomes pliable and, under the influence of body load, moves from a supination position to a pronation position, the forefoot abducts and the arches drop.
Paralytic flatfoot (Fig. 3) occurs in the vast majority of cases as a consequence of poliomyelitis. The degree of flatfoot depends on the degree of paralysis and the number of muscles involved. A flatfoot is formed after poliomyelitis, usually with paralysis of one or both tibial muscles with satisfactory function of all other muscles of the leg.
Traumatic flatfoot can be formed as a result of fractures of various tarsal bones, but most often it is a consequence of improperly healed Dupuytren-type ankle fractures.
Static flatfoot (Fig. 4) is the most common type of flatfoot. The main reasons for its occurrence are weakness of muscle tone, excessive fatigue due to prolonged standing.
Clinical picture and course. Early symptoms of flat feet include leg fatigue and pain in the calf muscles when walking and at the end of the day. Subsequently, increasing pain appears when standing and walking. In some cases, the pain is so severe that patients have difficulty moving on crutches or are forced to lie down. The pain is usually localized in certain places: on the sole in the arch area, in the area of the talonavicular joint and in the area of the lower leg muscles. With more severe foot valgus, pain occurs in the ankle area. Signs of pronounced flat feet: lengthening of the feet, widening them in the middle part, flattening of the longitudinal arch, pronation of the feet with the heels moving outward. When examining, special attention should be paid to the inner edges of the feet and the degree of flattening of their arches. Patients suffering from flat feet wear out the inside of the sole and heel of their shoes. To diagnose flat feet, plantography (see) and podometry (see) are also used according to the method of M. O. Fridlyand.
Rice. 4. Feet with static flat feet.
X-ray examination . Convincing objective signs of flat feet are obtained from radiographs taken with the foot loaded. In the lateral projection with longitudinal flatfoot, the heel bone is located parallel to the sole; the angle of the arch of the foot increases. The pathological statics of the bones of the foot with flat feet already early, even in adolescence, leads to osteoarthrosis in the tarsal joints. With congenital flatfoot, caused by a sharp vertical position of the talus, on a lateral radiograph of the foot, the joint space between the calcaneus and cuboid bones gapes widely, and the talus articulates with the scaphoid not with its head, but with its neck. Transverse flatfoot on plantar radiographs is manifested by a more pronounced than normal fan-shaped divergence of the peripheral parts of the metatarsal bones with increased distances between their heads. The transverse arch of the foot decreases in height, the heads of the metatarsal bones lie in a plane almost parallel to the plantar surface of the foot. Flatfoot should be differentiated from Morton's metatarsal neuralgia, as well as from osteochondropathy and zones of restructuring of the metatarsal bones, a partial prerequisite for which flatfoot may be. Treatment of congenital flat feet consists of massage and foot bandaging. For severe forms of this deformity, treatment with plaster casts with fixation of the foot in a varus position is indicated.
When flat feet begin, treatment consists of strengthening the muscles with warm baths, massage and gymnastics. Only if this treatment is unsuccessful can insoles-instep supports be used in preschool children. Rhythmic faradization of the tibial muscles gives a good effect. Patients should be prohibited from wearing soft or felted shoes. School-age children and adults are primarily treated with conservative treatment aimed at restoring the normal alignment of the foot, its arch and spring function. The patient must first be provided with appropriate orthopedic shoes with an arch insert and raising the inner edge of the heel.
For flat feet complicated by severe pain, treatment begins with the application of plaster casts in the supinated position of the feet. After the pain disappears, orthopedic shoes are prescribed (see Orthopedic shoes), which raise the inner edge of the heel and moderately perform the arch, massage, and gymnastics. In cases of failure, surgical treatment is indicated, which consists of manual redressing, and then tenotomy of the Achilles tendon and transplantation of the peroneus longus muscle to the inner edge of the foot.
In case of pronounced pes planovalgo-abductus, treatment should begin with the patient making properly fitted orthopedic shoes while simultaneously carrying out physical treatment methods. If orthopedic shoes do not bring relief, surgical treatment is resorted to. The operation begins with bloodless redressal (see) under intraosseous anesthesia or anesthesia; sometimes a tenotomy of the Achilles tendon is performed first. After restoring the arch by repositioning the head of the talus, the peroneus longus muscle is transplanted to the inner edge of the foot. If after this operation there is a tendency to relaxation, they resort to arthrodesis of the talonavicular joint.
In cases where bloodless reduction of the head of the talus is not possible, a part of its head and the adjacent articular surface of the scaphoid is resected for reposition, and a wedge-shaped resection of the talocalcaneal joint with the base of the wedge facing inward is performed to correct the pronation of the heel.
Instead of wedge-shaped resection, M.I. Kuslik recommended a more economical crescent-shaped resection - excision of a narrow crescent-shaped wedge behind the Shopard joint.
With pes plano-valgus contractus (flat foot), when the pain is intense and walking is impossible, treatment is reduced to calming the pain and moving the foot from a contractured pronation position to a supination position. In relatively mild cases, they are limited to complete rest, thermal procedures, and after the cessation of acute pain, when muscle contracture disappears, a removable plaster splint is applied for 10 days in the supination position.
For transverse flatfoot, treatment consists primarily of restoring the transverse arch by circular bandaging and unloading using orthopedic insoles using thermal procedures and massage. In cases of failure of conservative treatment, they resort to surgical tightening of the transverse arch with silk threads or nylon tapes.
For paralytic flat feet, shoes should be prescribed that support the arch and keep the foot from valving. At night, a plaster or plastic splint is recommended to hold the foot in supination and extension. Physiotherapy, balneological and drug treatment are prescribed. Surgical treatment consists of stabilizing the foot with subtalar arthrodesis and transplanting the peroneus longus tendon onto the scaphoid or first sphenoid bone. Subsequently, wearing orthopedic shoes is shown.
Prevention . Along with wearing rational shoes, it is necessary to include special physical exercises aimed at strengthening the neuromuscular and ligamentous apparatus of the feet.
The prevention and treatment of initial degrees of flat feet is also facilitated by walking barefoot on uneven ground, on sand and in a pine forest, where the “sparing reflex” operates.
Physiotherapy . In addition to the general health benefits, therapeutic exercises for flat feet are used to strengthen the ligamentous and muscular apparatus of the foot and lower leg, hold the arches of the feet in a certain position, and reduce fatigue during long walking. Special physical exercises for the foot, included in morning hygienic exercises, therapeutic exercise procedures are performed in various starting positions - lying, sitting, standing (Fig. 5). It is recommended to repeat each exercise 8-10 times. Various types of walking are very useful for flat feet: barefoot on sand, on toes, on heels, on the outside of the foot. Sets of special exercises for the foot should be repeated 2-3 times during the day, especially in breaks between work and long periods of standing.
Rice. 5. Therapeutic physical exercises for flat feet: 1 - simultaneous raising on the toes with maximum extension of the body upward; 2 - roll from heel to toe and back; 3 - transition to a standing position on the outer edge of the foot with subsequent return to the starting position; 4 - walking with the foot turning inward (“clubfoot”), raising on the toe at each step; 5 - alternately grasping various objects with your toes.
Flat feet are a fairly common pathology today. Not only children and teenagers, but even adults have to deal with it. At the very beginning, the disease is not accompanied by significant degenerative changes. As it progresses, many unpleasant symptoms appear. They become more pronounced already with longitudinal flatfoot of the 2nd degree. Are they allowed into the army with this diagnosis? This is the question that worries most patients. In today's article we will try to answer it, and also talk about the main methods of treating the disease.
This is a degenerative disease characterized by pathological descent of the longitudinal arch of the foot. As a result, its structure changes and its shock-absorbing properties deteriorate. Gradually, loads are redistributed to other areas of the supporting apparatus, which are not adapted to them by nature.
The disease manifests itself in the form of external displacement of the heel tendon. At the same time, the bone located in this area turns inward. The foot lengthens and its middle part widens. Occurring disorders contribute to the occurrence of pathological changes in muscle tissue. The blood supply and venous outflow systems cease to function fully.
Longitudinal flatfoot is a chronic disease of the supporting apparatus. It develops gradually, but always under the influence of certain factors. There are 3 degrees of pathology:
Determining the severity of the pathological process plays an important role. Without this parameter, effective treatment cannot be prescribed.
The army does not accept employees with this diagnosis, but only in some cases. Why? We'll talk about this below.
The initial stage of the pathological process goes unnoticed for most patients. The existing symptoms and visual signs are not sufficiently expressed. Therefore, many attribute leg pain to a consequence of ordinary fatigue. At the next stage, the clinical picture becomes more complicated, and the external deformation of the foot becomes more noticeable.
With level 2 flat feet, the prolapse of the arch of the sole can be seen with the naked eye. The pain syndrome increases every day, and the gait changes. The foot becomes more elongated. Shoes that previously fit in size have to be thrown away and new ones purchased.
How serious is this form of the disease? If you ignore its symptoms and do not treat it, the pathological process will continue to progress. The third degree is extremely difficult to tolerate and can provoke the occurrence of related ailments. It is advisable to stop at the second stage of the disease. Knowing its causes and main manifestations, it is possible to prevent further development.
Flat feet can appear at any age. The causes of its occurrence are usually associated with a person’s lifestyle, his daily loads and the shoes he prefers to wear. The longitudinal arch of the foot is considered a rather complex system. It is easy to damage this part of the supporting apparatus.
Longitudinal flatfoot of the 2nd degree most often develops as a result of excessive load on the arch of the sole. It can increase under the influence of the following factors:
One of the indirect causes of flat feet is the lack of physical activity. For example, in people with sedentary jobs, the arches and muscles of the feet gradually weaken. Therefore, the risk of developing the disease increases.
Longitudinal flatfoot of the 2nd degree is characterized by the appearance of severe pain in the legs. First, discomfort occurs in the arch of the sole, then moves to the heel or ankle. If at the initial stage of the disease the pain syndrome appears only after physical activity, then at subsequent stages it is constantly present.
Also among the symptoms of the pathological process, doctors identify the following:
In adolescents and children, grade 2 longitudinal flatfoot is much more pronounced. They may complain of back and lumbar pain. Other pathologies sometimes develop against the background of the disease. For example, arthrosis of the joints and osteochondrosis.
Most patients decide to seek help from a doctor when the disease has already progressed. Suddenly, shoes that fit just a few months ago become uncomfortable.
Diagnosis of pathology always begins with the study of complaints and the general clinical picture. Then they move on to instrumental examination methods. The classic option is radiography, which is performed in two projections with a load. Additionally, podometry and podography are prescribed. In the first case, the arch of the foot and its length are measured, and a number of related indicators are determined. Podography is necessary to evaluate parameters related to plantar biomechanics.
Based on the examination results, the doctor confirms or refutes the preliminary diagnosis, and also gives recommendations for eliminating the problem.
Pathological arch drop is a serious problem that requires constant monitoring. Sometimes you even have to limit the load on your sore legs. Do they take you into the army with this disease? It is not possible to answer this question unambiguously.
In case of mild forms of violation, the man is subject to service. Even bilateral longitudinal flatfoot of the 2nd degree and the army are compatible. On the other hand, if there are concomitant diseases, a young man may refuse to serve. A conscript with grade 2 flat feet and severe arthrosis is considered unfit. At the same time, concomitant pathology should also progress.
It is possible to completely return the foot to a healthy position only in childhood, when the foot is still developing. In this case, treatment of grade 2 longitudinal flatfoot is limited to wearing special orthopedic shoes and a course of exercise therapy. Such measures do not allow the disease to progress, and keep the foot muscles in good shape.
In adulthood, it is not possible to completely get rid of the disease. However, with the help of therapy, it is possible to stop its development and minimize the activity of symptoms. In adult patients, treatment consists of the following measures:
After confirmation of flat feet, it is necessary to constantly monitor the orthopedist and adjust the prescribed therapy. Physiotherapy and massage are not mandatory for this diagnosis. Sometimes they are recommended to get quick results.
You can do gymnastics at home. It is recommended specifically for bilateral longitudinal flatfoot of the 2nd degree. The treatment complex must be selected by a doctor. It is better to perform the first exercises under his supervision, and then you can move on to home practice.
For children, a standard exercise therapy course includes hopping and bouncing, and walking on toes. For adults, such exercises are ineffective. It is useful for them to grab objects from the floor surface with their toes and roll balls of different diameters.
The main rule is that such gymnastics should be regular. The exercises should be repeated several times during the day. This treatment of grade 2 longitudinal flatfoot will be even more effective if combined with other methods.
In case of grade 2 foot deformity, surgical intervention is not required. Its help is resorted to at the next stage of development of the pathological process, when conservative treatment does not produce results. There are many types of operations. The choice of a specific procedure is up to the doctor.
Surgery is also recommended if grade 2 longitudinal flatfoot of both feet has resulted in degenerative changes in the spine. However, such cases are extremely rare, especially if the patient started therapy in a timely manner.
Flat feet is a serious disease that must be treated promptly. Sometimes it is not limited to conservative treatment and requires surgical intervention. In order not to encounter such problems, you need to engage in disease prevention.
Doctors offer the following recommendations:
If initial symptoms of pathology appear, you should immediately contact an orthopedic doctor. Timely diagnosis and high-quality therapy are the key to a favorable prognosis.