Starting from the second half of life, the child gradually learns to walk upright. During this period, the load on the lower limbs (legs) increases. With proper development and wearing good shoes, the physiological development of the legs occurs. With various diseases, constant stress on the legs, and excessive exercise, various changes in the lower extremities may appear, one of which is flat feet.
Normally, a child's foot has a concave structure. This structure depends on the strength of the muscles that attach to the bones of the foot. Some muscles pull bones upward, others downward. With a normal structure, the arch of the foot has an angle of 90?. If a child develops flat feet, then this angle increases, and depending on the degree, it can have values approaching a right angle (180?).
Flatfoot is a flattening of the foot. If you take a child's sole, smear it with paint and apply it to paper, you will get a foot print in which you can highlight painted and unpainted areas. In medicine, this study is called plantography, and helps to determine the presence and degree of flat feet. To determine the presence of flat feet, draw a straight line through the center of the print between the third and fourth toes. Normally, the painted part should not extend beyond this line. If the child's foot falls behind her, then he has flat feet. Depending on the relationship between the painted and unpainted parts, the degree of flatfoot is established (1, 2 or 3).
Flat feet can be congenital or acquired. Congenital flat feet develops during the intrauterine growth of the child. The development of this disease is influenced to a greater extent by maternal diseases than by the environment. Very often, a hereditary factor can be traced in the development of congenital flat feet. A feature of congenital flatfoot is a pronounced clinical picture. This condition develops due to the fact that the muscles are not attached correctly to the bones, and the muscles extend the foot too much. In some cases of congenital flatfoot, changes in the foot can be so severe that the foot takes on a paperweight-like appearance, with the center of the foot arched outward and the toes and heel raised upward. In this condition, it is very difficult for the child to walk, so he needs medical assistance.
Acquired flatfoot can be traumatic, rachitic, paralytic and static. Static flatfoot is the most common condition among children. This form of flatfoot develops due to increased load on the lower limbs and prolonged systematic standing. Most often, this flatfoot begins to develop at 3-4 years. In addition to constant loads, static flat feet can develop when shoes are worn incorrectly.
The child's shoes should be comfortable, with a small heel. Shoes should not be too hard, but not too soft. It is very important that the foot is tightly wrapped in the shoe and does not wobble from side to side. Therefore, it is very important to take into account the fullness of the foot when choosing shoes. It is very important that the child runs barefoot at home, as this contributes to the correct load on the legs.
Traumatic flatfoot develops due to improper fusion of bones after a fracture. In some cases, this type of flatfoot may develop due to unrecognized ligament tears.
Rachitic flatfoot develops against the background of a lack of vitamin D in the child’s body. Vitamin D is necessary for the absorption of calcium in the body, which is used to build bones. If not enough calcium enters the child's body, this leads to the fact that the bones become softer and more pliable. Since in the second half of a child’s life the load on the legs increases, this leads to a change in the structure of the foot. In addition to changes in the child’s foot, other manifestations of rickets are observed: curvature of the bones of the lower extremities, flattening of the back of the head, the appearance of characteristic growths on the ribs (rachitic rosary).
Paralytic flatfoot is associated with the development of paralysis of the muscles of the lower extremities, which therefore cannot hold the foot in the correct shape. Very often this condition is observed after suffering from polio.
The main symptom of flat feet is increased fatigue when walking. The load on the foot when walking is not uniform, and therefore children quickly get tired, they develop pain in the foot, in some cases it can rise into the calf muscles. Most often, the pain intensifies in the evening; after rest, the pain goes away completely. In some cases, with severe flat feet, it becomes much more comfortable for children to walk on the inner surface of the leg.
To make a diagnosis, the child's foot is examined, paying attention to the presence of natural foot structures. For a more accurate examination, plantography is performed. One of the ways to clarify the diagnosis is an X-ray examination of the foot with calculation of the angle of the arch of the foot. Making a diagnosis based on one examination is not possible, since children have more developed fatty tissue in the foot than adults, and this may look like flat feet, but in reality it is not.
After an accurate diagnosis is established, treatment begins. For congenital flat feet, plaster casts are used to secure the foot in the correct position. These dressings are applied for a period of 7-10 days, after which they are removed and reapplied. Treatment lasts 8-10 weeks. After completion of treatment, courses of massage and physiotherapy are prescribed. Surgical treatment for congenital flatfoot is indicated only as a last resort, when it is impossible to achieve adequate correction by other means.
To correct acquired flat feet, it is recommended that the child receive massage and physical therapy. During physical therapy, children are asked to walk on their toes, on their heels, and on the inside and outside of their feet. It is necessary that children try to pick up a string from the floor with their toes, throw a ball while holding it with both feet. You can easily do all these exercises at home on your own. Conducting exercises on the sand has a good effect.
Wearing orthopedic insoles depends on the age of the child. If the child is of preschool age, it is recommended to wear shoes with hard soles and small heels. At this age, wearing orthopedic insoles is not recommended. Starting from school age, the load on children’s legs increases, which is associated with physical education, therefore at this age it is recommended to wear orthopedic insoles, which are selected individually by an orthopedic doctor. If a child has severe pain when walking, it is recommended to move the foot to the correct position and fix it with a plaster cast. Leave the bandage on for 2-3 weeks, after which the bandage is removed and put on again, but with less fixation. The bandages are reapplied for 3-4 weeks. After their removal, the child is recommended to massage and wear orthopedic insoles. Surgical treatment is indicated only for very severe cases of flat feet in older children.
Treatment and prevention of flat feet should begin as early as possible.
The duration of one lesson is 10 minutes. Before the exercises, you should walk on your toes, then jump over the rolling pin (also on your toes) - on one or two legs.
1. Exercise “skating rink” - the child rolls a ball, rolling pin, or bottle back and forth. The exercise is performed first with one leg, then with the other leg.
2. Exercise “robber” - the child sits on the floor with his legs bent. The heels are pressed tightly to the floor and do not come off it during the entire period of the exercise. By moving his toes, he tries to pull under his heel a towel (or napkin) laid out on the floor, on which some kind of load (for example, a stone) lies. The exercise is performed first with one leg, then with the other leg.
3. Exercise “painter” - a child, sitting on the floor with legs extended, knees straight, runs the big toe of one foot along the instep of the other leg in the direction from the big toe to the knee. “Stroking” is repeated 3-4 times. The exercise is performed first with one leg, then with the other leg.
4. Exercise “collector” - a child, sitting on the floor with bent knees, collects various small objects laid out on the floor (toys, clothespins, Christmas tree cones, etc.) with the toes of one foot and puts them into piles. With the other leg he repeats the same thing. Then, without using his hands, he transfers objects from one pile to another. Objects should not be allowed to fall while being carried.
5. Exercise “artist” - a child, with a pencil held by his toes, draws various shapes on a sheet of paper, holding the sheet with the other foot. The exercise is performed first with one leg, then with the other leg.
6. Exercise “caterpillar” - the child sits on the floor with knees bent, heels pressed to the floor. By bending his toes, he pulls his heel forward towards his toes, then his toes straighten again and the movement is repeated (imitating the movement of a caterpillar). Moving the heel forward by flexing and straightening the toes continues until the toes can touch the floor. The exercise is performed with both legs at the same time.
7. “Boat” exercise - a child, sitting on the floor with his knees bent and pressing the soles of his feet to each other, gradually tries to straighten his knees until the toes and heels of his feet can be pressed together (trying to give the feet a boat shape).
8. Exercise “mill” - a child, sitting on a floor with straightened legs, describes circles with his feet in two directions.
9. Exercise “sickle” - a child, sitting on a floor with knees bent, places the soles of his feet on the floor (the distance between them is 20 cm). The bent toes first come closer together and then spread in different directions, while the heels remain in one place. The exercise is repeated several times.
10. Exercise “drummer” - a child, sitting on the floor with his knees bent, without touching his heels to the floor, moves his feet up and down, touching the floor only with his toes. During the exercise, the knees gradually straighten.
11. Exercise “window” - a child, standing on the floor, spreads and closes his straightened legs without lifting the soles of the floor.
12. Exercise “walking on heels” - the child walks on his heels; without touching the floor with your toes and soles.
To prevent flat feet, you need to wear the right shoes; you can always do the exercises with your child that are used during physical therapy, especially on the beach, in the sand. After walking for a long time, it is recommended to take a warm foot bath.