Acquired longitudinal flatfoot
With this disease, deformation of the foot occurs with flattening of its longitudinal arch. The reasons for the development of longitudinal deformation of the arch of the foot are varied and depend on the state of the muscular-ligament-bone system, calcium content, and external influences.
Traumatic form of deformation - as a result of fractures of the bones of the foot and ankle joint, with damage to the soft tissues that strengthen the arch of the foot.
Paralytic deformity - develops due to paralysis or paresis of the muscles that support the arch of the foot. This foot deformation is typical for post-poliomyelitis, spastic paralysis, and spinal cord diseases.
Static deformation of the feet - develops as a result of overload of the foot. The reason may be a rapid increase in body weight (obesity, pregnancy), heavy physical work associated with stress, as well as the exhaustion of compensatory capabilities with age, with general atrophic phenomena (poor nutrition, prolonged fasting, etc.).
The diagnosis of longitudinal flatfoot is substantiated by a doctor based on data from a clinical examination, plantography and radiography. Patients pay attention to the appearance of fatigue in the lower extremities. Periodic pain in the area of the longitudinal arch of the feet, in the legs when walking, and towards the end of the day is also common. As the disease progresses, pain in the hips and lower back begins to bother me. As a consequence of gait disturbances, swelling of the feet and ankle joints appears, and arthrosis of the joints of the feet develops.
Surgical treatment of longitudinal foot deformity is used extremely rarely, in exceptional cases.
Treatment of longitudinal flatfoot is predominantly conservative, aimed at relieving pain and preventing the progression of foot deformity. Use warm foot baths with saline solutions, herbal decoctions, and foot massage. Therapeutic gymnastics is aimed at strengthening the muscular-ligamentous apparatus of the foot. These are exercises for flexion and supination of the feet, flexion and extension of the toes, using objects: a ball, a rolling pin, etc.
For severe pain, it is recommended to limit the load on the feet, often bed rest for 2-3 weeks, followed by foot massage and therapeutic exercises.
Physiotherapeutic procedures include paraffin and ozokerite applications, hydrocortisone phonophoresis, novocaine electrophoresis. It is necessary to regularly repeat courses of conservative treatment throughout the year.
People prone to developing flat feet are recommended to undergo bone desyntometry during periods of intense growth, weight gain, pregnancy, and menopause.
Preventive measures include therapeutic exercises. Exercises are used aimed at increasing the foot's endurance under load and strengthening the muscles involved in maintaining the arch of the foot.
Patients suffering from longitudinal flat feet are recommended to wear orthopedic shoes and orthopedic insoles, which allows them to create a position that is comfortable for the foot. For grade 3 longitudinal flatfoot, orthopedic shoes in the form of a lace-up boot are recommended.
Acquired transverse flatfoot The most common cause of the development of transverse flatfoot is a constant increased static load on the feet against the background of a constitutional predisposition, or less often due to injuries or diseases of the nervous system.
Transverse flatfoot is a consequence of insufficiency of the musculo-ligamentous apparatus, combined with functional weakness of the muscles of the foot and lower leg. However, the role of muscle weakness in the formation of transverse flatfoot remains controversial, since there are no muscles on the foot that bring the metatarsal bones together. Nevertheless, electromyographic studies have indicated primary changes in the functional properties of the muscles of the lower leg and foot during the development of transverse flatfoot.
Transverse flatfoot is clinically manifested by foot deformities. This is a lateral deviation of the 1st toe; osteochondral growths along the medial edge of the head of the 1st metatarsal bone; tension in the extensor tendons of the toes (under the skin, on the back of the foot); the appearance of skin calluses on the plantar part of the foot; so-called hammertoe deformity of the 2nd and 3rd toes.
With the development of foot deformity, constant pressure from shoes is placed on the medially protruding head of the 1st metatarsal bone, which is one of the reasons for the appearance of osteochondral growths along the medial edge of the bone and the development of bursitis of the 1st metatarsophalangeal joint. Lateral deviation of the 1st toe and hammertoe deformation of the 2nd and 3rd toes are more severely exposed to constant pressure from the edges of the shoe. The consequence of this is the formation of an ingrown nail of the 1st toe, the appearance of calluses on the area of the interphalangeal joint of the 2nd and 3rd toes.
a diagnosis of transverse flatfoot based on clinical examination, plantography and x-ray examination. Patients suffering from acquired transverse flatfoot usually complain of fatigue of the lower extremities when walking or standing for long periods of time. Also disturbing are periodically occurring pain in the heads of the 1st metatarsal bone, pain from the side of the sole, in the projection of the heads of the 2nd and 3rd metatarsal bones. All this causes difficulties in choosing shoes.
Treatment of acquired transverse flatfoot is usually conservative - aimed at eliminating pain and preventing further progression of foot deformity.
The complex of traditional conservative treatment includes: warm foot baths with saline solutions and herbal decoctions; therapeutic exercises and massage of feet and legs. Physiotherapeutic techniques used include ozokerite and paraffin applications, electrophoresis of drugs (novocaine solution, etc.), phonophoresis with hydrocortisone.
A variety of foot-correcting devices are also used: rubber cuffs worn on the forefoot; U-shaped spacers between the 1st and 2nd fingers; orthopedic insoles for constant wearing in shoes. For severe foot deformities, various types of orthopedic shoes are used.
For grade 1 transverse flatfoot, I usually use only conservative treatment methods. Since it is impossible to eliminate developed foot deformities using conservative methods, methods of surgical correction of the foot are also used, according to indications. In cases of 2nd and 3rd degree transverse flatfoot, accompanied by persistent pain, dysfunction of the foot (support and walking), progressive deformation of the foot, and the failure of conservative treatment methods, surgical treatment is used.
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Among all types of foot deformities, the majority are static deformities. They occur in different age groups, but predominate in adulthood and old age, and predominantly in women. Most often, patients who are bothered by pain and who, due to deformation, cannot use shoes, seek medical help. Static deformities include flat foot, valgus deviation of the first toe, hammertoes, etc.
Among all types of flat feet (traumatic, paralytic, post-strachitic), bilateral static flat feet occur in 82.1% of cases. It is believed that this pathology is caused by hereditary-constitutional weakness of the antagonist muscles of the leg and foot, ligaments and bones. The causes of flat feet can be various static-dynamic factors, but mainly it is physical overload of the feet due to prolonged standing (salesmen, mechanics, etc.), especially with excess body weight and age-related muscle atrophy. In young people, the occurrence of this deformity is facilitated by professional excessive rotational movements in the joints of the mediotarsal area of the feet with a weak, insufficiently trained muscular-ligamentous apparatus.
Patients complain of foot pain at the end of the working day, which decreases after rest. On examination, the foot is elongated, widened in the mediotarsal area, slightly pronated, and its longitudinal arch is lowered. The patient's gait is abnormal. The navicular bone protrudes on the inner surface of the foot in the form of a tuberosity. On the sole, an expanded load-bearing area of the midfoot is visible on the roughened epidermis. It is especially well determined using a subgram - an imprint on paper of the painted sole, when the patient stands only on this leg.
During palpation, painful points are determined, which, as a rule, are localized in the center of the arch and at the bones, sometimes between the heads of the metatarsal bones. If there is static arthrosis deformans, you can feel the marginal growths of the scaphoid bone, pain and limitation of movements in the Chopart and Lisfranc joints. Sometimes plantar nerve neuritis occurs. The degree of arch drop can be determined using the Friedland submetric index. To do this, the distance from the arch of the foot (in the projection of the navicular bone) to the floor in millimeters must be multiplied by 100 and divided by the length of the foot in millimeters. Normally the index is 31-29. If the foot is flat, the index is lower, and if it does not reach 25, this indicates significant arch depression.
The diagnosis is clarified using x-rays, and the degree of arch prolapse is determined on x-rays. For an objective determination, the radiograph should be taken with full weight-bearing of the foot in a standing position. There are various methods (Beler, Kuslik, Gorbunov, etc.) for determining the angles based on the ratio of the metatarsal and calcaneal bones on a profile radiograph of the bone. According to Gorbunov, two lines are drawn: one from the middle of the block of the supracalcaneal bone (from its articular surface) to a point on its support, the second - from the same point to the upper surface of the sesamoid bone of the finger. Normally, this is an angle of 90°. Flat foot I degree is when the angle is about 100 °, II - 110 °, and when the foot is completely flat - 120-125 °.
Both prevention and treatment of patients with flat feet of I-II degrees include:
1. Use rational shoes, which should be selected according to the size and shape of the foot. The sole should have an elastic instep support on a medium (for women 3-4 cm) heel. They do not allow you to wear shoes with soft elastic rubber soles (sneakers, sneakers, rubber boots, etc.). If there is no proper padding in shoes, patients are recommended in-line instep supports, mass-produced or manufactured individually at prosthetic factories. Arch supports should be used constantly, even while wearing slippers.
2. Strengthening the muscles of the foot, for which patients are given a massage and a special set of physical therapy exercises (it is recommended to walk on your toes). In summer, patients are advised to walk barefoot on rough ground or gravel surfaces (beaches), which cause irritation and reflex tension of the foot muscles. Muscle faradization is recommended.
3. Surgical treatment, if conservative therapy is ineffective, the pain does not decrease and arthrosis deformans progresses in the Chopart and Lisfranc joints. After appropriate correction of the foot using staged plaster casts, the peroneus longus tendon is transplanted to the inner edge of the foot, suturing it to the navicular bone. Sometimes tenotomy and transposition of the calcaneal tendon are performed. In case of an inflexible, rigid foot (the bony form of the flat foot), which is caused by arthritic changes between the bones of the foot, operations are performed on the bones of the foot. Depending on the shape and degree of deformation, wedge-shaped resection of the foot, crescent resection according to the method of M. I. Kuslik, etc. are performed.
If the flat foot is combined with valgus deviation of the heel, subtalar resection, wedge-shaped transplantation according to Perthes, etc. are used. Surgeries on bones give the greatest lasting positive results. After them, patients should use orthopedic shoes.
Transverse splayed foot most often occurs in women over 35 years of age. The cause of this pathology was seen in the deviation of the first toe due to walking in dress shoes (vestimentary theory). However, numerous examinations of people and clinical observations have established that transversely splayed foot occurs in adolescents and men who do not use such shoes. The theory of muscle weakness, which is also reliably proven in the case of longitudinal flat foot, was not confirmed.
Due to the fact that the metatarsal bones are connected to each other only by connective tissue structures, transverse flatness is associated with insufficiency of the aponeurosis of the sole and the ligamentous apparatus, caused by static factors. G. A. Albrecht believed that the key to this pathology is in the joints between the metatarsal and metatarsal bones; The I metatarsal bone is adducted and rotated, the V is abducted, and the II-IV bones, as a rule, remain in place. Dislocation of the sesamoid bones occurs in the metatarsal-sesamoid joint.
It has been proven that the heads of the metatarsal bones, in fact, do not form a transverse arch and not with all flattening of the foot, corns are formed in the area of the heads of the II-III bones.
As a result of adduction of the first bone, the thumb moves outward, accompanied by gradual subluxation. Without foot spread, there is no valgus deviation of the first toe, and the degree of deviation depends on the degree of foot spread. This pathology is usually bilateral. Patients complain of pain in the area of the callus on the sole in the projection of the heads of the metatarsal bones II-III or caused by bursitis on the side of the formed exostosis of the head of the first metatarsal bone. On examination, a classic foot deformity is detected.
Conservative treatment is recommended for the initial form of foot deformity. Patients are prescribed orthopedic shoes of various designs or shoe inserts with a special “pear” or Seitz roller to relieve the transverse arch. For this purpose, it is also recommended to carry out transverse bandaging of the distal foot and other means. Patients are prescribed baths, massage, and for bursitis, anti-inflammatory drugs.
However, conservative remedies are symptomatic therapy and do not eliminate the root causes, therefore, surgical treatment methods are used, of which there are more than a hundred. In clinical practice, not all are used, but only palliative and more radical ones. Palliative measures include burectomy and knocking down the exostosis of the head of the first metatarsal bone (according to Schade), which alleviate the patient’s condition, but do not eliminate the root causes; relapses often occur.
Resection of the head according to Gitter also gives unsatisfactory results, since the static-dynamic conditions of the foot change, and pain occurs due to load redistribution. However, marginal resection and modeling of the head (arthroplasty) in older people gives satisfactory results.
Pathogenetically based operations include those that eliminate adduction of the first metatarsal bone and valgus deviation of the first toe.
G. M. Kramarenko (1956) proposed suturing the first and fifth metatarsal bones together in the area of the necks from the side of the sole with silk or lavsan threads or ribbon. This operation is supplemented by knocking down the exostosis and capsuloplasty with the removal of the first finger to its normal position, which gives good results. The disadvantage is the complication - resorption of the bone sore and pathological fracture of the neck.
Osteotomies of the first metatarsal bone are more effective - perforated according to K. M. Kocheva, wedge-shaped according to Logroshino, B. K. Babich, which after adduction and fusion of the bone do not have a tendency to relapse. As a rule, osteotomy is combined with knocking down the exostosis and capsuloplasty.
Pathogenetically justified is also the operation to eliminate subluxation of the sesamoid bones by capsuloplasty and plastic movement of the tendons.
Hammer toes almost always accompany a complex foot deformity, and are very rare on their own due to congenital pathology. They are more often combined with a transversely spread foot and valgus deviation of the big toe, with foot deformities due to cerebral palsy (Little's disease), myelodysplasia, etc. The formation of a hammertoe is explained by increased tension of the extensor muscles of the finger and passive hyperextension of the flexors. Hyperextension of the proximal phalanx of the finger and maximum flexion of the middle and distal phalanges occur.
The main reason for a patient to see a doctor is pain due to pressure on the head of the proximal phalanx of the toe from normal shoes or due to secondary deforming arthrosis.
Conservative treatment of patients with hammertoes is ineffective. The goal of surgical treatment is to eliminate hyperextension of the proximal phalanx and flexion in the interphalangeal joints. In the pre-arthrosis stage and mobile phalanges, transplantation of the flexor hallucis longus to the proximal phalanx is used.
For persistent contractures and arthrosis, resection of the heads of the proximal phalanges or arthrodesis is performed after resection of the interphalangeal joint. Sometimes resection of the diaphysis of the proximal phalanx is used. All these operations, as a rule, are a complement to surgical treatment for valgus deviation of the first finger. For neurogenic deformities, S. F. Godunov crossed the tendon of the flexor digitorum brevis.
A calcaneal spur is a spiny exostosis (osteophyte), which is located on the side of the sole and, as a rule, does not manifest itself clinically.
The occurrence of heel spurs is associated with flat feet, chronic and acute trauma, various infections, inflammation, neurotrophic disorders, etc. It is plausible that the spur is an ossifying fibrositis of the aponeurosis of the sole of the tendons at the site of their attachment to the calcaneus. The appearance of pain can be explained by excessive trauma to the soft tissues of the spur area - post-traumatic aseptic inflammation of the tissues. The pain when putting weight on the heel can be very sharp—it “stands on a nail.”
During examination, the patient holds his leg in a forced position, steps on the outer edge of the foot or walks on his toes. During palpation, only the point of maximum pain is determined, because the spur has no other clinical signs. The diagnosis is confirmed by x-ray.
1) unloading of the heel (in the acute period - bed rest, and then - special perforated felt lining of shoes so that when the heel is loaded there is no pressure on the spur);
2) physiotherapy and balneotherapy (UHF, paraffin, ozokerite therapy, novocaine electrophoresis, etc.);
3) injections of novocaine (2 ml of 1% solution), hydrocortisone (1 ml) with an antibiotic into a sore spot with an interval of 4-5 days
4) sessions (2-3) of anti-inflammatory radiotherapy.
If conservative treatment is ineffective and pain recurs frequently, the spur is removed.
Valgus deformity of the feet - this diagnosis is made by an orthopedist for some children in the first years of life . With early detection and treatment of pathology, the probability of complete correction of the foot approaches one hundred percent; in advanced cases, the child will develop many problems with the spine in later life.
In a normal position, any person, including a child, has feet parallel to each other. While taking steps, parallelism is maintained, with the main load falling on the area under the toes and the heel.
With the development of hallux valgus in children, the load when walking falls on the inner part of the foot, while the outer part is raised, the little toe does not rest on the floor, but is in a “suspended” state.
It is at this time that the prerequisites for improper formation of the foot and the lack of preventive measures can lead to an advanced stage of hallux valgus.
Hallux valgus deformity can be congenital or acquired . Congenital pathology occurs rarely; much more often the disease is detected in the second year of life. The main causes of hallux valgus in children include:
Orthopedists use a certain classification of hallux valgus, based on the causes of the pathology:
According to the severity of the disease, the disease is divided into several degrees:
You can learn from our article why hallux valgus is dangerous and what measures should be taken first.
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Parents may suspect hallux valgus in children based on the following signs:
If you suspect a foot pathology, you should consult an orthopedist. The doctor makes a preliminary diagnosis based on an external examination; a number of examinations are carried out to confirm:
To exclude congenital or acquired pathologies of the central nervous system, the doctor prescribes an examination by a pediatric neurologist . It is also necessary to visit an endocrinologist and surgeon.
The main goal of treating hallux valgus in children is to restore the normal, anatomical position of the foot. In the first degree, it is enough to wear orthopedic shoes, massage courses and constant physical education, all this allows you to strengthen the muscular-ligamentous apparatus.
Identification of more severe degrees requires long-term complex treatment.
Conservative treatment methods include:
Surgical intervention to correct hallux valgus in a child is resorted to in rare cases and only if all the treatment measures are ineffective:
After arthrodesis operations and surgical interventions using the Dobbs method, the recovery period can take up to six months.
During this time, it is necessary to wear orthopedic shoes, braces, shock wave physiotherapy can increase blood circulation in the feet.
After six months, you can start playing sports and regular physical activity.
If left uncorrected, hallux valgus deformity leads to:
Preventing the development of hallux valgus is not so difficult. Parents should follow these guidelines:
If you suspect an incorrect position of the leg, you should definitely contact an orthopedist; in the early stages, the pathology is corrected within a few months.
All adults love to watch how funny kids stomp. However, upon closer observation, it becomes clear that all the little ones stomp differently. Looking at the first steps of their child, parents sometimes wonder if everything is okay with his gait, whether he steps on his feet correctly.
The fears are quite understandable, because tiny legs under the influence of new loads can undergo pathological changes. We will talk about one of them - hallux valgus - in more detail.
It is very difficult to confuse valgus deformity of children's feet with something else. She looks too typical. Hallux valgus is a deformity of the legs in which the toes and heels move to the outside, and the inside of the foot “collapses.”
If your legs are straightened at the knees and pressed tightly against one another, then the distance from one ankle to the other will be more than 4 centimeters. Visually, it looks like the letter X, which is why hallux valgus is often called X-shaped.
In childhood, such orthopedic pathology is common. Moreover, in most cases, valgus curvature is accompanied by a decrease in the height of the arches of the feet, that is, flat feet. This combined pathology is called “flat-valgus foot.”
With an X-shaped curvature of the feet, the metatarsal joints are flattened, which leads to deformation of the forefoot and toes. Tendons and ligaments begin to work with greater amplitude than they should, which cannot but affect the baby’s well-being and his gait. Normally, the child’s feet should be parallel to each other, and the same parallelism should be visible in the first steps.
With hallux valgus, the load falls on the inside of the foot, and not the area under the toes and heel, as nature intended. The little toes are thus practically “hanging” in the air, and the shock absorption of the foot is impaired.
A child’s feet can become deformed even during intrauterine development of the fetus. The likelihood of such a pathology is influenced by the mother’s metabolism and the characteristics of the gestation period.
In fact, congenital pathology is quite rare . Much more often, orthopedists are forced to diagnose acquired valgus curvature. To understand why such a deformity develops, you should understand that the ligaments and tendons of babies are very weak, because in the first year of life there is no load on the lower limbs.
Closer to the year, when the baby begins to stand on his feet, the deformation becomes obvious. It most often affects children with weakened muscles and overweight children. Heavy stress on weak legs can lead to an X-shaped deformity.
Often, after a year, pathology is detected in children who were born prematurely, with low weight, in babies weakened by frequent diseases of infectious and non-infectious origin, as well as in children with congenital weakness of connective tissue.
A disease such as rickets can affect the development of acquired hallux valgus . When it occurs, mineral metabolism in bone tissue is disrupted, which creates the preconditions for the development of various disorders of the musculoskeletal system. Quite often, hallux valgus deformity develops in children suffering from cerebral palsy and other ailments with neuromuscular symptoms.
Much less often, pathology can arise as a consequence of injury associated with rupture of tendons, muscles, fractures of the foot, leg, in which the child was forced to spend a long period of time in a cast.
Doctors note with regret that often the cause of the disease lies in parental mistakes . Sometimes mom and dad want to see their child grow up so much that they put him on his feet too early. Walkers and jumpers, in which a child is placed until the age of 9-10 months, and other verticalizing devices, unfortunately, only contribute to the incorrect position of the feet and an excessive load on the spine.
After the baby begins to walk, there remains a risk of developing hallux valgus if the baby takes his first steps in incorrectly selected, uncomfortable shoes. An example of such shoes are booties. They do not secure the foot, are too soft, and the baby’s foot at first needs additional fixation and support.
Whatever the reason, the processes are approximately the same - the ankle will move inward, “pushing out” the outer part of the foot, toes and heel, forcing them to take a position of rotation towards the outer side.
Congenital hallux valgus deformity becomes visible to the naked eye already in the first months of a child’s life. The foot is unnaturally curved inward.
Parents usually find themselves faced with the fact of acquired X-shaped foot when the child is one or one and a half years old. By this age, babies begin to walk, and some signs can be seen even without being an orthopedic doctor:
Over time, the feet take on a characteristic shape resembling the letter X, and the child’s gait is clumsy, uncertain, and shuffling. The baby gets tired quickly, cannot play for a long time, and has difficulty in outdoor and active games. Aching pain appears in the legs and spine; in the evenings, parents may notice slight swelling of the lower extremities.
A child with an X-shaped curvature of the feet cannot run like his peers. It is running that is most difficult for him; parents can pay attention to the fact that when trying to run, the baby swings his arms wildly, trying to maintain balance.
Shoes wear out in those places that bear the main load when walking, usually the inside of boots and sandals wears out.
Hallux valgus may vary significantly between children. So, there are several main types of this pathology:
Much in correction and prognosis depends on the degree of pathology. To visualize the criteria for assessing degrees, the child should be placed upright with his knees straight.
Normally, two parallel straight lines can be drawn from hip to heel along the back of the legs. With hallux valgus, the lines will be refracted in the area of the ankle joint. The angle of refraction will determine the severity of the pathology:
If parents notice that the baby’s feet are “squinting” inward, they should definitely visit an orthopedic doctor who can confirm or refute mom and dad’s fears. But even if nothing in the baby’s gait alarms the parents, the pathology can be identified by an orthopedic surgeon during a routine medical examination or during a commission when registering the child in a nursery.
A visual examination by a specialist alone is not enough to establish such a diagnosis. A special examination is required. It includes:
Only on the basis of the images obtained and a study of the morphological properties of the foot and the distribution of the load when walking will an orthopedic surgeon be able to make a final conclusion about the presence of hallux valgus, its type and degree, after which appropriate treatment will be prescribed.
Today, the most common pathology in orthopedics is considered to be hallux valgus. A manifestation of this pathology is the deviation of the thumb towards the adjacent fingers. This has an unsightly appearance, and all the structures of the foot - joints, bones, ligaments and tendons - undergo changes. However, the pathology is not limited to just the curvature of the big toe and the appearance of a pronounced bone on the inside of the foot. Other orthopedic diseases may also occur, such as chronic bursitis, deforming arthrosis, flat feet (transverse or combined) and others. Why does this pathology occur and how to deal with it? This remains to be seen.
Bunions can appear due to several factors: genetic predisposition or inflammation in the joints and ligaments. Bunions can also be a complication due to flat feet or club feet.
Most often, females over 30 years of age suffer from this pathology. This is due to the fact that it is women who love to wear beautiful, although not always comfortable, shoes, which can be too narrow or with high heels. Toes in such shoes are forced to spend a lot of time in an unnatural position, which can cause bursitis of the big toes. And when the foot is constantly curved in the same place, a bump appears there over time. It causes discomfort and women feel pain.
Other causes of foot deformities include:
Traumatologists and orthopedic doctors, depending on the cause of the appearance of hallux valgus deformity, name the following types:
According to the severity of the hallux valgus deformity, three different degrees are called - mild, moderate and severe.
In order to identify a developing pathology in time, you need to know what symptoms accompany the initial stage of deformation, as well as all subsequent ones.
At the initial stage of deformation:
In the middle stage of the disease
At the next (advanced) stage of the disease
This disease in childhood is visually manifested in the fact that while walking the child steps on the inside of the foot. In children, foot deformities appear early after birth, already by the first year. And often this pathology is diagnosed by the way the foot looks. Parents who notice that their baby is walking by stepping only on the inside of the leg should immediately visit a doctor. In addition to this symptom, you can notice others: an awkward gait, shuffling when walking, unsteady steps, rapid fatigue from walking. All of these symptoms appear at the initial stage of the disease, and the disease itself appears a little later.
A pediatrician can make a preliminary diagnosis, but to make sure of it, he can refer the child for a consultation with a pediatric orthopedist.
In addition, sometimes a final diagnosis may require radiography of the feet, computer plantography and podometry.
Why do children develop hallux valgus? As a rule, this disease can be from birth or acquired at a certain age. The congenital form develops while the baby is in the mother’s stomach. The acquired form occurs when at some point the development of the musculoskeletal system is impaired. Sometimes the development of foot deformities may be preceded by previous illnesses (bronchitis, pneumonia, ARVI). If a child is overweight, then deformation may occur due to dysplasia.
Pediatric doctor Komarovsky believes that hallux valgus should not be added to the list of serious diseases. If the therapy is chosen correctly, the disease can be cured without any problems. The main thing is to notice a deviation in your child as early as possible and take him to the doctor so that he can help straighten his gait. Just don’t be irresponsible and take the treatment of deformity seriously.
The first degree of the disease, according to Komarovsky, can be treated with conservative methods, and an advanced deviation that has become severe can only be cured surgically.
The doctor believes that the child’s development should take its course, so there is no need to rush and put a seven-month-old child on his feet, as this can provoke deformation of the feet. Already from the second month of life, the baby must receive sufficient vitamins, otherwise a lack of them can also provoke the development of this disease. Komarovsky urges parents to allow their children to walk around the house barefoot.
In this video, Dr. Komarovsky talks in detail about flat feet and the problems that arise as a result:
It is not difficult to completely restore JOINTS! The most important thing is to rub this into the sore spot 2-3 times a day.
X-ray of the foot is the main method of examining various pathologies of the foot and ankle, characterized by simplicity and speed of execution. Taking an x-ray does not require any special preparation. The main thing is that the body of the person being examined (except for the area being examined) must be protected with an apron that will reflect X-rays.
X-rays of the foot are performed in frontal and lateral projections. Projections from different angles (oblique) are required only in cases where the diagnosis cannot be made using these two. In addition, X-rays are also performed with a load on the foot.
Stress X-ray is an excellent way to identify various pathologies. It can be prescribed by surgeons, orthopedists and traumatologists. Each foot is removed separately, and at this time the patient is asked to stand on the leg being examined so that the entire load falls on it. In this way, the specialist receives information about the height of the arch of the foot and its angle, and can accurately diagnose the degree of longitudinal flatfoot.
Diagnosis of hallux valgus consists of several successive stages:
As a rule, patients with a similar problem complain of constrained movements, a feeling of heaviness after physical exertion, as well as aching pain in the forefoot.
Referral to additional diagnostic methods, which include:
Based on the results obtained during such a comprehensive examination, a treatment method for foot deformity will be selected for the patient.
When the examination has already been completed and the diagnosis of hallux valgus has been confirmed, you can begin treatment, but be patient in advance, since the treatment process will be long and very labor-intensive.
Treatment of this disease can be conservative or surgical. Conservative treatment is only suitable for the initial stage of the disease, but not in every case it can lead the sick person to a complete recovery. Most often, with timely initiation of treatment, it is possible to significantly slow down the progression of foot deformity and avoid surgery for a long time.
Conservative treatment methods include massage and exercise, wearing special orthopedic shoes, as well as treatment with medications. Each method should be discussed in more detail.
For this type of foot disease, therapeutic foot massage is a clear indication. You should definitely turn to professionals for help. Very often, an orthopedic doctor, setting himself the task of ridding his patient of foot deformities, prescribes him a course of massage, which consists of at least 10 sessions. It is recommended to repeat the course every few months.
If hallux valgus is still at the initial stage, then you can resort to self-massage of the foot. It can be done at home and without the help of a massage therapist. The foot must first be prepared by thoroughly steaming the feet in a bath or basin and drying them. To carry out self-massage, use a cream or other product for external use intended for rubbing into the skin of the foot. The massage always begins with the fingers and gradually moves to the foot.
The process of getting rid of foot deformities will be incomplete without performing special exercises. Exercise therapy is suitable for both adults and children. And although adults have fully formed bones in their legs, they will have to perform a set of exercises for a long time, but the result will please them. The main thing is to do them regularly and conscientiously.
There are no difficulties in exercises for patients with hallux valgus. To feel better, you need to set aside time for them every day.
A good effect in getting rid of foot deformities is achieved by wearing orthopedic shoes or insoles. But it is extremely important to make the right choice. So, when choosing shoes, you need to pay attention to its height, sole, the presence of an orthopedic instep support, as well as the material from which the shoes are made.
Shoes should be quite soft, with a wide toe, and the heel should not exceed 4 cm. A person wearing them should not feel pressure on the foot or any discomfort. He should feel free and comfortable in these shoes.
Good quality orthopedic shoes are quite expensive. But if you happen to encounter a foot deformity, then it is better not to skimp on your health and fulfill all the requirements of your attending physician. This will prevent even bigger problems from arising.
Medication therapy for hallux valgus involves the administration of hormonal drugs into the joint (Hydrocortisone or Diprospan). This is necessary in order to relieve inflammatory processes. And hormonal drugs do an excellent job of this task.
In addition, drug treatment for this pathology includes corticosteroids and the simultaneous use of anti-inflammatory drugs.
Surgical treatment is a drastic method; it is used only in the most difficult, advanced situations.
These include situations when a sick person cannot even stand on his leg and immediately feels acute pain. The bone grows to such a size that a purely physically ill person cannot put on shoes - their feet cannot fit into them. And there is only one option left - surgery.
Today this is not a problem, because there are about 150 surgical methods of therapy. The growths are removed for foot deformity of any stage. Years ago, operations were frightening because of their primitiveness and were really dangerous, since they had to cut down part of the phalanx or remove the head of the metatarsal bone. Today, thanks to modern methods, operations have low morbidity, and rehabilitation takes little time.
How is surgery performed for foot deformities? In its process, the metatarsal bone is put in place, the angle of the bones in the phalanx of the big toe is changed to the one that is normal, the tendons are moved, and the anterior arch of the foot is straightened. After the operation is completed, you can start walking in about a day. There are no casts or crutches. The patient is discharged from the hospital within 3-4 days. True, for some time he will have to wear orthopedic devices and not engage in physical activity.
In the most extreme cases, it will be necessary to cross the bones. The bones are fixed with special screws, which remain in the body forever. Rehabilitation will take one and a half months.
As for the prices for operations to eliminate hallux valgus, they add up and depend on various factors. So, in some regions they do not perform such operations at all, and in those where they do, prices for the same operation vary. So, surgery on 1 foot will cost an average of 25 thousand rubles, and on 2 feet – 30-40 thousand rubles. Also, the price of surgery depends on the severity of the foot deformity. The operation for a mild degree will cost an average of 38 thousand rubles, for a moderate degree - 48 thousand, and for a severe degree - 56 thousand.