Name of diseases, degree of dysfunction
Point “a” includes pathological equine, calcaneal, varus, hollow, plano-valgus and equino-varus feet, the absence of a foot proximal to the level of the metatarsal heads and others acquired as a result of injuries or diseases, irreversible, pronounced deformities of the feet, in which it is impossible use of established military footwear.
Point “b” includes:
Point “c” includes:
Point “d” includes longitudinal or transverse flatfoot of the II degree.
Absence of a toe is considered to be its absence at the level of the metatarsophalangeal joint, as well as complete abduction or immobility of the toe.
To determine the degree of post-traumatic deformation of the calcaneus, calculate the Böhler angle (the angle of the articular part of the calcaneal tubercle), formed by the intersection of two lines, one of which connects the highest point of the anterior angle of the subtalar joint and the top of the posterior articular facet, and the other runs along the upper surface of the calcaneal tubercle. . Normally, this angle is 20 - 40 degrees, and its decrease is characterized by post-traumatic flatfoot. The most informative way to assess the condition of the subtalar joint is its computed tomography scan, performed in the coronal plane, perpendicular to the posterior articular facet of the calcaneus. Transverse flatfoot is assessed by radiographs of the forefoot and midfoot in a direct projection, taken while standing on two legs under body weight. Reliable criteria for the degree of transverse flatfoot are the parameters of the angular deviations of the first metatarsal bone and big toe. On radiographs, 3 straight lines are drawn, corresponding to the longitudinal axes of the first and second metatarsal bones and the axis of the main phalanx of the first toe. With the I degree of deformation, the angle between the I and II metatarsal bones is 10 - 14 degrees, and the angle of deviation of the first finger from the axis of the I metatarsal bone is 15 - 20 degrees, with the II degree these angles respectively increase to 15 and 30 degrees, with the III degree - up to 20 and 40 degrees, and at degree IV - exceed 20 and 40 degrees.
Stage I deforming arthrosis of the foot joints is radiographically characterized by a narrowing of the joint space by less than 50 percent and marginal bone growths not exceeding 1 mm from the edge of the joint space. Stage II arthrosis is characterized by a narrowing of the joint space by more than 50 percent, marginal bone growths exceeding 1 mm from the edge of the joint space, deformation and subchondral osteosclerosis of the articular ends of the articulating bones. In stage III arthrosis, the joint space is not radiologically determined, there are pronounced marginal bone growths, gross deformation and subchondral osteosclerosis of the articular ends of the articulating bones.
Traditional treatment. Varus alignment of the feet (photo) in adults, which appears as a result of grade 3 hallux valgus, can be corrected at home (without surgery). The most effective technologies. Bunions on the feet (valgus deformity of the feet). The entire section “Orthopedics and Traumatology”. We were diagnosed with FLAT VALGUS FEET grade 3. They gave recommendations: insoles and arch supports; scenar therapy; massage.. - moderately severe deformities of the foot with minor pain and static disturbances, for which it is possible to adapt military-style shoes for wearing. ; - longitudinal flatfoot of the III degree without valgus placement of the heel.... After measuring all the obtained radiological parameters, the degree of valgus deformity of 1 toe is determined, and the issue of treatment tactics is decided accordingly. There are three degrees of deformation of the first toes. Degree of development of hallux valgus. Depending on the results of the examination, further treatment measures will depend. An orthopedic doctor can identify the following degrees of severity of the pathology. Plano-valgus feet are regulated by Article 68 of the Schedule of Diseases. Plano-valgus foot deformity is transverse flatfoot. Let's look at the requirements for exemption from transverse flatfoot of the 3rd degree.
Correction of hallux valgus in anyone? If this is a child, then this is the introduction of a kalix endorthosis into the subtalar joint (usually used in patients with cerebral palsy) with 5-7 The reason for this is transverse flatfoot. The degree is assessed using the Rg-gram. (total 3 degrees).. Causes of hallux valgus. The disease is based on weakness of bone and connective tissue, which provokes transverse flatfoot. 3rd degree: more than 18 degrees between the metatarsal bones, the first toe deviates by more than 35 degrees.. Hallux valgus in children is a foot defect characterized by a decrease in the height of its arches and an X-shaped curvature of the axis. 3rd degree – the angle between the metatarsal bones is more than 18 degrees, the angle of deviation of the first finger is more than 35 degrees.. Degrees. The difference in degrees of hallux valgus depends on the angle that changes between the first toe and the treatment. It is almost impossible to completely cure plano valgus deformity of the 3rd degree, but it is possible to do without surgery. Alternative treatment. Varus alignment of the feet (photo) in adults, which appears as a result of grade 3 hallux valgus, can be corrected at home (without surgery). The most effective technologies. The medical name for bunions sounds ominous: hallux valgus, or hallux valgus. With the third and fourth degree of foot deformity, there is a need for surgical treatment. Flat valgus foot deformity in a child. Rating 3.59 (49 Votes). An orthopedist’s diagnosis of “flat valgus foot deformity” in a child somewhat confuses his parents.. Hallux valgus deformity in children? How serious is this? The child’s body is actively growing, which determines the good mobility of the joints and the “softness” of the skeletal bones. During the period of time when the baby begins to walk independently, to a large extent... Traditional treatment. Varus alignment of the feet (photo) in adults, which appears as a result of grade 3 hallux valgus, can be corrected at home (without surgery). The most effective technologies. Traditional treatment. Varus alignment of the feet (photo) in adults, which appears as a result of grade 3 hallux valgus, can be corrected at home (without surgery). The most effective technologies
One of the most common foot deformities is hallux valgus (Hallux valgus). There are three degrees of deformation of the first toes.. Plano valgus deformity of the foot in adults can occur due to the following factors: Difference in degrees with valgus. It is almost impossible to definitively cure plane valgus deformity of the 3rd degree, but it can be done without surgery.. The problem of “bumps” and “bunions” on the feet, scientifically called “valgus foot deformity.” You must not ignore it, otherwise the problem will begin to progress. At this level, you can engage in prevention and save yourself from negative consequences.. The most common foot deformity is valgus deformity of the first toe - Hallux valgus, or the so-called bunions or bunions on the feet. There are three degrees of deformation of the first toes. Traditional treatment. Varus alignment of the feet (photo) in adults, which appears as a result of grade 3 hallux valgus, can be corrected at home (without surgery). The most effective technologies. 6. various foot injuries. Doctors distinguish three degrees of severity of planovalgus foot deformity: mild, moderate and severe. so-called (vertical ram, paperweight foot) – the most severe degree of deformation…. There are three degrees of hallux valgus, which are characterized by the severity of pain and the severity of external defects (the deviation angle of the big toe is respectively less than 20 degrees, from 25 to 35 degrees, more than 35 degrees). Hallux valgus is one of the most common orthopedic diseases today day, it manifests itself in a strong deviation 1st degree - deviation up to 15°; 2nd degree – 15-20°; 3rd degree – 20-30°; 4th degree – deviation more than 30°.. Examination of the musculoskeletal system. flat feet in children, transverse flat feet, flat feet correction, foot massage, flat feet 2 degrees, flat feet 3 degrees Hallux valgus - Duration: 51:59 Elena Malysheva 327 views.. Valgus deformity of the toes is nothing more than those same “bumps” and “bones” on the inside of the feet near the first toe, as they are popularly called. The need for surgical treatment appears with grades 3 and 4 of foot deformity. The orthopedist’s diagnosis of “flat valgus foot deformity” in a child somewhat confuses his parents. The meaning of the word “flat” is self-explanatory, but the second part of the name – “valgus” – requires clarification... And then the valgus deformity of the walking operation remains, protrusion and pronation of the entire foot. The therapeutic effect then, with apparently high degrees II and III of the elderberry scale of 1 toes, and this is important, but minimally invasive surgery is usually ineffective.
There are three degrees of valgus deformity of the first toe depending on the angle of deviation of the big toe. I'm worried about the congenital plano- valgus position of the feet of the 3rd degree . I was x-rayed and diagnosed on the right ankle joint with congenital valgus deformation of the foot with subluxation to the outside, hypoplasia of the talus, flatfoot of the 3rd degree on the right and the second degree on the left. Flat- valgus placement of feet 3rd degree . a hallux valgus is formed - flattening of the arch of the feet with deviation of the heel to. Flat valgus foot deformity (flatfoot) is. In case of II – III degree of deformity, along with the reconstructive stage on soft tissues, it is necessary to perform osteotomies of the first metatarsal bones. Surgery to correct hallux valgus is usually performed under local anesthesia. 3 . Stage of arthrosis in the metatarsophalangeal joint, 4. Hypermobility in the medial metatarsocuneiform joint, 8. Degree of longitudinal flatfoot. TRANSVERSE FLATFOOT, VALGUS DEFORMITY OF THE FIRST TOE ( Hallux valgus). Valgus foot deformity . Asks: Irina. Female gender. Valgus-about reviews Please tell me how effective the new product Valgus-Hypremobilnos.2x side flatfoot, 3rd degree ! . Traditional treatment. Varus alignment of the feet (photo) in adults, which appears as a result of grade 3 hallux valgus , can be corrected at home (without surgery). The most effective technologies. Hallux valgus deformity of the foot x-ray Hallux valgus exercises Hallux valgus in children , valgus foot , gymnastics for hallux valgus . There are 3 degrees of deformation of the first toes . Transverse flatfoot degree , hallux valgus , hammertoe deformity of 2-5 toes, metatarsalgia of 2-5 toes. What to do with hallux valgus ? Lat. hallux valgus or hallux valgus , treatment of which in grades not require any radical measures. At the initial stage of the disease. We have flat -valgus foot deformity . We have been wearing insoles since I was 2 years old. Hello Nina. My daughter (8 years old) was diagnosed with flat feet of 2-3 degrees . We don't have an orthopedic doctor. It was precisely to strengthen the muscles of the transverse arch that special gymnastics was developed for feet with hallux valgus . Currently, private clinics, in order to earn money, offer similar operations for the second degree of deformity
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Flat feet and other foot deformities
Disease schedule article
Category of suitability for military service
Flat feet and other foot deformities:
a) with significant impairment of functions
b) with moderate dysfunction
c) with minor dysfunction
d) in the presence of objective data without dysfunction
The article provides for acquired fixed deformities of the foot. A foot with increased longitudinal arches (115 - 125 degrees), when correctly installed on the surface with a supporting load, is often a normal variant. A pathologically hollow foot is considered to be a foot that has deformation in the form of supination of the rear and pronation of the forefoot in the presence of high internal and external arches (the so-called sharply twisted foot), while the forefoot is flattened, wide and somewhat adducted, there are calluses under the heads of the middle metatarsal bones and claw or hammertoe deformity of the fingers. The greatest functional impairments occur with accompanying components of deformity in the form of external or internal rotation of the entire foot or its elements.
Point “a” includes pathological equine, calcaneal, varus, hollow, plano-valgus and equino-varus feet, the absence of a foot proximal to the level of the metatarsal heads and others acquired as a result of injuries or diseases, irreversible, pronounced deformities of the feet, in which it is impossible use of established military footwear.
longitudinal III degree or transverse III - IV degree flatfoot with severe pain, exostoses, contracture of the fingers and the presence of arthrosis in the joints of the midfoot;
absence of all fingers or part of the foot, except for the cases specified in paragraph “a”;
post-traumatic deformation of the calcaneus with a decrease in the Böhler angle over 10 degrees, pain syndrome and arthrosis of the subtalar joint of stage II.
With decompensated or subcompensated longitudinal flatfoot, pain in the feet occurs in a standing position and usually intensifies in the evening, when their pastiness appears. Externally, the foot is pronated, lengthened and widened in the middle part, the longitudinal arch is lowered, the navicular bone is outlined through the skin on the medial edge of the foot, the heel is valgus.
deforming arthrosis of the first metatarsophalangeal joint, stage III;
post-traumatic deformation of the calcaneus with a decrease in the Böhler angle to 10 degrees and the presence of arthrosis of the subtalar joint.
Point “d” includes longitudinal or transverse flatfoot of the II degree.
Longitudinal flatfoot and hammertoe deformity are assessed using radiographs taken in the lateral projection in a standing position with full static load on the test foot. On radiographs, the angle of the longitudinal arch of the foot is determined by constructing a triangle. The vertices of the triangle are:
the lowest point of the head of the first metatarsal bone;
the lower point of contact of the bone surfaces of the navicular and wedge-shaped bones of the foot; the lowest point of the calcaneal tuberosity. Normally, the arch angle is 125 - 130 degrees. Flatfoot degree I: angle of the longitudinal internal plantar arch 131 - 140 degrees; II degree flatfoot: angle of the longitudinal internal arch 141 - 155 degrees; III degree flatfoot: the angle of the longitudinal internal arch is more than 155 degrees.
Longitudinal or transverse flatfoot of the first degree is not a basis for the application of this article and does not interfere with military service and admission to military educational institutions.
officers, midshipmen - IND
The article provides for acquired fixed deformities of the foot.
A foot with increased longitudinal arches, when correctly positioned on the surface under a supporting load, is often a normal variant. A pathologically hollow foot is considered to be a foot that has deformation in the form of supination of the posterior and pronation of the anterior section in the presence of high internal and external arches (the so-called sharply twisted foot), the forefoot is flattened, wide and somewhat adducted, there are corns under the heads of the middle metatarsal bones and clawed or hammertoe deformity of the fingers. The greatest functional impairments occur with concomitant eversion-inversion components of the deformity in the form of external or internal rotation of the entire foot or its elements.
Point “a” includes pathological equine, calcaneal, varus, hollow, plano-valgus, equino-varus feet and other irreversible, pronounced curvatures of the feet acquired as a result of injuries or diseases, in which it is impossible to use shoes of the established military standard.
longitudinal III degree or transverse III - IV degree flatfoot with severe pain, exostoses, contracture of the fingers and the presence of arthrosis in the joints of the midfoot;
absence of all toes or part of the foot at any level;
persistent combined contracture of all toes on both feet with claw or hammertoe deformity;
post-traumatic deformation of the calcaneus with a decrease in the Böhler angle over minus 10 degrees, pain syndrome and arthrosis of the subtalar joint of stage II.
moderately severe foot deformities with minor pain and static disturbances, for which standard military-style shoes can be adapted for wearing;
longitudinal flatfoot of the third degree without valgus position of the heel bone and phenomena of deforming arthrosis in the joints of the middle foot;
longitudinal or transverse flatfoot of the second degree with deforming arthrosis of the second stage of the joints of the midfoot;
deforming arthrosis of the first metatarsal joint stage III with limitation of movements within plantar flexion of less than 10 degrees and dorsiflexion of less than 20 degrees;
post-traumatic deformation of the calcaneus with a decrease in the Böhler angle from 0 to minus 10 degrees and the presence of arthrosis of the subtalar joint.
Point “d” includes longitudinal or transverse flatfoot of the I or II degree with stage I deforming arthrosis of the joints of the middle foot in the absence of contracture of the toes and exostoses.
Longitudinal flatfoot and hammertoe deformity of the calcaneus are assessed using profile radiographs in a standing position under load..
On radiographs, the angle of the longitudinal arch and the height of the arch are determined by constructing a triangle.
Normally, the angle of the arch is 125 - 130 degrees, the height of the arch is 39 mm.
Flatfoot degree I: the angle of the longitudinal internal plantar arch is 131 - 140 degrees, the height of the arch is 35 - 25 mm;
Flatfoot degree II: angle of the longitudinal internal arch 141 - 155 degrees, arch height 24 - 17 mm;
Flatfoot degree III: the angle of the longitudinal internal arch is more than 155 degrees, the height of the arch is less than 17 mm.
To determine the degree of post-traumatic deformation of the calcaneus, calculate the Böhler angle (the angle of the articular part of the calcaneal tubercle), formed by the intersection of two lines, one of which connects the highest point of the anterior angle of the subtalar joint and the top of the posterior articular facet, and the other runs along the upper surface of the calcaneal tubercle. . Normally, this angle is 20 - 40 degrees. Its decrease usually accompanies post-traumatic flatfoot. The most informative way to assess the condition of the subtalar joint is its computed tomography scan, performed in the coronal plane, perpendicular to the posterior articular facet of the calcaneus. Transverse flatfoot is assessed using radiographs of the forefoot and midfoot in AP projection, taken under load. Reliable criteria for the degree of transverse flatfoot are the parameters of the angular deviations of the first metatarsal bone and the first toe.
On radiographs, three straight lines are drawn, corresponding to the longitudinal axes of the first and second metatarsal bones and the main phalanx of the first toe.
With the I degree of deformation, the angle between the I and II metatarsal bones is 10 - 12 degrees, and the angle of deviation of the first toe is 15 - 20 degrees;
at degree II, these angles respectively increase to 15 and 30 degrees;
at grade III - up to 20 and 40 degrees,
at IV degree - exceed 20 and 40 degrees.
Stage I deforming arthrosis of the foot joints is radiographically characterized by a narrowing of the joint space by less than 50 percent and marginal bone growths not exceeding 1 mm from the edge of the joint space.
Stage II arthrosis is characterized by a narrowing of the joint space by more than 50 percent, marginal bone growths exceeding 1 mm from the edge of the joint space, deformation and subchondral osteosclerosis of the articular ends of the articulating bones.
In stage III arthrosis, the joint space is not radiologically determined, there are pronounced marginal bone growths, gross deformation and subchondral osteosclerosis of the articular ends of the articulating bones.
Longitudinal flatfoot of the 1st or 2nd degree, as well as transverse flatfoot of the 1st degree without arthrosis in the joints of the midfoot, contractures of the fingers and exostoses are not the basis for the application of this article, and do not interfere with military service, admission to military educational institutions and colleges.
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3.3.3. CONGENITAL FOOT DEFORMITIES
Congenital clubfoot. Equivarus clubfoot Q66.0.
According to WHO estimates, more than 100 thousand children worldwide are born with congenital clubfoot every year. 1-4 cases per 1000 live births. It ranks 3rd in frequency (about 35.8%) after hip dysplasia and muscular torticollis. The deformity is 2-3 times more common in boys (68%) than in girls, and can be unilateral or bilateral (38-40%). In 10-30% of cases, a combination of congenital clubfoot with congenital malformations is observed: congenital hip dislocation, congenital torticollis, syndactyly, patent hard palate, amniotic bands of various locations.
The causes of congenital clubfoot are very diverse and have not yet been sufficiently studied. Currently, congenital clubfoot is considered a manifestation of a pronounced dysplastic development process of the whole organism with a predominant lesion of the foot and lower leg, where, depending on the severity of the deformity, underdevelopment of the bone, muscular and neurovascular systems prevails to varying degrees. Clubfoot can be either an independent pathology or accompany a number of systemic diseases (arthrogryposis, Freeman-Sheldon syndrome, Larsen syndrome, etc., and also have a neurogenic etiology with malformations of the lumbosacral spine). Occurs with a congenital defect of the tibia. This may be a true contracture of the joints of the foot, more often in boys it is bilateral.
Congenital clubfoot is a manifestation of complex arthro-, myodesmogenic contracture of the joints of the foot. The basis of the deformity in congenital clubfoot is subluxation in the talonavicular joint (inward displacement of the navicular bone) and subluxation in the subtalar joint (inward rotation of the foot).
To date, there is no single universal classification of congenital clubfoot. Classification of clubfoot according to T. S. Zatsepin, 1947: typical forms, which include varus contractures described by E. Yu. Osten-Sacken (1926); ligamentous clubfoot with a well-defined plantar fat layer and mobile skin; both groups respond well to treatment; as well as bone forms, characterized by inactive skin, deformations are not easily eliminated; atypical forms : amniotic, due to bone defects.
Classification by severity: mild degree of deformity - it is possible to simultaneously correct all components of the deformity (equinus, supination and adduction) and bring the foot to the middle position, equinus deformity and supination of the foot do not exceed 10-15 0; medium degree of deformity - it is possible to correct all components of clubfoot: supination and adduction of the forefoot and a largely equinus position, however, the deformity remains pronounced and rigid, the equinus position and supination of the foot range from 15 to 30 0; severe degree - the deformity is stable, it is possible to partially correct it and improve the shape of the foot, but changes in the osteoarticular apparatus remain unresolved; the supination position of the foot and equinus exceed 30-35 0. .
Clinical signs: equinopolovarus foot deformity; internal torsion of the shin bones and, accordingly, internal rotation of the feet when standing and walking; the formation of painful corns, most often at the base of the 5th metatarsal bone; paradoxical mobility in the ankle joint: in the frontal direction; when walking, the ankle joint does not function, the roll disappears, the gait becomes stilted; increased lumbar lordosis and constant tension in the back muscles; severe pain when walking, changes in gait and posture, development of joint diseases; with unilateral clubfoot, there is a shortening of the length of the footprint of the affected limb and atrophy of the lower leg muscles.
Necessary examinations when referring to MSE: examination by a pediatrician, neurologist, surgeon, orthopedic traumatologist, general clinical examination (complete blood count, urine test, ECG), consultation with a geneticist (if necessary), data from electromyo- and electroneuromyographic studies; X-ray examination and ultrasonography of the feet and ankle joints before and after treatment.
Indications for referral to MSA: the child has a severe form of congenital clubfoot for the provision of social protection measures, including rehabilitation.
Disability criteria: persistent minor to moderate impairments of neuromuscular, skeletal and movement-related functions (statodynamic) and impairments caused by physical external deformity (total – moderate), leading to restrictions on independent movement, determining the need for social protection of the child
The degree of dysfunction of the foot according to diagnostic tables for assessing disorders of motor functions of the lower extremities according to R.V. Latypov, Nikitchenko I.I., Lebedeva N.N. etc. are presented in table. 62.
Clinical and functional signs of foot dysfunction
Foot dysfunction
there is no hypotrophy of the lower leg; no shortening of the foot; during correction, the foot is moved to the middle position; equinus 0-20 0 ; Varus and adduction in the frontal plane 0-20 0; rotation in the horizontal plane 0-20 0 ; support on the outer and anterior sections, the heel;
lower leg hypotrophy less than 10%; shortening of the foot less than 10% of the length of the foot; during correction, some components of the deformity are eliminated; equinus 20-45 0; Varus and adduction in the frontal plane 20-45 0; rotation in the horizontal plane 20-45 0. Support on the outer and forefoot;
lower leg hypotrophy more than 10%; shortening of the foot by more than 10% of the length of the foot; the deformity cannot be corrected; equinus more than 46 0; Varus and adduction in the frontal plane more than 46 0; rotation in the horizontal plane more than 46 0; support on the mid-lateral part of the foot;
with bilateral severe deformity.
Children with congenital foot deformity need timely elimination of the existing deformity (by conservative and (or) surgical methods). Even severe deformities detected in a timely manner (at birth or in the first months of life), as a rule, can be eliminated in a child using conservative treatment methods until he learns to walk independently. First of all, this applies to deformities that formed in utero due to pathology of the musculo-ligamentous apparatus of the foot. The adduction of the forefoot, as well as supination and pronation, can be almost completely corrected. Correction of a fixed calcaneal or equinus foot is more difficult. Clubfoot is the most difficult and less complete to eliminate due to severe osteoarticular pathology.
Only if the complex treatment provided is insufficiently effective and the deformity persists, impairing the ability to support and move the affected limb, can the child be referred for a medical and social examination. At the same time, it should be taken into account that even after the elimination of foot deformities, the active growth of the child can provoke both a partial relapse and the formation of a new pathology.
A quantitative system for assessing the severity of persistent dysfunctions of the human body as a percentage is guided by the following approaches.
Quantitative assessment of the degree of dysfunction of the musculoskeletal system (MS) in children over the age of 1 year suffering from unilateral or bilateral congenital clubfoot should take into account the effectiveness of staged treatment, the degree and cause of progression; clinical and radiological manifestations (severity) of the pathological process after treatment, the volume of active and passive movements in the ankle joint, fixed deviations of the position of the feet from the midline in the sagittal and frontal planes, disturbances in support and movement due to the pathological position of the feet (areas of hyperkeratosis, trophic disorders on the supporting plantar surface), as well as concomitant disorders of the musculoskeletal system and other systems of the child’s body.
Equivarus clubfoot: 10-20% can be established for clubfoot after staged treatment (conservative and surgical). The clinical and radiological picture includes: dorsiflexion of the foot at the ankle joint is possible up to an angle of no more than 95 0, which may be due to a change in the natural configuration (flattening of the upper surface) of the talus as a result of treatment with staged plaster casts and (or) contraction of the gastrocnemius muscle; supination deformation of the hindfoot 10° or less; complex types of movements (walking) are available, the plantar surface of the foot is not changed or changed slightly. Sophisticated orthopedic shoes correct the deformity and promote support on the entire plantar surface of the foot;
40-50% can be established for clubfoot with progressive deformity after staged treatment (conservative and surgical), in case of recurrence of deformity, untreated deformity. The clinical and radiological picture includes: the presence of a fixed equinovarus position of the calcaneus in combination with the location of the talus outside the ankle joint; supination of the entire foot and adduction of its anterior section, distal from the level of the Chopart joint by 80-90 degrees or more; disturbance (slowing) of the growth of the tarsal bones on the inside of the foot in combination with atony and atrophy, especially of the gastrocnemius muscle; shortening of the foot by 2 cm or more; shortening of the limb due to the lower leg, progressing with the age of the child; dysfunction of support (occurs on the outer-lateral and even dorsal surface of the foot with the formation of a painful “corns” (hyperkeratosis), bursa in the area of the talocuboid joint) and walking. Uncorrectable varus deformity of the foot of more than 40 0, progressive, not completely corrected by special orthotic means. At an older age, when the deformity recurs, in addition to the above, cyst-like formations may be detected in the area of the articulating surfaces of the ankle joint and foot joints (at the age of 8-9 years); signs of deforming arthrosis of the ankle joints (age 12 years); severe atrophy of the leg muscles (more than 7 cm), recurvation of the knee joint, hyperlordosis of the lumbar spine.
Recommendations for the rehabilitation of a disabled child in the IRP.
Medical rehabilitation: rehabilitation therapy from 5-7 days of life until the end of the child’s growth: therapeutic exercises aimed at developing movements in the ankle joint - manipulations of anterior abduction, pronation and dorsiflexion; massage of the extensors of the foot and peroneal muscles; plastering using the Zatsepin, Vilensky or Ponseti method; physiotherapy: electromagnetic influence (electrical stimulation of muscles and nerves); magnetotherapy (exposure to the ankle joint by an electromagnetic field); electrophoresis with vascular preparations (aminophylline, trental), phonophoresis (with lidase, hydrocortisone); thermal procedures on the ankle joint (paraffin, ozokerite, mud applications); drug treatment to enhance nerve conduction (prozerin, B vitamins). The complex of treatment of primary clubfoot using the Ponseti method does not include the use of massage, exercise therapy, or physical therapy. Reconstructive surgery: from 4–4.5 months of age, indicated for resistant clubfoot , which is not amenable to conservative treatment (if conservative treatment and staged plaster casts for 2-3 months do not produce an effect and the equinus deformity and supination of the foot are not eliminated ; in the presence of a fibrous coalition, deformation of the talus or sphenoid bones, anomaly of the point of attachment of the tendon of the anterior tibialis muscle); when the diagnosis of clubfoot was made late and conservative treatment was not carried out or there is a recurrence of the deformity that cannot be eliminated conservatively. Depending on the characteristics of the deformity and the age of the patient, operations on soft tissues are performed; operations on the osteoarticular apparatus, on the skeleton of the foot. The extent of surgical intervention depends on the severity of the detected disorders and is determined individually.
Stages of treatment depending on the age of the child:
– from birth to 1 year, conservative treatment methods using exercise therapy, massage, redressing and staged casting are recommended;
– in children under 3 years of age: surgical intervention on the tendon-ligamentous and capsular apparatus of the foot and ankle joint;
– from 3 years: performing surgical interventions on soft tissues with fixation of the foot using a distraction-compression device; for residual deformities of the feet in the form of adduction of the anterior section, accompanied by a supination position, it is supplemented by transplantation of the tibialis anterior muscle to the outer edge of the foot, resection of the body of the cuboid bone, without affecting its articular surface, and osteotomy of the first wedge-shaped bone with the introduction of a bone graft in the osteotomy area;
– from 3-4 years of age with a pronounced equinus deformity of the feet - the Sturm-Zatsepin operation, supplemented by dissection of the tibiofibular syndesmosis and the application of a compression-distraction apparatus;
– from 9-10 years of age, in patients with unilateral clubfoot, accompanied by severe bone deformation and shortening of the foot by more than 2 cm, “lengthening arthrodesis of the foot” is performed;
– from 10 years of age and older , with severe degrees of equinovarus deformity of the feet, accompanied by pronounced changes in the osteoarticular apparatus, two-stage surgical treatment is indicated: the first stage is intervention on the tendon-ligamentous apparatus with fixation with a distraction-compression device and bringing the foot into position of the maximum possible correction; the second stage is arthrodesis of the subtalar, calcaneocuboid and talonavicular joints;
– from the age of 12 – operations on the osteoarticular apparatus of the feet with resection of the articular surfaces;
- after 14 years of age, they operate on the skeleton - crescent resection of the foot according to Kuslik, three-joint arthrodesis according to Lyambrinudi, etc.
Relapse of the deformity is possible during treatment by any method - the appearance of the deformity no earlier than a year after the start of adequate vertical load on the feet when using ordinary shoes during the day and without fixation with a splint or device on the ankle joint (brace) at night or while sleeping during the day. The absence of deformation elements under such conditions is an indicator of an excellent treatment result.
Orthosis of the lower limb to fix the achieved result: splints are used mainly during sleep until the age of 2-3 years, as well as devices for the ankle joint with additional functions (braces) to fix the feet up to the age of five (for at least 2 years). years), are used only after the clubfoot has been completely corrected; provision of complex orthopedic shoes for at least 2-3 years after treatment. In some cases, with a tendency towards recurrence of deformity, the use of orthopedic shoes is necessary until the end of foot growth (up to 14–15 years).
Sanatorium-resort treatment is indicated as a stage of rehabilitation treatment. Dynamic observation by an orthopedic surgeon 3-4 times a year after surgery, then once every 6 months until the end of growth to detect possible signs of relapse of the disease and monitor the effectiveness of rehabilitation measures.
Psychological and pedagogical rehabilitation: obtaining general education in basic educational programs on a full-time basis, the training schedule corresponds to the class of study; carrying out psychological and pedagogical correction: the formation of educational and social skills (movement, leisure activities, etc., if possible, independently with the help of technical means of rehabilitation), relationship skills in the children's team, in the family and other activities), when conducting career guidance, recommend for professional training professions that do not involve long periods of standing, without static load on the lower limbs.
Social rehabilitation: social-environmental rehabilitation: training in movement using technical means of rehabilitation, incl. on different coatings; social and everyday adaptation: teaching social and everyday skills (dressing, etc.) using TSR, physical education and health activities and adaptive sports; other activities focused on the individual needs of the child.
Technical means of rehabilitation:
Calcaneal-valgus clubfoot Q66.4.
Congenital flat foot (pes planus) Q66.5 Congenital flat foot.
It is quite rare and is a consequence of intrauterine malformations of the structural elements of the foot. It is observed in 2-11% of all cases of congenital foot deformities; occurs with congenital inferiority of the muscular-ligamentous and bone apparatus of the foot against the background of congenital insufficiency of connective tissue. At the same time, in addition to flat feet, other signs of connective tissue insufficiency are found - myopia, an additional chord in the heart, an inflection of the gallbladder, etc. Flat feet can be the result of underdevelopment of muscles, the absence of the fibula, and other developmental defects. Arthrogryposis and neurofibromatosis are noted as mixed pathologies in these patients. Pathology in 50% of cases is bilateral
This pathology is based on disturbances in the relative position of the talus, calcaneus and navicular bones. Congenital planovalgus foot (“congenital vertical talus, rocker foot”) in children is the most severe form of congenital deformity. The deformity is caused by the verticalized position of the talus, sometimes combined with contraction of the gastrocnemius muscle, which causes the main support on the inner region of the unformed longitudinal arch of the foot with a valgus (sometimes equinus) position of the heel. During the growth process, a fixed deformity is formed in the form of a so-called “rocker foot” (paperweight foot).
There are three degrees of severity of congenital flat-valgus foot (Mirzoeva I.I., Konyukhov M.P., 1978, 1980): mild degree : the longitudinal arch of the foot is slightly smoothed, the foot is in a pronation position, actively and passively moved to a position of hypercorrection, the heel is valgused, the tone of the lower leg muscles is not changed, all symptoms are not expressed before the start of independent walking; with the beginning of standing and walking, valgusation of the heel and a decrease in the height of the longitudinal arch of the foot become noticeable; angle of the longitudinal arch of the foot up to 140º; the angle between the axes of the talus and calcaneus is 30–40º; angle of inclination of the heel bone – from 10 to 30º; forefoot abduction – within 8–10º; valgus position of the posterior section – up to 10º; moderate severity: the deformity is noticeable from the first days of life, the longitudinal arch of the foot is absent, it is in a position of pronounced pronation, the heel is valgus, the forefoot is moderately abducted; decreasing the angle of the longitudinal arch of the foot to 140–160º; the angle between the axes of the talus and calcaneus is 40–50º; angle of inclination of the heel bone – from 0 to 10º; angles tibiocalcaneal – 100–120º, tibiotalar – 130–160º; valgus position of the posterior section and abduction of the anterior section – up to 15º; the foot is passively moved into a position of moderate overcorrection, but is not maintained in it; the tone of the lower leg muscles is not changed or moderately reduced; in older children there is callus on the medial surface of the foot; children get tired quickly when walking; severe degree : clinical manifestations are expressed from the first days of life, the foot takes on the characteristic appearance of “papier-mâché”, or rocking foot; its anterior section is abducted, the heel is sharply valgated, the longitudinal arch is absent or convex, the protruding head of the talus is visually identified and palpated on the inner surface, movements in the joints of the foot are limited, the valgus position of the posterior section and the abduction of the anterior section are more than 20º; on the radiograph, the head of the talus is tilted plantarly and medially, taking a vertical position; the body of the talus articulates with the tibia only in the posterior part; calcaneus – in the position of equinus and valgus; the angle between the axes of the talus and calcaneus is 50–70º; the angle of inclination of the calcaneus to the support area is negative, the tibial-calcaneal angles are 120–140º, the tibiotalar angles are 160–180º; the foot is brought into the average physiological position with difficulty or not at all; begin to walk later, from 1–1.5 years of age; the deformity progresses rapidly with the onset of walking; muscle tone is reduced; all muscle groups of the lower leg are hypotrophic; calluses are noted along the inner edge of the foot; wearing shoes is difficult.
Necessary examinations when referring to ITU - see congenital clubfoot.
Indications for referral to MSA are the presence of a severe form of congenital flat-valgus foot in a child - vertical talus;
Disability criteria: persistent moderate impairments of neuromuscular, skeletal and movement-related functions (statodynamic) and impairments caused by physical external deformity, leading to limited ability to move independently, determining the need for social protection of the child
A quantitative system for assessing the severity of persistent dysfunctions of the human body is guided by the following approaches.
10-20% can be set for moderate severity of deformation; after staged conservative and/or surgical treatment of the initial deformity, the tone of the lower leg muscles is not changed or moderately reduced, the foot is passively moved to a moderate position. Orthopedic shoes provide correction of pathological foot alignment ;
40-60% can be determined in case of severe fixed deformity “vertical talus”, with the ineffectiveness of staged conservative and surgical treatment, progression of the deformity with the possibility of minor passive correction of the deformity, with unsatisfactory relationships in the talonavicular joint, with changes in the plantar surface (trophic disorders: areas of hyperkeratosis, “attrition”), which impede support and locomotion, and cannot be corrected with simple orthopedic shoes.
Coding of functioning according to the ICF: disturbance of structures: structures of the lower limb s730; dysfunction: functions of joints and bones b710-b729; muscle functions b730-b749; motor functions b750-b789.
Recommendations for the rehabilitation of a disabled child in the IRP.
Medical rehabilitation: conservative treatment from 5-7 days of the child’s life, staged casting in the position of adduction, varus and supination of the foot for 1-2 months before moving the feet to the middle position, change of bandages once every 7 days; plaster casting using the Dobbs method (4-6 changes of plaster casts with an exposure of 5-6 days); rehabilitation therapy: therapeutic exercises - corrective exercises aimed at forming the arch, strengthening the arch-supporting muscles, breathing exercises, biofeedback method using EMG-feedback devices to train pathogenetically important muscles, use of various exercise machines; massage of the internal muscles of the lower leg and feet, plantar muscles 4 times a year; physiotherapy: electromagnetic influence (electric stimulation of the arch-supporting muscles of the anterior and posterior tibial muscles and the short and long flexor of the toes, 10 sessions; electromyostimulation is carried out 4 courses per year.); thermal procedures on the ankle joint (paraffin, ozokerite, mud applications); hydromassage; acupuncture of the muscles of the foot and lower leg. Reconstructive surgery: surgical treatment in case of failure of conservative treatment at the age of 1 year; when treated using the Dobbs method, after 4-6 changes of plaster casts, percutaneous fixation of the talonavicular joint with a wire and percutaneous transverse achillotomy. Orthosis of the lower limb, provision of orthopedic shoes. Sanatorium-resort treatment is indicated as a stage of rehabilitation treatment. Dynamic observation by an orthopedic surgeon once every 6 months until growth ends.
Stages of treatment of vertical ram depending on the age of the child:
– newborn : closed manipulations and staged casting; subcutaneous achillotomy; it is possible to selectively lengthen the tendons of the tibialis anterior muscle, finger extensors, and peroneus brevis; fixation of the reduced talus with Kirschner wires;
– infant , if closed manipulations and staged casting are ineffective: lengthening of the Achilles tendon, tendons of the tibialis anterior muscle, finger extensors, peroneus brevis; capsulotomy in the posterior part of the ankle joint, capsulotomy of the subtalar joint; capsulotomy of the calcaneocuboid joint; open reduction of the talus at the talonavicular joint; fixation with Kirschner wires;
– young children have a tendency to relapse of the plantar orientation of the neck of the talus, even after open reduction and lengthening of the tendons: lengthening of the Achilles tendon, tendons of the anterior tibial muscle, extensor fingers, peroneus brevis; capsulotomy in the posterior part of the ankle joint, capsulotomy of the subtalar joint; capsulotomy of the calcaneocuboid joint; fixation with Kirschner wires; transfer of the tibialis anterior tendon to the neck of the talus;
– school-age children with unsatisfactory relationships in the talonavicular joint, even despite the release of the contracted joint capsule and lengthening of the tendons: excision of the scaphoid bone in order to facilitate the reduction of the talus; fixation with Kirschner wires; transfer of the tibialis anterior tendon to the neck of the talus;
– adolescents with untreated vertical talus or residual deformity after previous operations for vertical talus: triple arthrodesis of the foot joints as a palliative operation.
Psychological, pedagogical and social rehabilitation - see Congenital clubfoot