Flat feet is a deformation of the shape of the foot with lowering of its arches. With such deformation, the feet completely lose their spring and shock-absorbing abilities.
In a normal state, the human foot has two arches - longitudinal (along the inner edge of the foot) and transverse (located under the bases of the toes).
Both arches of the foot perform a very important function - maintaining balance and absorbing the shaking that occurs when walking. But if the muscles and ligaments of the feet stop working and become weak, then the normal shape of the foot is disrupted - it settles and becomes completely flat, losing its main function - the spring function.
In this case, the entire load that the feet previously took on is forced to compensate for the joints of the legs (hip, knee, ankle) and the spine. And since by their nature the joints and spine are not designed for this, they cope with this function quite poorly and fail very quickly.
This is why many people feel pain in the back and legs, but not everyone understands that the root cause of all this is flat feet. Flat feet is a disease that results in rapid fatigue when walking, pain in the feet, knees, hips and lower back.
Pain begins to appear when the body no longer has enough strength to ensure normal and safe movement. It is because of flat feet that the ankle, knee and hip joints suffer, and pathological posture also develops. Which ultimately, as a result of disruption of the support system, can lead to arthrosis and scoliosis. The development of varicose veins is also associated with flat feet.
Therefore, it is very important that the muscles and ligaments of the feet are strong and support the foot in an elevated state, removing the load from the joints of the legs and spine.
Interestingly, flat feet occur both in people with sedentary professions and those who spend their entire working day on their feet. This is due to the fact that in the first case, the muscles and ligaments become weak due to lack of loads, and in the second case, the loads are too large and the ligaments and muscles simply cannot cope with them.
As we have already said, the human foot has two arches, therefore, first of all, all types of flat feet are divided into longitudinal flat feet (decreased longitudinal arch of the foot) and transverse flat feet (decreased transverse arch). Accordingly, the foot can increase both in length and width. If a person experiences flattening of the longitudinal and transverse arch at the same time, then they speak of combined flatfoot, or as it is also called longitudinal transverse flatfoot. Moreover, both types are very common, but transverse flatfoot is usually the predominant of the two.
Also, all types of flat feet can be divided into congenital and acquired. But here, too, everything is very simple. Congenital flat feet, which are treated from the first days of a baby’s birth, are very rare and are a consequence of a malformation of fetal tissue. Therefore, basically, flat feet are always acquired.
Acquired flatfoot occurs at absolutely any age and comes in several types:
Traumatic flat feet are the result of fractures of the bones of the foot and ankle, as well as damage to the soft muscle tissue and ligaments that strengthen the arch of the foot.
As a result of polio, as well as as a result of paralysis of the foot and tibial muscles, paralytic flatfoot may occur.
Rachitic flatfoot is a consequence of previous rickets. Rickets disrupts the proper formation of the bones of the foot. The bones of the foot become more fragile and under the influence of loads the foot becomes deformed and flat feet form.
The most common form is static flatfoot (80% of all cases), the causes of which may be:
Many of the listed symptoms of flat feet may correspond to varicose veins, therefore, at the first appearance of pain in the foot and lower leg, you should immediately consult an orthopedist.
Longitudinal flatfoot and its symptoms:
Transverse flatfoot and its symptoms:
As you can see, there are many reasons for flat feet, but the main reason, about 8 out of 10 cases, is poor development of the muscles and ligaments of the foot. Therefore, in order to properly form the arch, you need to constantly train them. Without load, the foot muscles become weak and are unable to support the foot in a normally elevated state, which is the cause of flat feet.
Flat feet is the flattening of the arches of the foot and the complete loss of all its spring (shock-absorbing) functions.
Normally, the foot has two arches - longitudinal (along the inner edge of the foot) and transverse (between the bases of the toes).
Flat feet can be longitudinal (flattening of the longitudinal arch of the foot) and transverse (flatness of the forefoot). If there is flattening of the longitudinal and transverse arches, they speak of combined flatfoot.
Both arches of the foot are designed to maintain balance and protect the body from shaking when walking.
The foot functions normally as a single complex when the load acting on it is completely balanced by strong ligaments and muscles. If the muscular-ligamentous apparatus is weakened, then the normal shape begins to be disrupted - the foot settles, becomes flat, and one of its main functions is lost - springing (spring).
Many people know pain in the back and legs, when the calves feel like they are filled with lead in the evening. But not many people know that the cause of these phenomena is flat feet. Flat feet is a disease that constantly reminds itself of itself by rapid fatigue when walking, pain in the feet, hips, legs, and lumbar region.
Pain appears when the body has run out of strength to ensure normal movement. By this time, both the knee and hip joints have time to suffer, and pathological posture has developed.
All this can lead to a disastrous outcome - arthrosis. Also, with flat feet, scoliosis often occurs as a result of a violation of the supporting system.
of varicose veins is also associated with flat feet . It can be difficult to help patients at this stage. Long-term special treatment, or even surgical intervention, is required.
Flat feet can be congenital or acquired.
Congenital flatfoot is quite rare and is a consequence of intrauterine malformations of the structural elements of the foot.
Acquired flatfoot occurs at ANY age, and can be traumatic, paralytic, rachitic, or static.
Traumatic flatfoot develops as a result of fractures of the bones of the foot and ankle joint or damage to the soft tissues that strengthen the arch of the foot.
Paralytic flatfoot (paralytic flatfoot) occurs after polio. The cause in this case is paralysis of the foot and tibial muscles.
Rachitic flatfoot develops after suffering from rickets. Rickets disrupts the normal formation of the bones of the foot. The bones become less strong and under the influence of stress, when muscles and ligaments are weakened, the foot becomes deformed and flat feet form.
Static should be considered a separate form , the causes of which may be:
• hereditary predisposition (congenital weakness of the ligamentous apparatus)
• weakness of the muscles and ligaments of the foot and lower leg due to low physical activity and lack of training in people with “sedentary” professions
• prolonged stress on the legs (long standing, high-heeled shoes, pregnancy, etc.).
the FIRST SYMPTOMS OF FLAT FOOT yourself:
• your shoes are worn down and worn out on the inside
• legs get tired quickly when walking and standing
• fatigue and pain in the legs at the end of the day, cramps, a feeling of heaviness, swelling
• swelling in the ankle area
• very difficult to walk in heels
• your foot seems to have grown - you have to buy shoes a size larger (especially in width)
• your foot has become so wide that you can no longer fit into your favorite shoes.
However, the listed signs may correspond not only to flat feet, but also to other diseases - for example, varicose veins .
In any case, if you experience unpleasant or painful sensations in the foot area, you should consult an orthopedist.
DIAGNOSIS OF FLAT FOOT is based on:
1) Clinical examination by an orthopedic doctor
2) Performing an X-ray examination of the feet (according to indications)
To determine the degree of flatfoot, radiographs of both feet are taken in frontal and lateral projections with a load.
The final diagnosis is made on the basis of x-rays.
Early diagnosis and timely prevention will help keep your feet beautiful and healthy!
The severity of flatfoot disease can vary.
Ligamentous failure is the earliest stage of the disease. The shape of the foot is not changed, but as a result of overstretching of the ligaments, pain occurs that appears after a long walk or at the end of the day. After rest, the pain in the feet goes away.
With mild flat feet (grade I), after physical activity, a feeling of fatigue appears in the legs, and painful sensations occur when pressing on the foot. Fatigue is noted when walking, the gait becomes less flexible, and often the foot swells in the evening.
Combined flatfoot is the next, 2nd stage of the disease. The arches of the feet disappear, the foot is spread out. Pain in the feet is constant and more severe. The pain covers the entire leg down to the knee joint. There is significant difficulty walking.
Finally, degree III flatfoot is a pronounced deformation of the foot. Often patients consult a doctor only at this stage. After all, pain in the feet, legs, which are almost always swollen, and in the knee joints is constantly felt. The lower back often hurts, and a painful headache appears. With grade III flat feet, sports become unavailable, ability to work is significantly reduced, and even quiet, short walking is difficult. A person can no longer move in ordinary shoes.
Flat feet are one of those diseases that, once they occur, progress quite quickly.
This causes deformation of the fingers; they acquire a hammer-like shape. The more sharply it is expressed, the more the thumb deviates outward.
The list of complications with flat feet is quite impressive.
• Pain in feet, knees, hips, back
• Unnatural “heavy” gait and posture, club feet when walking
• Disproportionately developed or underdeveloped leg muscles
• Diseases of the knee joints (arthrosis deformans, inflammation of the menisci, knee joint laxity)
• Spinal diseases (osteochondrosis, curvature, herniated discs, radiculitis)
Another consequence of flat feet is a disease of the plantar aponeurosis, a nerve, so-called Mardan’s neuralgia, heel spur. It occurs even in young women 20-25 years old and is accompanied by burning pain.
Treating this seemingly simple disease is quite difficult. In addition, you need to know that there will never come a moment when a person can breathe a sigh of relief: well, I’m cured! Especially with advanced pathology. Flat feet are a lifelong disease. Complete cure for flat feet is possible only in childhood. In adults, with the help of special rehabilitation measures, the development of the disease can only be slowed down and prevent it from developing into more severe pathologies.
The earlier the signs of the disease are identified, the smaller the foot deformity, the more favorable the conditions for stopping the progression of flat feet and its correction.
Treatment should be comprehensive, aimed at relieving pain, strengthening the muscles and ligaments of the foot in order to stop the progression of the deformity and prevent the development of complications.
To relieve pain, medications and physiotherapeutic procedures are used.
The basis of treatment is special therapeutic exercises, which must be carried out at home daily.
Therapeutic gymnastics is used to achieve a corrective effect (for the first degree of flat feet), trains muscles, strengthens the ligaments, corrects the defective alignment of the foot bones, and forms the correct walking stereotype.
There are various special sets of exercises. When choosing exercises, the following are taken into account: shape, position of the foot, complaints, age. An orthopedic surgeon will help you choose specific exercises and their intensity.
Special individually selected exercises are alternated with regular exercises that strengthen the muscles of the foot and lower leg.
To improve blood circulation and normalize muscle tone, massage of the feet and legs and foot baths are useful.
A special role in the treatment and prevention of progression of flat feet is given to orthopedic insoles, which are prescribed already at the first degree of pathology. They help relieve painful areas of the foot and correct identified deformities at the initial signs of flat feet, return the foot to its normal position and take on the functions of a shock absorber.
They are made to order based on an individual impression of the foot after examination, taking measurements of the foot and determining the degree of flattening of the arch.
In cases of advanced flatfoot, special orthopedic shoes are made in the form of boots with lacing, a solid sole and lateral support for the foot.
An orthopedic surgeon will help you select all these simple devices.
If there is severe deformation of the big toe, constant pain and the inability to find shoes, one has to resort to surgical treatment .
Equally important in the prevention of flat feet is the correct selection of shoes.
Undoubtedly, fashionable high-heeled shoes look very nice on your feet, but do not wear them every day. Otherwise, it may happen that after a while you will be doomed to wear only orthopedic shoes.
The best shoes are made of soft leather with flexible soles, low heels (3-4 cm), wide toes, no platforms, a leather upper is a must. Sneakers too (unless, of course, they are fake).
Avoid wearing shoes that are too wide or loose. It causes chafing, inflammation and calluses. But wearing tight shoes is even more harmful - in addition to calluses, it leads to crooked fingers, poor circulation and ingrown nails. Shoes should fit your foot like a second skin.
Unfortunately, there are now a lot of low-quality and even harmful products on our market, brought to us from God knows where.
Flat feet are a very serious and insidious pathology that accelerates wear and tear of almost the entire musculoskeletal system.
So take such a seemingly insignificant problem as flat feet more seriously. Don't delay his treatment.
But for some reason people generally pay little attention to their feet, forgetting that the health of the feet is the health of the entire body, and most often they go to the doctor with complications of flat feet.
It’s a bit late, of course, it would be better to contact an orthopedic specialist much earlier, but still better than never.
By contacting our Clinic, you will receive adequate treatment, the result of which will be relief from long-term, sometimes long-term pain, bad mood, and subsequently you will feel quite comfortable.
Health is much more important than the time spent on a visit to the hospital.
Flat feet is a change in the shape of the foot, characterized by the lowering of its longitudinal and transverse arches with the loss of all its spring (shock-absorbing) functions.
Normally, the foot has two arches - longitudinal (along the inner edge of the foot) and transverse (between the bases of the toes). Pain in the back and legs is widely known, when the calves feel like “filled with lead” in the evening. Sometimes the cause of these phenomena is flat feet.
Flat feet is a disease that constantly reminds itself of itself by rapid fatigue when walking, pain in the feet, hips, legs, and lumbar region.
All this can lead to a disastrous outcome - arthrosis.
Also, with flat feet, scoliosis often occurs as a result of a violation of the supporting system.
Foot print for different degrees of flat feet.
Flat feet are one of those diseases that, once they occur, progress quite quickly. It causes deformation of the fingers, they acquire a hammer-like shape. The more sharply it is expressed, the more the thumb deviates outward.
However, the listed signs may correspond not only to flat feet, but also to other diseases - for example, pathology of the vascular or endocrine systems, etc.
In any case, if you experience unpleasant or painful sensations in the foot area, you should consult a doctor.
In children under 2 years of age, the longitudinal arch of the foot is flat. Experts consider this condition to be physiological, since the bone tissue of children is soft and elastic. It contains few minerals, which give bones strength, and the muscular system is poorly developed. When children begin to stand on their feet (at 7-9 months) and walk independently (at 10-12 months), the “fat pad”, which is located on the sole, under the skin, takes on the function of a shock absorber. At 2-3 years, the bones gain a sufficient amount of minerals, the articular surfaces acquire normal shape, the ligaments become stronger, and muscle strength allows you to stay on your feet longer. The process of formation of the bones of the foot continues until approximately 5-6 years of age. Only during this period can we talk about the presence or absence of flat feet in a child.
With transverse flatfoot (more common), the transverse arch of the foot is flattened, its anterior section rests on the heads of all five metatarsal bones, the length of the feet decreases due to the fan-shaped divergence of the metatarsal bones, the deviation of the first toe outward and the hammer-shaped deformation of the middle toe. Transverse flatfoot most often occurs between the ages of 35 and 50 years.
With longitudinal flatfoot, the longitudinal arch is flattened and the foot is in contact with the floor with almost the entire area of the sole, the length of the feet increases. Longitudinal flatfoot and, consequently, the load on the feet is more pronounced, the greater the body weight. This pathology occurs mainly in women. Longitudinal flatfoot occurs most often at the age of 16-25 years. The main symptoms of longitudinal flatfoot are pain in the foot and changes in its shape.
With combined flatfoot, there is a flattening of the longitudinal and transverse arch.
Based on the origin of flat feet, they are divided into:
congenital flat feet before the age of 5-6 years, since all children younger than this age have all the elements of a flat foot. However, in approximately 3% of all cases of flat feet, the flat foot is congenital.
Traumatic flatfoot is a consequence of a fracture of the ankles, heel bone, and tarsal bones.
Paralytic flat foot is the result of paralysis of the plantar muscles of the foot and the muscles starting on the lower leg (a consequence of Poliomyelitis).
The causes of rachitic flatfoot may be:
Static flatfoot (the most common) occurs due to weakness of the muscles of the lower leg and foot, ligaments and bones. The reasons for the development of static flat feet can be different - an increase in body weight, working in a standing position, a decrease in muscle strength with physiological aging, lack of training in people with sedentary professions, etc. Internal reasons contributing to the development of foot deformities also include a hereditary predisposition to external reasons - overload of the feet associated with the profession, housekeeping, wearing narrow, uncomfortable shoes (irrational).
When walking in high heels, a redistribution of body weight occurs: from the heel it moves to the area of the transverse arch, which cannot withstand the increase in load force and becomes deformed, which is why transverse flat feet occur.
The final diagnosis is made on the basis of x-rays. Early diagnosis and timely prevention will help keep your feet beautiful and healthy! Contact your doctor at the first symptoms of the disease.
To prevent flat feet, it is advisable to wear high-quality shoes, preventive or therapeutic insoles, and do foot exercises.
Treatment should be comprehensive, aimed at relieving pain, strengthening the muscles and ligaments of the foot in order to stop the progression of the deformity and prevent the development of complications.
FAQ
The site provides reference information. Adequate diagnosis and treatment of the disease is possible under the supervision of a conscientious doctor.
Arches of the feet
The arches of the foot are the most important structural element of the foot, which determines its entire functional ability.
In general, the arches of the feet act as springs and levers, providing maximum comfort of movement with minimal consequences for the body. Damage to this link can lead to disruption of the entire musculoskeletal system, since the body is a single whole and the slightest change in any part of it affects its entire functioning. Thus, flat feet can lead to damage to the knee and hip joints, deformation of the spine and disruption of the functioning of internal organs. This is due to the fact that if the foot cannot cope with its function (shock absorption, balance, etc.), then the structures above begin to perform its function (knees, hip joints, spine). And since they are not adapted to this type of load, they fail much earlier.
The longitudinal arch is located along the inner edge of the foot. The longitudinal arch is divided into external and internal arches. The external longitudinal arch is formed by the metatarsal bones (4th and 5th), cuboid and calcaneus.
The external longitudinal arch performs a supporting function to a large extent when standing and walking.
The internal longitudinal arch is formed by the sphenoid, first and second metatarsal bones, as well as the talus and navicular bones. Unlike the outer arch, the inner arch performs a more springy function.
Transverse flatfoot
The foot normally has 3 points of support: C - heel, A - head of the 1st metatarsal bone, B - head of the 5th metatarsal bone. With flat feet, the support points change. Such changes radically change the mechanics of walking, contributing to various disorders of the musculoskeletal system (arthrosis, scoliosis, etc.).
External signs of flat feet
Pain is the main signal of a problem
Most often, pain with flat feet occurs in the foot (often the top of the arches, the calcaneal tubercle), calf muscles, aching muscles of the lower leg, under the knee, and aching tarsal bones. In the later stages, the thigh muscles, knee, hip joints, sacral and lumbar spine hurt. The pain does not occur immediately, but gradually and intensifies towards the end of the working day, especially if during the day the person walked for a long time or was in a standing position. In the unadvanced stages of the disease, the pain subsides by the morning after a night's rest.
To make an approximate diagnosis of flat feet, you can conduct a simple test yourself. Lubricate the soles with some kind of coloring substance (mascara, iodine, brilliant green, etc.), or with a thick cream. Then leave an imprint on a piece of paper so that the load on your feet is even and you are in your usual standing position. On a piece of paper, draw a line parallel to the plantar notch from the toes to the heel, and draw a perpendicular to it at the deepest point of the notch to the outer edge of the foot. In the case when the imprint of the narrow part of the foot occupies half or more of a line drawn perpendicular to the first line, this indicates a possible flat foot.
Internal causes are everything related to the developmental characteristics of the human musculoskeletal system.
External causes are all factors that lead to weakness of the muscular and ligamentous apparatus of the foot and the development of flat feet from the external environment:
Sneakers can also do a bad job. When moving, the sneakers take on most of the load, this is due to the good shock-absorbing ability of the sole and their ability to perfectly fix the foot. Thus, the muscles and ligaments of the foot do not function properly and ultimately lose tone and become sluggish, which favors the development of flat feet.
Walking in stiletto heels
In children under 10 years of age - this is the norm.
5 types of flat feet depending on the cause
Stages of longitudinal flatfoot
— From time to time, give the arch muscles a rest, placing your feet parallel to the outer surfaces
- It is advisable to change working conditions
- wearing insoles - arch supports
- wearing orthopedic shoes
— other types of treatment
— surgical treatment in the absence of effect from conservative methods
Assessment of the degree of transverse flatfoot
Assessment of the degree of longitudinal flatfoot
With flat feet, the inner surface of the sole and heel wears out first; normally, the outer part wears out first.
In most cases, the diagnosis of flat feet can be suspected based on complaints and examination data.
Plantography - the essence of the technique is to obtain an imprint of the contour of the foot on paper. The foot is smeared with various dyes (iodine, brilliant green, ink, etc.) and a footprint is left on a sheet of paper. In this case, the subject must assume his usual posture, stand comfortably, so that the load on both limbs is equal. The assessment of plantography results should be carried out in accordance with age, since the normal foot print of a child differs significantly from the print of an adult. Plantography provides approximate data on the condition of the arches of the feet; if flat feet are suspected, the examination should not stop only at this technique.
Flat feet The most effective treatment methods
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Prof. Kiseleva E. G.
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Alexandra Vasilyeva BONE DISEASES. The most effective treatments
Alexandra Vasilyeva LIVER DISEASES. The most effective treatments
Alexandra Vasilyeva KIDNEY DISEASES. The most effective treatments
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Alexandra Vasilyeva HEALTH OF YOUR FEET. The most effective treatments
Lidiya Goryacheva, Lev Kruglyak CHILDREN - “CATASTROPHES”. How to help a hyperactive child
Lidiya Goryacheva, Lev Kruglyak HOW TO RAIS A CHILD HEALTHY. Alternative methods for preventing and treating childhood diseases
Lev Kruglyak HOW TO CURE INFERTILITY. The most effective treatments
Yulia Popova STROKE. The most effective treatments
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Yulia Popova ANALACY. The most effective treatments
Yulia Popova OSTEOCHONDROSIS. The most effective treatments
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Flat feet are a fairly common disease, especially in women. If you are overweight, if your job requires you to constantly be on your feet, if your favorite shoes are high-heeled shoes, then you may well have already encountered this illness.
Orthopedic specialists have recently noted an avalanche-like increase in the number of people suffering from flat feet. Regular medical professional examinations show that flat feet are found in more than 35% of children by the age of seven, and in the future the percentage of the disease only grows. According to scientists, from 40% to 60% of the entire population on the globe suffers from flat feet.
So what is flat feet?
In fairly simple terms, flat feet is a flattening of the foot that creates discomfort when a person walks and stands. However, this is not just a modification of the foot. It entails a number of complications that worsen the general condition of the body. These include various diseases of the spine (for example: herniated intervertebral discs, sciatica, osteochondrosis, various curvatures of the spine, including variants of scoliosis), diseases of the pelvic bones and joints, as well as various ailments of the knee joints: inflammation of the menisci, deforming arthrosis and many others .
In addition to the complications already listed, flat feet often entail additional diseases of the flat foot. For example, people with flat feet often develop calluses, heel spurs, curvature of the toes (especially the big toe), local neuralgia, varicose veins, and ingrown toenails.
What does medicine offer us to combat this invisible but serious disease?
And here we have to admit that the views on flat feet of different medical directions and options for its treatment, both in Russia and abroad, are sometimes radically different from each other - even to the point of their complete opposite. However, there is nothing surprising in this: each type of flatfoot requires its own approach, its own treatment option.
In our book, we tried to answer in detail the main questions: what is flat feet, why is it dangerous, how to effectively deal with it, what treatment options exist in the world and are used in Russia.
What do we know about the foot?
A healthy foot is a single well-coordinated mechanism, a perfect “tool” for support and movement, consisting of a skeletal system and a muscular-ligamentous corset.
A healthy person can easily roll his foot smoothly from heel to toe. This happens thanks to the muscles and ligaments that pull the bones of the foot together. Weakening of any of these links leads to deformation of the foot.
It should be noted that in different regions of the world and in different eras, the feet have always suffered all kinds of human interventions. These interventions were determined by the historical and ethnic views of various cultures on the beauty of the human body, which they thus tried to improve.
However, the artificial deformation of the feet not only impressed some people with its unusualness and, by local standards, beauty, but in some cases it also represented a symbolic necessity.
For example, in China there was a tradition of foot binding. For girls from 4 to 5 years of age, their legs were bandaged with strips of fabric until four small toes were pressed close to the sole of the foot. The legs were then wrapped horizontally to arch the foot like a bow. Over time, the foot no longer grew in length, but instead protruded upward and took on the appearance of a triangle. It did not provide strong support and forced women to sway, like a lyrically sung willow tree. Sometimes walking was so difficult that the owners of miniature legs could only move with the help of strangers.
Although it is difficult for Europeans to imagine, the so-called “lotus leg” was not only the pride of women, but also the object of the highest aesthetic and sexual desires of Chinese men. A girl without wrapped feet could only count on the position of a servant, while a girl with very small feet, even from a very poor family, could marry successfully.
This tradition reigned in China for almost 1000 years, until it was completely banned in the early 1950s.
According to some researchers, the foot represented the embodiment of discontinuity, a kind of division between the body and the earth. Therefore, foot worship was often equivalent to earth worship. It is not without reason that in some religions and customs shoes (separating the foot from the ground) are left at the entrance to the sanctuary for Muslims or to any room for the Japanese. There was even a sect of “barefoot” monks and nuns - religious ascetics who did not wear shoes at all.
The foot could also act as a symbol of the soul. In a number of museums you can see ancient sculptures, the legs of which at different levels - lower leg, ankle joint, foot - are equipped with wings. Researchers regard these wings as an indication of the possibility of spiritual takeoff.
The process of washing the feet acquired not only direct, but also symbolic meaning in ancient times. Guests' feet were usually washed by slaves. However, Christ also washed the feet of his disciples before the Last Supper, thus expressing endless Christian humility.
It has been proven that there are many biologically active points on the foot, by acting on which all internal organs can be treated. Points susceptible to the action of a magnetic field were also discovered here.
Toes are shorter than fingers - they are less functional and in less demand. Usually the first and second toes are almost the same length, the second is often even longer. There is such a sign among the people: if the first toe is longer than the second, then the husband will be the head of the family, and if vice versa, the wife will be the head of the family.
In a newborn, the big toe on the foot has significant mobility (reminiscent in function to that of the hand at this time). Then humans lose the grasping ability of their toes, but monkeys do not. As we grow up, we lose the function of gripping, and then our feet serve primarily for support until the end of our days.
The smallest toe on the foot is the fifth toe, the little toe. Some scientists predict its complete disappearance in the distant future due to the fact that it does not really participate in the support.
But the heel, the heel, has always been perceived as the “end” of a person. This is where the soul “goes” when frightened. It is with this part of the foot that they press, crushing evil, a snake, a scorpion; it is the heel that was the only vulnerable spot of the ancient Greek hero Achilles.
Fortunately, nowadays people are increasingly thinking about the health of their feet. After all, it is healthy legs that give us freedom of movement, allow us to drive a car comfortably, and women’s legs are also considered one of the most attractive parts of the body.
The bones of the foot consist of three sections: tarsus, metatarsus and toes.
Rice. 1. Bones of the foot (top view)
tarsal bones combine seven short spongy bones arranged in two rows. The posterior row is formed by the talus and calcaneus, and the anterior row by the scaphoid, medial, intermediate and lateral sphenoid bones and the cuboid bone. The talus articulates with the bones of the lower leg.
Metatarsals are short, tubular bones. The bases of the metatarsal bones connect and form joints with the cuboid and sphenoid bones. And with their heads, the metatarsal bones connect to the main phalanges of the fingers.
The bones toes are formed from three phalanges (main, middle and nail). The exception is the thumb, which is formed by only two phalanges (main and nail).
And the foot also has arches. This is a complex spring structure that ideally distributes the load when walking and accumulates and releases energy at each step phase. The longitudinal and transverse arches of the foot are the very springs and levers by which this living mechanism works.
It would seem that nothing could be easier - he got up and walked. But every step a person takes is like an unfinished fall, an amazing balancing act on one leg using the most subtle balance mechanisms. And running, jumping is also a flight – and a landing! The arches of the feet are quite well adapted to absorb such loads.
The foot rests on the calcaneal tubercle and the heads of the metatarsal bones. The moderate support area is combined with savings in biological material and the strength of the entire device.
Normally, the foot has two arches - longitudinal (along the inner edge of the foot) and transverse (between the bases of the toes). Both the longitudinal and transverse arches are designed to maintain balance and protect the body from shaking when walking. Thanks to the muscles of the lower leg descending onto the foot, its own muscles and ligamentous apparatus, together with the plantar tendons, the arches have spring properties: softening impacts on the ground, distributing weight, which allows the foot to smoothly adapt to uneven soil.
Rice. 2. Walking phases
In the longitudinal arch, in turn, two more arches are distinguished: external and internal.
The internal longitudinal arch is formed by the talus, navicular, sphenoid, 1st and 2nd metatarsal bones. The center of the inner arch of the foot is located in the area of the talonavicular joint.
The external longitudinal arch of the foot is formed by the calcaneus, cuboid, 4th and 5th metatarsal bones. When standing and walking, it is adjacent directly to the plane of support.
The transverse arch is formed by the heads of the metatarsal bones, located in an arc. The center of the transverse arch coincides with the head of the 3rd metatarsal bone, which is most distant from the plane of support.
However, such an elegantly and beautifully designed structure as the foot cannot be considered separately from the rest of the musculoskeletal system. If you look at the entire skeleton as a whole, you can be convinced that this huge spatial structure not only serves as a support for internal organs and muscles, but also protects them from excessive loads and injuries (for example, when jumping) due to a wisely calculated system of “springs” and "shock absorbers".
The knee and ankle joints usually work in pairs, also softening shocks when walking. For example, if the leg twists at the ankle joint (that is, the load increases in the lateral direction, and the ankle moves, as we know, only up and down), then the knee automatically seems to break, removing the load from the ankle and preventing it from breaking.
The axis of the lower limb itself is not directed vertically downward, but at a certain angle inward, which also gives the step some softness: the leg does not “type a step,” but, as it were, “sneaks”, steps one after another, lining up the tracks in a chain.
Rice. 3. Direction of the axis of the foot when walking
In this case, normally the load on the foot is distributed unevenly - the vector of forces is directed from the big toe to the outer edge of the heel tubercle.
The pelvis, as a fairly massive structure, resembles a balancing flywheel when walking, which dampens the swaying of the torso. This is especially clearly visible in a woman’s gait - the captivating swaying of the hips, no matter how prosaic, is caused by the fact that in the fair sex the lower half of the body is more massive due to the relatively larger pelvis than in men, and therefore its movement is more noticeable.
Next, the movement is limited to the spine: the load from both legs is transferred to a vertical, fairly flexible axis.
And to top it off - arms with a rhythmic swing in time with walking. They also move for a reason, but help the body balance - they dampen excess vertical vibrations of this entire complex and balanced structure.
A humanoid robot without perfect human feet spends four times more energy on walking, since the regrouping of the musculoskeletal system of the foot is much more effective than a simple roll available to a machine.
Why haven’t designers yet created a walking car? Despite all attempts, there is still no viable model. The reason is the incredible complexity of each step we take.
However, when we walk, we think about anything, but not about how to place our foot, when to bend our knee or swing our arm. The complex process of walking is automatically controlled by the central nervous system, so that our gait is, as it were, a reflection of all the processes occurring in it. Therefore, an experienced gait doctor can make a preliminary diagnosis, and a psychologist can assess the type and mental state of the individual.
A lot of specialized literature is devoted to the biomechanics of gait, its pathology (ill health) and recovery mechanisms after various diseases; entire volumes have been written about this. After all, if we walk incorrectly (can sore legs walk correctly?), each step only aggravates the disease.
It is on the foot that half of our, sometimes excess, weight rests, and when walking or running, each foot in turn takes on the full weight! This is the foot being squeezed into uncomfortable, narrow shoes placed on incredibly high heels or an unstable platform. Let's add to this excessive stress and some diseases: arthrosis, arthritis, rheumatism, gout, diabetes, which usually also lead to foot deformities. There is also congenital weakness of the ligamentous apparatus. But often we acquire such a problem as flat feet ourselves.
What is flat feet
The medical definition of the disease is as follows.
Flatfoot is a change in the shape of the foot, characterized by drooping of its longitudinal and transverse arches.
Now we invite you to take a simple test that will allow you to find out whether you have flat feet or not.
To do this, just smear your soles with any rich cream and stand on clean sheets of paper located on a flat floor. There will be a clear footprint on each sheet. Take a ruler and a pencil and draw a straight line along the imprint of the inner edge of the foot, where there is a so-called plantar recess, and then through the recess of the footprint in its deepest place, draw another straight line - perpendicular to the first straight line.
If the imprint of the narrow part of the foot occupies no more than one third of this line, the foot is normal; if it reaches the middle of the line, you have flat feet and you should not delay a visit to the doctor.
Rice. 4. Footprints are normal and with flat feet
Normally, only the heel, a narrow strip of the outer edge of the foot, the toes and the ball in front of them should touch the surface. Flat feet lead to deformation of the arches of the feet in the longitudinal, transverse or longitudinal-transverse direction. As a result, the foot seems to spread out - and the entire sole begins to come into contact with the surface.
Here's another test. Try standing barefoot on one leg for a few minutes with your eyes closed and arms outstretched, without leaning to the side. If this requires a lot of effort from you, then you are not one of the lucky twenty percent of people with healthy feet. But you don’t notice flat feet, most likely because it is not yet pronounced or you don’t have to put much strain on your legs.
The foot of a person with flat feet is long, wide, and the heels are slightly turned outward. The owner of such a foot usually wears out the inner sides of the sole and heels faster. Over time, the metatarsal bones - those on which we rely when we stand on our toes - become deformed, and an unpleasant “bone” is formed.
At the initial stage of development of this disease, there is no severe pain, but a feeling of fatigue appears in the legs, and problems arise when choosing shoes. However, later the pain when walking becomes more and more noticeable, it radiates to the hips and lower back. The calf muscles are tense when walking. At the same time, due to an increase in the volume of bone tissue, so-called maclyps are formed, which sometimes reach such a size that surgical intervention is required. Corns (areas of skin callus) also appear on the sole - painful bone-scar growths at the base of the big toe, which do not allow walking for a long time, and deformation of the other toes. There is a feeling that the soles are rubbed with sandpaper, and every step is painful.
Motorists know that driving with a flat tire is not only ineffective, but also extremely expensive. A flat foot, like a flat tire on a car, does not fully fulfill its function. So walking on flat feet has a bad effect on the entire musculoskeletal system. My legs get very tired and hurt even after short walks. Sharp pain usually occurs in the area of the non-existent arch of the foot and in the muscles of the lower leg.
The position of the spine directly depends on the position of the foot, so its deformation also means the obligatory occurrence of general musculoskeletal changes. Flat feet lead to overload of the knee and hip joints, curvature of the spine and diseases of the entire musculoskeletal system. Increased fatigue appears not only in the legs, but also in the entire body. A person begins to feel pain in various parts of the lower extremities and lower back, a burning sensation occurs in the sole, and the foot swells.
As a result of disturbances in the body's spring system, microtraumas of the spinal cord and brain can occur, which, in turn, leads to the development of many diseases that, at first glance, have nothing to do with flat feet! These are scoliosis, osteochondrosis, various diseases of internal organs (kidneys, heart, stomach, intestines). This is not surprising, because flat feet lead to a disruption in the functioning of the human body as a single system, in which a disruption in the functioning of one link will certainly lead to a failure in other links.
Causes of occurrence and development of flat feet
Flat feet can have different causes. Excess weight, pregnancy or constant repeated overuse of the foot with shock loads weakens the arch of the foot, leading to its flattening.
Flat feet are typical for people with congenital weakness of connective tissue. The foot functions well as a single complex when the load acting on it is completely balanced by strong ligaments and muscles. If the muscular-ligamentous apparatus is weakened, then the normal shape begins to be disrupted - the foot settles, becomes flat, and one of its main functions is lost - springing (spring).
In this case, the spine and leg joints (ankle, knee, hip) are forced to compensate for the shaking when walking. By their nature, they are not designed for this function, so they cope with it rather poorly and quickly fail.
Rice. 5. Normal foot and with different forms of flat feet
Often, people who have to stand on their feet all day suffer from flat feet - sellers, hairdressers, couriers and representatives of other similar professions. When a person has weak muscle tone, and his foot is overloaded due to excess weight, lifting and carrying heavy things, as well as other characteristics of the profession, then the prerequisites for flattening the shape of the foot appear. But this is not necessary either. To the weakness of the muscular-connective system, add narrow, tight, ill-fitting shoes, with high heels or without them at all, and flat feet will also be guaranteed.
The ratio of men to women with flat feet is 1 to 10. Even if we take into account other factors leading to flat feet, it cannot be denied that the influence of heels on the development of foot deformities is undeniable.
When wearing high heels, the center of gravity increases and shifts closer to the axis of the body, which, together with an increase in the angle in the ankle joint, leads to increased load on the forefoot and tucking of the foot inward. Therefore, the smaller the heel, the better. For adults, the optimal heel height is 3–4 cm, for children – 1–1.5 cm.
Shoes with flat soles are also harmful. Especially for children under 6–7 years of age, whose feet are just developing, and people who are just beginning to develop flat feet.
Types of flat feet (classification by origin)
Flat feet are divided into congenital and acquired.
Congenital flatfoot is quite rare (about 3% of cases) and is a consequence of intrauterine malformations of the structural elements of the foot. As a rule, other skeletal structure disorders are found in such children. Treatment for this type of flatfoot should begin as early as possible. In difficult cases, surgical intervention is resorted to.
Acquired flatfoot occurs at any age and is divided into the following options:
Traumatic flatfoot occurs as a result of injury. Most often, these are consequences of fractures of the ankles, heel bones, tarsal and metatarsal bones, or damage to soft tissues (muscles and ligaments) that strengthen the arch of the foot. The heel, combined with the navicular and cuboid bones, as well as the tubular metatarsal bones, resembles a complex arched vault laid out by a skilled mason. Now imagine that a bomb fell on this vault. Needless to say, how difficult it is to later restore the original structure.
Paralytic flat foot is the result of paralysis of the muscles of the lower extremities: the plantar muscles of the foot and the tibial muscles starting on the lower leg, and most often a consequence of flaccid (or peripheral) paralysis of the muscles of the foot and lower leg caused by polio or other neuroinfection.
Rachitic flatfoot is not congenital, but acquired. It is formed as a result of improper development of the skeleton caused by a deficiency of vitamin D in the growing body and, as a consequence, insufficient absorption of calcium - this “cement” for bones. The bones become less strong, and under the influence of the load on the weakened bones of the foot, when the muscles and ligaments are weakened, the foot is deformed and flat feet are formed. It can be prevented by preventing rickets (sun, fresh air, exercise, good nutrition, fish oil, vitamins, vegetables, fruits).
Static flatfoot is the most common - in 82.1% of cases.
It develops for the following reasons:
• hereditary predisposition (congenital weakness of the ligamentous apparatus), such a foot is often called “aristocratic”;
• weakness of the muscles and ligaments of the foot and lower leg due to a decrease in muscle strength with physiological aging, with little physical activity and lack of training in people with “sedentary” professions;
• overweight - in most overweight people, the arches of their feet cannot support their excessive weight, and leg pain is usually combined with back pain;
• inconvenient, irrational shoes - constant wearing of high-heeled shoes or on a rigid platform distorts the biomechanics of a normal step so much that it almost fatally leads to this disease;
• prolonged stress on the legs (long standing, regular carrying of heavy objects, etc.); often they are associated with a person’s professional activity (“on your feet all day”), this also applies to housekeeping.
The following pain areas are characteristic of static flat feet:
• on the sole, in the center of the arch of the foot and at the inner edge of the heel;
• on the back of the foot, in its central part, between the navicular and talus bones;
• under the inner and outer ankles;
• between the heads of the tarsal bones;
• in the lower leg muscles due to their overload;
• in the knee and hip joints;
• in the thigh due to muscle strain;
• in the lower back – due to compensatory-increased lordosis (deflection) of the spinal column.
Pain with static flat feet intensifies in the evening, but subsides after rest, sometimes swelling is observed in the ankle area. Severe pain appears when the body has run out of strength to ensure normal movement. By this time, both the knee and hip joints have time to suffer, and pathological posture has time to develop. All this can lead to a disastrous outcome - arthrosis and scoliosis as a result of dysfunction of the supporting system.
Degrees and types of flat feet
Flat feet are one of those diseases that, once they occur, progress quite quickly. The severity of flatfoot disease can vary. There are three degrees of flat feet in total.
I. Mild Insufficiency of the ligamentous apparatus is the earliest stage of the disease. The shape of the foot is not changed, but as a result of overstretching of the ligaments, pain occurs that appears after a long walk or at the end of the day. After rest, as a rule, the unpleasant pain goes away. With mild flat feet, a feeling of fatigue appears in the legs after physical activity, and painful sensations occur when pressing on the foot. The gait becomes less flexible, and often the foot swells in the evening.
II. Combined Combined flatfoot is the next stage of the disease. At this stage, the flattening of the foot is determined by doctors with the naked eye, as the foot expands and clubfoot and heavy gait appear in the gait. At this stage, the intensity of the pain increases, and it already affects not only the feet and ankles, but can also reach the knee. The arches of the feet disappear, the foot is spread out. Pain in the feet is constant and more severe. The pain covers the entire leg down to the knee joint. There is significant difficulty walking.
III. Severe The third degree of flatfoot is a pronounced deformation of the foot, which, during the operation of the musculoskeletal system, is accompanied by disorders of various types (arthrosis, osteochondrosis, scoliosis and herniated intervertebral discs). It causes deformation of the fingers - they acquire a hammer-like shape. The more pronounced the deformity, the more the thumb deviates outward. Often patients consult a doctor only at this stage. After all, pain in the feet, legs, which are almost always swollen, and in the knee joints is constantly felt. The lower back often hurts, and a painful headache appears. With grade III flat feet, the ability to work is significantly reduced, even calm, short walking is difficult. A person can no longer move in ordinary shoes.
There are several types of flat feet: it can be longitudinal (flattening of the longitudinal arch of the foot) and transverse (flatness of the forefoot). If there is flattening of the longitudinal and transverse arches, they speak of combined flatfoot. In addition, children have varus or valgus feet.
Longitudinal flatfoot occurs most often at the age of 16–25 years, transverse – at 35–50 years. Longitudinal flatfoot in combination with other deformities is 29.3%, transverse flatfoot in combination with other foot deformities is 55.23%.
Longitudinal flatfoot occurs in 20% of cases. The causes of longitudinal static flatfoot are weakness of the muscles of the foot and lower leg, and the ligamentous apparatus of the bones. Under the influence of body weight on the feet, the outer and inner longitudinal arches become flattened, the foot comes into contact with the floor over almost the entire area of the sole, resulting in flat feet. This shifts the bones of the foot in such a way that the tendons of the peroneal muscles are stretched and as a result the appearance of the foot changes. It becomes elongated, its middle part is expanded, the longitudinal arch is lowered, the entire foot is turned inward. On the inner edge of the foot, the outline of the navicular bone is visible through the skin. This condition of the foot is reflected in the gait, which becomes awkward, with the toes pointed out to the sides.
The following stages of the course of longitudinal flatfoot are distinguished:
• stage of intermittent flatfoot;
• stage of development of the flat foot;
• stage of flatvalgus foot.
In the prodromal stage (pre-disease stage), the patient experiences fatigue and pain in the foot after prolonged static load on it. The pain usually occurs in the calf muscles and at the top of the arch of the foot. The fact is that the lower leg muscles are used to support the arch of the foot, which become painful from constant overexertion. At this stage of the disease, the patient is advised to maintain a correct gait, without spreading his toes when walking. Those who, due to the nature of their work, must stand for a long time, should place their feet parallel and from time to time give relief to the muscles of the arch. To do this, the feet are placed on their outer surfaces and stand this way for some time.
The next stage is the stage of intermittent flat feet. At this stage, pain in the feet and legs intensifies towards the end of the day, but they often appear after prolonged walking, especially in heels, or after prolonged standing. The muscles become tense, and temporary contracture (shortening, tightening of the muscle) may occur. The longitudinal arch of the foot becomes flatter by the end of the day, but in the morning, after sleep, the normal shape of the foot is restored. The severity of flat feet is determined using special techniques: plantography, podometry, X-rays. In the stage of intermittent flatfoot, a slight decrease in the arch is detected. At this stage, the same therapeutic and health measures are carried out as during the prodromal stage, and it is recommended, if possible, to change the working conditions.
If the arch of the foot is no longer able to recover after a long rest, this means that a new stage has begun - the stage of development of a flat foot. The patient develops pain and fatigue in the feet after a small static load. Over time, the pain becomes almost constant. The foot lengthens, its front part widens, the arch becomes lower, and the gait becomes awkward. Changes in the shape of the foot lead to the fact that the body weight is not distributed, as normal, over the entire foot, but falls mainly on the talus and the anterior part of the heel bone. The foot turns inward, its forefoot spreads out. The first toe deviates outward. The pain decreases, but this does not mean improvement at all. Treatment at this stage of the disease, in addition to previously given recommendations, includes wearing insoles, orthopedic shoes, and other types of treatment. If there is no effect and the disease progresses, surgical intervention is recommended.
If the patient is not treated, he develops the next stage - planovalgus foot. Longitudinal flat feet in combination with valgus alignment of the feet are called flatfoot feet. At this stage, pain in the foot appears even with a slight load. The arch of the foot is flattened, and the foot itself is sharply turned inward with the sole (valgus deformity of the foot). At this stage, the possibilities of conservative therapy are limited; surgical treatment is prescribed.
The most common complication of longitudinal flatfoot is a heel spur, which occurs as a result of overstretching and traumatization of the plantar aponeurosis - a broad ligament lining the longitudinal arches of the feet and attached with its base to the heads of the metatarsal bones, and its apex to the tubercle of the calcaneus.
Degrees of longitudinal flatfoot
• I degree: arch angle 131 – 140 degrees, arch height 35 – 25 mm. There is no deformation of the foot bones.
• II degree: arch angle 141 – 155 degrees, arch height 24 – 17 mm. The talus is shortened, its neck is not emphasized. There may be phenomena of deforming arthrosis in the talonavicular joint or calcification of the ligamentous apparatus on the dorsum of the foot.
• III degree: arch angle 156 degrees or higher, arch height less than 17 mm. A small protrusion on the plantar surface of the heel bone becomes massive. There is also a flattening of the transverse arch, abduction contracture of the 1st toe, the foot pronates (in this case, turns inward), the heel deviates outward.
It is mainly a hereditary disease that is characterized by weakness of connective tissue. In children under 10 years of age, this is the norm, since transverse arches in people are formed by 10–11 years of age.
Transverse flatfoot can occur in women when walking in stiletto heels - in this case, a redistribution of the load occurs: from the heel it moves to the area of the transverse arch, which cannot support it, becomes deformed, which is why transverse flatfoot occurs.
With transverse flatfoot (as a result of weakness of the ligamentous apparatus, under the influence of body weight), the transverse arch of the foot is flattened, the forefoot is also flattened, that is, it rests on the heads of all five metatarsal bones, and not on the 1st and 5th, as is the case happens to be normal. The big toe deviates to the side, and osteochondral growths appear along the inner edge of the head of the 1st metatarsal bone. The extensor tendons of the toes become stretched, skin calluses appear on the plantar part of the foot, and the 2nd and 3rd toes acquire the so-called hammertoe shape.
With further deformation of the foot, constant pressure from shoes is applied to the head of the 1st metatarsal bone, protruding to the inner side, and this becomes one of the reasons for the appearance of osteochondral growths along the medial (inner) edge of the bone. The outwardly deviated 1st toe and hammertoe-shaped 2nd and 3rd toes are subjected to even more pressure from the edges of the shoe. As a result, complications arise: an ingrown nail of the 1st toe forms, calluses on the interphalangeal joints of the 2nd and 3rd toes. But the most common complication of transverse flatfoot is valgus deformation of the first toe (Hallux Valgus), popularly called “foot bunions.” In men, it may well be confused with gout.
Typically, with transverse flatfoot, there are complaints of fatigue of the lower extremities when walking or standing for long periods of time. Pain in the head of the 1st metatarsal bone, pain from the side of the sole, and in the projection of the heads of the 2nd and 3rd metatarsal bones are also disturbing.
The consequences of the development of transverse flatfoot cannot be underestimated. Even if the flattening of the transverse arch of the foot is almost invisible. We should not forget that flat feet are one of those diseases that, once they arise, progress quite quickly. Therefore, soon the transverse arch may not be determined at all. The further you go, the more the big toe deviates outward, which leads to subluxation of the head of the first metatarsal bone.
Degrees of transverse flatfoot
• I degree: the angle between the 1st and 2nd metatarsal bones is 10 - 12 degrees, the angle of deviation of the 1st toe is 15 - 20 degrees.
• II degree: the angle between the 1st and 2nd metatarsal bones is 13 - 15 degrees, the angle of deviation of the 1st toe is 21 - 30 degrees.
• III degree: the angle between the 1st and 2nd metatarsal bones is 16 - 20 degrees, the angle of deviation of the 1st toe is 31 - 40 degrees.
• IV degree: the angle between the 1st and 2nd metatarsal bones is more than 20 degrees, the angle of deviation of the 1st toe is more than 40 degrees.
Assessment of the degree of transverse flatfoot
Combined flatfoot Longitudinal-transverse (combined) flatfoot is a hereditary disease that is characterized by weakness of connective tissue. Combined flatfoot is a combination of longitudinal and transverse flatfoot, which we have already described in detail above.
Figure 6. Imprint of the arches of a healthy foot
Figure 7. Degrees of longitudinal flatfoot in children (a) and adults (b)
Figure 8. Degrees of transverse flatfoot
Flat feet in children and adolescents
Generally speaking, flat feet begin in children, develop in adolescents, and end with foot deformity in adults. Therefore, at first glance, the book should begin with flat feet in children.
If you had not become acquainted with the sections of the book, which, I hope, helped you understand what flat feet are, how they can be identified, what types of flat feet there are and what complications they threaten, it is unlikely that the story about flat feet in children would be completely understandable.
In some ways, information about flat feet in children will overlap with material already read. We will simply not dwell once again on details that are already known to readers, but which nevertheless cannot be ignored in this section.
So, a healthy father and mother gave birth to a completely healthy child.
However, try to show him to an orthopedist in the very first weeks - for some congenital pathologies, which we ignore here (for example, congenital hip dislocation). Let the doctor look at how the child positions his leg, whether his feet are symmetrical, whether his leg is shortened, or whether there are any deformities.
Interestingly, all children are born with flat feet. And only from the time when the child gets to his feet and tries to walk independently, the musculo-ligamentous apparatus of the foot receives a certain load. This promotes the development of ligaments and muscles not only of the foot, but also of the entire musculoskeletal system. From this moment, the active formation of the arches of the foot begins, which ends by 6–7 years of age.
The child begins to stand more or less confidently on his feet by the age of 2 years. During this time, the baby must be examined by a specialist at least twice. It is during this period that the norms for the further condition and development of the skeleton and foot, the correct posture, posture and gait are laid down.
By the age of 3–4 years, the child develops an arched longitudinal arch of the foot (on the inside, from the base of the big toe to the heel bone). It is very important that the arches are formed correctly. For this purpose, in order to prevent flat feet, there are special massages and special exercises.
Be sure to keep an eye on your baby! It happens that parents are unaware that the child’s foot has fallen slightly inward (valgus, as orthopedists say) and is in a pronation position, that is, the sole is down with the outer edge raised. This may be a sign of congenital flat feet. The characteristic position of the thumbs - in different directions outwards - should immediately alert parents.
Or it may turn out that the arch of the foot is too high, as happens with increased muscle tone. It would seem great - what an elastic foot the child has! However, there is nothing to be happy about here. Try to ride in an empty truck bed along a rocky road - after a kilometer you will not find a living place on your body. And why? The truck's springs are rigid and designed to operate under a load equal to the weight of the cargo being transported. Such a rigid “spring” foot transfers all impacts to the skeleton no worse than a flat one. The child walks like a bear cub, has a clubfoot, the big toes are directed inward, the foot is supinated (the sole is turned inward and upward), the lower leg is in the position of the virus (deformation with deviation outward). True, this option, called “hollow foot,” is much less common.
Therefore, you should definitely show the child to an orthopedic doctor, who will tell you whether the baby has deformities, whether his feet are symmetrical, whether he places his foot correctly, and, if necessary, prescribe treatment to correct the disorders.
Today, flat feet are one of the most common foot diseases in children. Statistics say that by the end of school, more than 70% of students acquire this disease.
Features of the development of flat feet in children
Most often, longitudinal flat feet occur in children. It, as you already know, can be congenital and acquired.
The congenital form of the disease is rare and is a consequence of intrauterine malformations; it is detected already in the maternity hospital. In most cases, one foot is affected, but sometimes both are affected. This pathology is very noticeable in children: a convex sole and an outward-turned forefoot. Treatment is carried out from the first days of the child’s life: the deformity is gradually corrected using plaster casting using the Ponseti method (especially common in the USA, but already used in the Russian Federation). If this does not help, then, in agreement with the parents, they resort to surgical intervention.
The critical moment in the development of flat feet is the age from 8 months to 1.5 years, when the child begins to learn to walk. At this moment, it is important for parents to prevent the onset of foot deformities, given that it is very problematic to reliably establish whether a child has congenital flat feet or not before the age of 5–6 years.
All children under 2 years of age have a flat longitudinal arch of the foot. Experts consider this condition to be physiological, because the bone tissue in babies is soft and elastic. It contains few minerals, which give adult bones strength, and the muscular system is not well developed.
When children begin to stand on their feet (at 7–9 months) and walk independently (at 10–12 months), the function of a shock absorber is taken over by the “fat pad,” which is located on the child’s sole under the skin.
At 2–3 years, the bones acquire a sufficient amount of minerals, the articular surfaces acquire normal shape, the ligaments become stronger, and muscle strength allows you to stay on your feet longer.
Up to 3–4 years of age, if the child does not complain of pain in the legs, develops normally and exhibits normal physical activity, there is no need to worry about flat feet. At this age, if there can be flat feet, then there are only two categories.
• Rigid flat foot. This is a congenital disorder in which two or more bones in the foot that are normally separated are fused together. This category of flat feet can limit a child's mobility and cause pain when walking. Fortunately, it occurs quite rarely, no more than 2% of all cases.
• Flexible flat foot. When the child is sitting, the foot looks normal, but when the child stands, the arch of the foot drops and flattens. This is the most common type of flatfoot.
A small child does not require treatment or correction with either flexible or rigid flat foot. But it is not harmful for parents to know about these conditions in order to be able to monitor the development of the child’s foot in the future.
The process of formation of the bones of the foot continues until approximately 5–6 years of age. Only during this period can we talk about the presence or absence of flat feet in the child - the very thing that you should worry about.
The only problem that may worry parents of babies is clubfoot. And even then, mainly because with clubfoot, the toes of the shoes wear out faster. Many children in early childhood walk with their toes inward - it’s just more convenient for them to maintain balance.
It is at the age of 4 to 7 years, when the ossification points are not closed, that it is easier to prevent or correct the development of foot deformities and form a correct gait and prevent disruption of the entire musculoskeletal system, including the spine.
It should be noted that complete cure of flat feet is mainly possible in childhood.
Factors influencing the development of flat feet in children
During the period of intensive growth of the body - at 3 and 6 months, 1 - 3 and 5 years - differentiation of the shape and structure of the bones occurs. Frail bone apparatus, connected by ligaments that are still too extensible, as well as weak muscles, cause significant fluctuations in the height of the longitudinal arches of the foot during loading. This contributes to the appearance of static foot deformities, which can lead to the development of flat feet.
In children of this age, during the period of learning to walk, conditions arise for the occurrence of planovalgus deformity, since in order to increase the area of support and keep the body in balance, the child places his legs wide apart, leaning on the inner parts of the foot.
In addition, the hereditary factor plays a role: if parents have flat feet, then it can be inherited by children.
And finally, shoes. Tight and uncomfortable (but perhaps beautiful), if worn for a long time, it can also form flat feet.
The insidious thing about flat feet is that the child has no complaints at first. Parents see no reason to worry or be wary. Due to the fact that the child is in constant motion (study, sports, games), it is almost impossible to notice any serious changes in his health. And parents logically assume that fatigue, for example, is simply the result of a dynamic lifestyle.
But if a careful examination of children’s feet reveals flattening of the soles, then the reason is flat feet.
It is very important not to overload your child with sports activities. Today, many parents bring their children to sports clubs early. Dreaming of their future victories, they do not commensurate the load with the capabilities of the actively developing musculoskeletal system, which often leads to its disorders and, as a consequence, to curvature of the spine and joint diseases.
If one day, after an active walk or active game, the baby complains, “My legs are tired (they hurt)…”, this complaint should certainly alert the parents! Very often, problems such as pain in the legs and back, disturbances in posture and gait, muscle imbalance, appear in children already with flat feet and are one of its consequences. Only parents are not aware of the presence of initial foot deformation, and local pediatricians rarely search for it in advance. Whereas a safe, healthy and properly developed foot is not only a support, but also your baby’s hope for health in the future.
Varus and valgus placement of feet
Varus position of the feet (varus) is a fairly rare pathology. It is formed as a result of weakness of connective tissue (hereditary factor), which is part of the human ligamentous apparatus. Due to the impact of body weight (when the child begins to walk) on the weak ligaments of the feet, they cannot hold the joints in the correct position and the feet fall outward. It is also called O-shaped feet.
Treatment of varus feet comes down to wearing children's orthopedic shoes, wearing individual orthopedic insoles with pronating (deviating the foot inward) elements, performing specialized gymnastics for the feet, massage, and walking on a massage mat.
Hallux valgus (valgus) is the most common pathology in children. It is formed as a result of weakness of connective tissue (hereditary factor), which is part of the human ligamentous apparatus. Due to the impact of body weight (when the child begins to walk) on the weak ligaments of the feet, they cannot hold the joints in the correct position and the feet fall inward. In combination with flat feet, this is called planovalgus feet. It is also called an X-shaped foot placement.
Rice. 9. Normal foot and with valgus position (inward pronation of the foot)
Treatment of valgus feet comes down to wearing children's orthopedic shoes, wearing individual orthopedic insoles with supinating (deviating the foot outward) elements, performing specialized gymnastics for the feet, massage, and walking on a massage mat.
How to prevent the development of flat feet in children
Attentive parents can already notice signs of flat feet in a 2-3 year old child: after a short walk (30 minutes or more), the child quickly gets tired, asks to be held, or prefers to move in a stroller. After 1–2 months, new boots lose their original shape (for example, the inner edge of the sole or the heel along the inner edge has worn down, or the boot has become deformed inward).
In all these cases, it is necessary to urgently consult an orthopedic doctor.
In a 3-year-old child (but not earlier), you can independently carry out an initial diagnosis of the pathology using the simple test that we talked about at the beginning of the book (a print of a foot smeared with a thin layer of cream on a sheet of paper).
Perhaps all parents understand that preventive examinations by specialists are not a whim of doctors, but a necessary measure. The main thing is not to miss the time to visit the doctor.
An examination by an orthopedist is carried out in the first month of life, this is necessary to exclude congenital deformities and skeletal diseases, including congenital flat feet, at 3 and 6 months of age, when rickets can be detected, and at 1 year. This is an important stage in a child’s life when he sits, crawls, and walks independently. At this time, the doctor checks the correct natural curves of the spine and the range of motion in the joints. At 3 years old, an orthopedist checks posture and gait, measures the length of the limbs, and examines the condition of the feet.
Ideally, from this age on, you should visit an orthopedist with your child every year so as not to miss the development of flat feet. Parents need to be prepared for the fact that the orthopedist (if he doubts the final diagnosis) will refer the little patient for additional examination to a consultative and diagnostic center.
If the child goes to kindergarten, this problem goes away by itself - preschool children in child care institutions are examined quite regularly. But if a child grows up at home until the 1st grade, parents should remember the date of the medical examination.
So, the foot still turned out to be deformed. What happens in the body?
The ligaments send signals to the nervous system about trouble in this area. In response, the muscles receive an “instruction” to engage in a “fight” with the deforming forces - that is, to tense up as much as possible. But they are not able to withstand such a load for a long time, so they quickly become exhausted, relax and stretch. And the deforming force continues to act - now on the ligaments. Soon, stretching occurs in them (especially if there is a congenital pathology of the connective tissue), since without muscle support they cannot work for a long time. Now all the load falls on the bones. When they cannot stand it, deformation from compression begins. By this time, the ligaments completely fail, and the deformation enters the final, irreversible phase. The gait loses its plasticity and smoothness. Children often complain of fatigue when walking, pain in the ankle joints or lower legs, and often in the lower back. Some cannot clearly identify where exactly they experience discomfort or pain, so they do not complain, but simply prefer calm, less active games. A deformity of the ankle joint appears (remember, it is also called valgus or X-shaped).
Sometimes a foot deformity can exist for many years (until adulthood) without showing itself in any way. But sooner or later, deterioration will occur, since the body’s compensatory capabilities are not limitless.
Children who are found to have flat feet are monitored by an orthopedist and undergo an appropriate course of treatment until they are 14–15 years old. During this time, they undergo courses of physiotherapy, therapeutic massage, are sent to sanatorium-resort treatment, and, if necessary, special orthopedic shoes are made for them.
To avoid clubfoot, the easiest way is to buy or order insoles at the pharmacy to stabilize the foot. Pain usually occurs due to the fact that the muscles of the flat feet work more intensely and become overstrained. An arch support will solve this problem. The arch support insole returns the child’s flattened foot to the correct position and during the day works as a kind of simulator of the foot muscles: those muscles that were previously hypertonic rest, and those that did not work begin to gain shape. Arch supports will also help children with flexible flat feet who sometimes experience foot pain. The correct selection of orthopedic insoles leads to alignment of the arches of the feet and normalizes the position of the heel.
However, not all orthopedists agree with this.
Medicine does not stand still, and it increasingly turns out that many things that were considered true a couple of decades ago no longer have a scientific basis.
One of these myths, according to many orthopedists, is the need for widespread correction of flat feet. If there's one thing kids need, they say, it's well-fitting shoes. And the most important thing for the baby’s health is to choose it correctly.
There is another myth about flat feet - that flat feet can affect a child’s participation in sports. Research shows that this is not the case and that a child with flat feet can play sports normally and excel at them. Interestingly, this fact is also confirmed by anthropologists: if our flat-footed ancestors could not quickly run away from predators, then thanks to natural selection, none of us would now have flat feet.
In any case, the treatment of flat feet in children should be approached very conservatively. Although surgical correction is indicated in some cases of rigid pes planus, surgery should be used as a last resort because the risk of complications after such operations is very high.
Choosing the right children's shoes
We have already written that the culprit of acquired flat feet may be incorrectly selected shoes. As soon as the child begins to stand on his feet, it means that it is time to buy him his first shoes. This usually occurs within a period of 7–8 months.
The criteria for “correct” children's shoes are defined quite clearly. The first boots should have the following qualities.
• Secure the foot and ankle joint tightly using lacing or Velcro, but in no case squeeze the leg or be too loose.
• Have a minimum number of internal seams so that the baby does not rub the skin around the ankle joints.
• Natural materials must be used in their manufacture (including insoles).
• The backdrop should be high, rigid, and fit the baby’s leg well. This is necessary in order to avoid lateral curvature in the ankle joint.
• It is better if the surface of the shoes is perforated so that the feet can “breathe”.
• The sole should be stable and non-slippery, with a small (1 - 1.5 cm) heel. In addition, it should be flexible in the middle, that is, where the leg anatomically bends. Where the leg does not bend, the sole should not bend either.
• Shoes for children under 2 years old should not have an instep support, because the function of a shock absorber is performed by the same “fat pad”, otherwise the instep support will only hinder the normal formation of the arches of the feet.
• When trying on, it is necessary to take into account that the shoes have a margin that does not interfere with the child’s walking - about 1.5 cm.
• It is advisable to change your baby's shoes every three months: in preschool age, feet increase by approximately 2 to 3 sizes per year. If the distance between the toe and the longest toe is less than the width of the baby's big toe, the shoes should be replaced immediately.
After a walk, you should pay attention to the baby’s feet: if the texture of tights or the inner seams of a shoe are imprinted on the skin, the shoes need to be changed. This will give little feet a chance to rest from their usual position, and if the child’s feet are sweating, the damp shoes need to be properly dried. Parents can do a lot to prevent flat feet in children. From 3 to 4 months, give your baby gymnastics and foot massage. And when he turns 2 years old and is already confident on his feet, do exercises with him to develop the muscles and tendons of the foot. Children are happy to join in the game when they are given the task of lifting a handkerchief or pencil with their toes or walking barefoot on their toes, heels, on the outer and inner sides of the foot. Place a foot massager or a ball under the student's desk and let him roll them while he is in a passive position.
Special cases of flat feet
Flat feet during pregnancy
Pregnancy causes a lot of different changes in a woman’s body. Many women have the same complaints during pregnancy. One of the common complaints that doctors practically do not take into account is the complaint of pain in the legs.
Due to natural weight gain during pregnancy, the body's center of gravity shifts forward. This causes a redistribution of the load on the limbs, and the pressure in the knee joints and feet increases.
During pregnancy, connective tissue (ligaments, joint capsules, fascia) becomes easily stretchable under the influence of changing hormonal levels. The normal asymmetrical position of the fetus in the womb shifts the center of gravity and unevenly flattens the feet. Scoliosis occurs in pregnant women. Pressure increases on the lower spine, knee joints and feet.
These changes can cause pain in the heels, arches, or metatarsals. Many women experience leg muscle cramps and varicose veins.
After childbirth, a woman’s flat feet increase by one and a half to two sizes. The deformation of the spine and feet is fixed by “strengthened” connective tissue in an altered, incorrect position. Therefore, all pregnant women need to have the necessary information about their health, and in particular about the function of their legs, so that they can have a more comfortable nine-month pregnancy period.
Overpronation of the feet and swelling of the feet are the most common problems during pregnancy.
Overpronation, which accompanies flat feet, occurs because the arch of the foot flattens under the influence of weight. This can cause strain and inflammation of the plantar fascia, which runs from the heel to the toes. Excessive pronation leads to the fact that walking becomes painful, as there is an increase in the load on the legs, shins (or popularly calves) and spine.
Overpronation should be addressed not only to relieve pain, but also to avoid further complications such as plantar fasciitis, heel spurs, metatarsalgia, posttibial tibialis posterior tendonitis, or toe deformities.
Edema (or swelling) of the legs usually occurs in the second half of pregnancy. Edema is caused by difficulty in the outflow of blood due to the pressure of the enlarging uterus on the large veins of the lower extremities, which is why swollen legs acquire a bluish tint.
In a pregnant woman's body, the total volume of fluid in the body remains the same as before pregnancy, but its distribution changes. During pregnancy, additional fluid accumulates in the body, which increases swelling.
Usually the swelling in both legs is the same. If your legs swell unevenly, this may be a symptom of vascular insufficiency, which requires the help of a qualified specialist. If your hands or face swell, the pregnant woman should immediately consult a doctor.
There are effective ways to combat overpronation and foot swelling during pregnancy.
Excessive pronation can be eliminated with the help of ready-made orthopedic products. These orthotics must provide adequate arch and rearfoot support. Thus, wearing arch supports from the early stages of pregnancy allows you to support the arches of your feet and save them from deformation in this difficult period for a woman. Individual arch supports, made taking into account all the characteristics of a pregnant woman (weight, physical activity, shoe model) will prevent foot deformation and make it as comfortable and effective as possible.
The correct selection of shoes is important. A pregnant woman should choose comfortable shoes with proper foot support and cushioning.
The following may also be recommended for pregnant women.
• Raise your legs as often as possible. If you have to sit for a long time, place a small stool and rest your feet on it.
• Wear sensible shoes. Shoes that are too narrow and short impede blood flow in the lower extremities.
• Measure your calf, thigh and foot size several times during pregnancy. These numbers are subject to change.
• Wear socks without seams that do not restrict blood flow.
• If you drive for long periods of time, take regular breaks to stretch your legs to improve circulation.
• Exercise regularly to improve your overall health. The best form of exercise is walking.
• Eat a balanced diet and avoid salty foods, as salt retains fluid in the body.
• Drink plenty of water to stay hydrated. This helps the body retain less fluid.
By saving the foot during pregnancy, we save the entire musculoskeletal system of a woman in the future!
Changes in the vascular system in diabetes are often generalized, but have different depths in different organs. In the foot area, diabetic changes in the neurovascular bundle are characterized by the phenomenon of “end arteries,” when, as a result of damage to small branches of arterioles (only capillaries are smaller than these arterial vessels), they lose interaction with neighboring arterioles. As a result of such changes, blood stops flowing into the soft tissues of the foot with affected arterioles, the tissues begin to die and disintegrate - up to the development of gangrene of one or more toes. The cause of foot gangrene can also be atherosclerotic narrowing of large arteries.
In diabetes mellitus, gangrene can initially develop according to the dry type (that is, the tissues dry out, as if mummified), and only when an infection occurs and the infectious process (inflammation) develops, a purulent-necrotic lesion of the foot occurs according to the type of wet gangrene (when the soft tissues begin to decompose and rot). The infection usually enters through damage to the skin near the nail bed, resulting from careless trimming of the nails, or as a result of their deformation, delamination, destruction, typical of diabetes, which often develops inflammatory processes in the area of the nail fold or bed.
The severity of diabetic foot disease is influenced by the severity of diabetic neuropathy, which causes ulcers to form on the foot. They can be a source of infection and the development of phlegmon (inflammation of fatty tissue), which sharply worsens the general condition of patients.
There are mainly six types of foot lesions in diabetes mellitus:
1) specific damage to the skin and nails;
2) local gangrene of fingers and skin;
3) gangrene in combination with a developing infection (atherosclerotic gangrene, local gangrene with good blood supply to the foot);
5) nonspecific suppuration of foot tissues;
6) anaerobic infection causing severe gangrene.
Of all the listed types of foot damage in diabetes, the most malignant course, which threatens the lives of patients, is purulent-inflammatory diseases caused by anaerobic infection. Usually in these cases, urgent amputation of the affected limb is required: not even the foot, but the lower leg to the knee, or complete amputation of the leg.
There are also diabetic arthropathy of the joints of the feet, in which the soft tissue does not decompose. They occur more often in women aged about 30 years with a duration of diabetes of at least 6 years and insufficiently active treatment. The main changes occur in the metatarsophalangeal and interphalangeal joints, especially the 1st toe. The joint spaces narrow, changes appear in the cartilage, the articular ends become flattened and thickened, and bone growths appear. Typical signs of deforming arthrosis occur: pain, limited mobility, joint deformation.
Treatment of foot lesions in diabetes mellitus is complex and should actively begin at the first signs of foot disease.
Anti-inflammatory and anti-atherosclerotic treatment is carried out: drugs are prescribed that normalize fat and carbohydrate metabolism, reduce the permeability of the vascular wall, lower blood pressure and normalize the formation of cholesterol. For diabetic microangiopathy of the foot, in order to improve blood supply, angioprotectors, antispasmodics, and also drugs that improve blood properties are prescribed.
Surgical operations for purulent-necrotic processes in the diabetic foot are possible if there is no pronounced swelling, the skin is in normal condition and pulsation is palpable on the femoral artery, as well as with good effectiveness of antibiotic treatment, good blood supply and blue coloration of the foot, with a difference in skin temperature on the foot and shin no more than 2 C.
In case of diabetic damage to the nail plate, it is removed only after the cessation of the inflammatory process and with good pulsation on the posterior tibial artery.
Painful calluses on the foot are removed with great care, avoiding damage to surrounding tissue.
Beginning ulcers are treated by unloading the corresponding part of the foot, which often ensures their healing. For long-term deep ulcers, the foot is amputated - partially or completely. If the ulcer is located in the heel area, then the entire lower leg is amputated.
Treatment of phlegmons of the foot begins with their opening, removal of dead tissue and drainage. The issue of amputation is decided depending on the further course of the process. After treatment, if the foot can be saved, patients need special orthopedic shoes, which can reduce the load on the deformed foot and prevent the formation of abrasions.
What are the complications of flat feet? Unfortunately, very different. First of all, this is a flattening of the transverse arch of the foot with subluxation of the 1st toe outward in adolescence. If the foot has been in an incorrect position for a long time, and especially if there is a valgus deformity of the ankle joint, this can lead to deformation in the joints of the foot and even to a change in the ratio of the articular surfaces of the knee and hip joints. In the future, this can lead to scoliosis, that is, an arched deformation of the spine to the right or left.
Here is an incomplete list of complications with flat feet.
• Disproportionately developed or underdeveloped leg muscles.
• Diseases of the foot itself (deformation of the toes or the entire foot, calluses).
• Diseases of the knee joints (arthrosis deformans, inflammation of the menisci, knee joint laxity).
• Pelvic diseases (coxarthrosis).
• Spinal diseases (osteochondrosis, curvature, herniated discs, radiculitis).
• Flat feet are associated with the development of varicose veins.
• Another consequence of flat feet is plantar nerve disease, the so-called. aponeurosis or heel spur. It occurs even in young women 20–25 years old and is accompanied by burning pain.
We will dwell on the most common of them in a little more detail.
“Bones” of the thumb and little finger
Hallux valgus, which is commonly called a bunion (we have already mentioned it), or Hallux Valgus in Latin, is one of the most common foot deformities. The deformity of the foot occurs due to the protrusion of the head of the first metatarsal bone, which is part of the joint of the big toe, along the inner surface of the foot. With hallux valgus, the big toe moves toward the other four toes, with the big toe sometimes positioned underneath the second toe. This position is called crossed fingers. Hallux valgus leads to inflammation in the area of the joint capsule, with pain along the inner surface of the thumb. Forefoot deformity is very troublesome and causes problems with walking.
Another type of anterior deformity is associated with varus curvature of the fifth finger (little finger), which has the Latin name Quintus Varus, or “tailor’s bone.” With this pathology, the little finger moves inward, towards the other fingers. The deformity occurs on the outside of the foot near the little toe. Painful bursitis (inflammation of the joint capsule) with redness of the skin may develop in this area.
Forefoot deformities mainly occur in women. The development of finger curvature is based on congenital weakness of connective tissue. Deformity occurs in many diseases, in particular arthritis. Incorrectly chosen shoes contribute to the development of deformity. Tight shoes with narrow toes have a negative impact on the foot, causing it to take the shape of the shoe and gradually lead to the formation of hallux valgus. Women with crooked toes most often wear shoes that are too small for them. You need to understand that wearing dress shoes, high-heeled shoes, or boots with narrow toes can cause progression of toe deformity to the point where surgery is required.
In the initial stages of deformity, warm foot baths bring relief. The best way to get rid of pain caused by bunions is to wear sensible, properly fitted shoes. People with forefoot deformities are advised to wear shoes with a roomy toe box or shoes with special rocker soles.
Conservative treatment includes the use of products that are used not only in shoes. These include a bunion night splint and a bandage with protective gel. These remedies can stop the progression of the deformity, relieve pain, and create a healthy environment for the foot to function.
To prevent further development of deformity and for a comfortable feeling of the foot, special orthopedic devices are recommended.
Known to doctors as ingrown toenails, it is a painful condition that occurs when skin on one or both sides of the nail grows over the edge of the nail, or when the nail itself grows in and sinks into the surrounding skin. So, this complication is typical for people with flat feet. Ingrown toenails become a chronic problem and cause pain. Irritation, redness, an unpleasant burning sensation, and swelling of the finger are all the result of an ingrown toenail.
Ingrown toenails can develop not only with flat feet, but also for many other reasons. In some cases, it may be congenital if the toenails are too large. People who have congenital finger deformities or crooked fingers due to arthritis are also prone to developing ingrown toenails. A finger injury may be the reason that the nail begins to grow over nearby soft tissues. This occurs after a blow to the finger or after the finger is squeezed. Repeated injuries, such as repeated impacts from football players and runners, can also cause the nail to grow into the surrounding tissue. A common cause is improper trimming of toenails. Tight stockings, socks and narrow-toed shoes can aggravate the situation. Redness, tenderness, or swelling of the skin around the nail indicates the presence of an infection. Ingrown nails are accompanied by the development of a humid, warm microclimate, which is favorable for the development of infection. Penetration of the nail into the skin facilitates the penetration of pathogenic bacteria into the skin.
The following simple measures can help treat an ingrown toenail.
• Foot baths in warm salt water.
• Thoroughly dry your feet with a clean towel.
• Applying a mild antiseptic to the affected area.
If inflammation, discharge from the wound, swelling or pain continues, then the finger is infected. An untreated ingrown toenail deep under the skin causes severe inflammation, which should be treated by a surgeon. The surgeon performs outpatient surgery to remove the infected nail. During surgery, part of the nail or overgrown skin can be removed and the infection treated. If an ingrown toenail is not hereditary, the best way to prevent ingrown toenails is to protect your feet from injury and wear properly fitting shoes with wide, roomy toes.
It is important to trim your nails correctly. To do this, you need to use sharp, safe scissors with narrow jaws. The nail is trimmed so that its edges remain visible. If the nail is cut short, this promotes its growth into the depths of the skin. The natural desire to trim the corner of a nail that is beginning to grow in is harmful. In this case, only a temporary effect is achieved, and the process of ingrown nails does not stop, but continues to progress and intensify.
Morton's neuroma is a benign thickening of the nerves of the foot. The most typical symptoms are burning, shooting pain and a feeling of numbness at the base of the 3rd, 4th or 2nd toes. In some cases, there may be a sensation of a foreign body, or a crease in the sock between the toes. The pain usually goes away after removing shoes and kneading the toes and feet.
When a thickening develops in the area of the nerve, the surrounding bones and ligaments begin to put pressure on it, resulting in irritation and inflammation. This condition can be caused by ill-fitting shoes. Tight shoes with narrow toes and high heels often contribute to the development of neuromas: they can compress the nerve between the toes, causing discomfort and severe pain. Symptoms of Morton's neuroma often occur after the foot has experienced significant stress in the forefoot during walking, standing, jumping or running, as well as when flat feet have developed.
The first step in treating Morton's neuroma should be choosing the right shoes. Shoes with high and wide toes are suitable to reduce pain. The next step is to use an orthopedic instep support with placement in the metatarsal area. This pad is placed under the ball of the foot to redistribute pressure and relieve pain caused by the neuroma.
Once the cause of the neuroma has been eliminated, it may take several months for the condition to improve. If conservative treatment does not lead to a positive result, then surgical treatment is resorted to, which consists of excision of the neuroma or expansion of the space in which the nerves pass. These types of surgical interventions are usually performed under local anesthesia. If part of the nerve is excised along with the neuroma, then after the operation a small area of numbness may remain.
Flat feet and military service
In accordance with the “Regulations on military medical examination” dated February 25, 2003 No. 123, longitudinal flatfoot of the I and II degrees, as well as transverse flatfoot of the I degree without arthrosis in the joints of the midfoot, contractures of the fingers and exostoses do not interfere with military service and admission to military educational institutions and colleges.
Below we present the requirements for the health status of citizens who are subject to initial military registration, who are subject to conscription for military service (military training), who are entering military service under a contract, who are entering schools, military educational institutions, military personnel and citizens who are in the reserves of the Armed Forces Russian forces.
I – citizens upon initial military registration, conscription for military service;
II – military personnel undergoing military service upon conscription;
III – military personnel undergoing military service under a contract, reserve officers who have not undergone military service, when they are called up for military service and military training;
IV – citizens intended for military service on submarines and undergoing military service on submarines;
a) include pathological equine, calcaneal, varus, hollow, plano-valgus, equino-varus and other feet, as well as 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;
1) 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;
2) absence of all toes or part of the foot at any level;
3) persistent combined contracture of all toes on both feet with claw or hammertoe deformity;
4) post-traumatic deformation of the calcaneus with a decrease in the Böhler angle [1] over minus 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;
1) moderately severe deformities of the foot with minor pain and static disturbances, for which it is possible to adapt shoes of an established military standard for wearing;
2) 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;
3) longitudinal or transverse flatfoot of the II degree with deforming arthrosis of the II stage of the joints of the middle foot;
4) 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;
5) 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;
d) refers to longitudinal or transverse flatfoot of the 1st or 2nd degree with deforming arthrosis of the 1st stage of the joints of the middle foot in the absence of contracture of the toes and exostoses.
D – unfit for military service,
B – limited fit for military service,
B – fit for military service with minor restrictions,
A – fit for military service,
NG - not fit for military service in the Armed Forces of the Russian Federation, branch of the military, in certain military specialties, not fit for admission to schools and military educational institutions,
IND - category of suitability for military service, service in the Armed Forces of the Russian Federation, branch of the military, suitability for certain military specialties, for admission to schools and military educational institutions of the Ministry of Defense of the Russian Federation is determined individually.
rightfully deals with flat feet .
Orthopedics (from the Greek orthos - direct and paideia - education) is a section of clinical medicine that studies congenital and acquired deformities and dysfunction of the musculoskeletal system and develops methods for their treatment.
But the problem of flat feet in the world turned out to be so urgent that in the most developed countries a separate science appeared - podiatry. Podiatrists who work in this field are called podiatrists.
When diagnosing flat feet, the following methods are used: survey, examination, podometry (measurement of the height of the arch of the foot), plantography, radiography.
Survey (identification of complaints and symptoms)
Every disease has its own early warning signs. They also exist for flat feet.
The first and main symptom of most diseases is pain. Any pain, wherever and whenever it occurs, should be alarming, like a red signal or an alarm bell. Pain signals that there is a malfunction or disturbance in the body and it is necessary to find and eliminate the cause of the disease.
You can notice the initial symptoms of flat feet yourself.
If you experience rapid fatigue of the legs, as well as aching pain in the feet, thigh and lower leg muscles and in the lower back, which manifest themselves when walking, and then when standing, if you notice swelling of the foot, which goes away during night sleep, poor posture , unnatural gait, this is a definite reason to pay attention to your feet. The foot hurts not because it is tired. Pain may be a symptom of the initial phase of flat feet. Therefore, we need to figure out what hurts and why. We must also remember that the listed symptoms may correspond not only to flat feet, but also to other diseases. In any case, if you experience unpleasant or painful sensations in the foot area, you should consult a doctor.
With flat feet, the sole of the foot hurts, the tarsal bones ache and the muscles of the lower leg ache - under the knee, outward from the bony crest of the tibia. Both the ankle joint and the inner surface of the knee may hurt (due to improper load on the ligaments). The pain appears in the evening due to fatigue, especially if the work is standing or involves long walking. In the initial stages of the disease, until the arches of the feet “sag,” the pain goes away by morning, and for some time the person feels quite well.
The fact that you do not have dilated veins, which can also cause pain, is proven by the absence of severe swelling, blue-purple color of the skin, and also by the fact that these same dilated veins are not visible under the skin.
There is another fairly common disease - obliterating endarteritis, or intermittent claudication, caused by blockage of the arteries of the leg. With this disease, the nature of the pain is different: it occurs suddenly, acutely when walking or running, when the artery does not provide sufficient blood supply. The foot begins to hurt very sharply and severely. A characteristic symptom is that the patient suddenly stops, he simply cannot walk. Wait, the blood will somehow flow through the spasmodic artery - and the pain will go away. With such a symptom, you should urgently contact a surgeon.
Particular attention should be paid to complaints of fatigue and pain in the feet, and sometimes in the legs, associated with standing and walking. Fatigue and “static” pain do not appear immediately, but gradually and especially intensify towards the end of the day. Their most typical and constant localization is the tops of the arches (calcaneocuboid and talonavicular joints) and the corresponding areas of the dorsum of the foot, as well as the area of the calcaneal tubercle. The combination of pain with leg fatigue, dependence on load and typical localization facilitates differentiation (recognition) of “static” pain in flat feet with other diseases that have similar pain (with apophysitis, Keller-2 disease, neuritis of the plantar nerves, etc.). In doubtful cases, the question of the cause of pain can be resolved by x-ray examination of the feet.
The next step is inspection. Moreover, it is necessary to examine not only the leg, but also the shoes. Worn down shoes will tell a lot to an experienced eye.
Normally, we wear the heel along the outer edge, and the toe along the inner edge.
With flat feet, the inner edge of the sole and heel wears out faster; with a hollow foot, the outer edge of the sole wears out faster. It's also helpful to compare both boots. Uneven degrees of wear indicate shortening of the leg. The one that is longer carries a greater load, and therefore the shoes on it wear out more quickly.
A crushed heel indicates instability and increased mobility of the heel, which indicates instability due to weakness of the ligamentous apparatus of the foot.
Parents should pay more attention to their children's worn-out shoes. If the shape of your worn-out shoes seems unusual, you should consult a podiatrist.
How is a foot examination performed?
You need to take off your shoes and sit down so that your shin (leg from knee to foot) is vertical relative to the floor, and your foot is at a right angle to your shin.
A healthy, stable foot is usually wide with straight, strong toes. Pay attention to the color of the skin (purple-bluish indicates venous congestion, pale indicates arterial insufficiency), calluses, thickening, and abrasion of the skin.
Then you need to stand up and place your feet tightly together. The big toes of both feet should be close to each other. The long narrow foot and visually high instep are only deceptively beautiful: if you look closely, your toes are looking in different directions. Under load, such arches often bend more than expected.
Shortening of one leg during growth is quite common, and subsequently it can pass, the legs will straighten out on their own. But it also happens that the relative shortening of the leg is caused by the uneven height of the arches of the feet, that is, again, flat feet. And only upon careful examination is a pronated (deviated) foot visible.
If you correct the leg length in time by simply placing a piece of ordinary rubber or cork half a centimeter thick under the heel (or better yet, make a special instep support), then troubles can be avoided.
Fatal skeletal diseases leading to severe consequences are very rare. Much more often, the musculoskeletal system suffers from our own inattention, laziness, and frivolity. In most cases, that part of the population that suffers from flat feet (and as a result, osteochondrosis of the spine, arthrosis of the joints, etc.) could get rid of such health problems in infancy if parents were more attentive to their child.
When examining your feet, you should pay attention to the following features:
1) the presence of pronation (outward or inward) of the entire foot or its forefoot, as well as abduction or adduction of the latter, laxity and valgus deviation (relative to the axis of the tibia) of the heel - these changes are a contraindication to the use of half-insoles, and therefore they must be identified;
2) the possible degree of therapeutic correction of lateral curvatures of the foot and flattened arch;
3) the nature of shoe wear.
The last two points are more important when ordering orthopedic shoes with appropriate corrective and rigid (high boots, barrels, heels, etc.) parts.
So, let’s remember the main symptoms of flat feet:
• shoes are worn down and worn out on the inside;
• legs get tired quickly when walking and standing;
• fatigue and aching pain appears (when walking, and later when standing) in the foot, leg and thigh muscles, in the lower back at the end of the day, cramps, a feeling of heaviness, swelling;
• swelling in the ankles and feet, disappearing overnight;
• it is very difficult to walk in heels;
• the leg seems to have grown – with a pronounced shape, the foot lengthens and widens in the middle part – you have to buy shoes a size larger (especially in width);
• the foot has become so wide that it no longer fits into your favorite shoes.
• it is easier to bend over than to squat, and when squatting, it is difficult to maintain balance;
• heavy, unnatural gait, club feet, and poor posture appear;
• the “bone” on the big toe (hallux valgus) grows.
For plantography, the following are used: a metal frame measuring 22 X 37 cm, consisting of two parts fastened to each other with screws, with a 0.2 mm thick polyethylene film stretched between them; contourograph for outlining the feet with their position strictly perpendicular to the support area; a felt roller mounted on a wooden handle for applying a thin layer of paint to one side of the film.
For prints, printing ink is used, diluted with turpentine (1 part ink to 3 parts turpentine), which must be stored in a tightly sealed container. It should also be remembered that before plantography the paint must be thoroughly shaken, as it settles relatively quickly.
Rice. 10. Plantography: normal foot print and with different degrees of longitudinal flatfoot
Before taking an imprint, the subject must assume his usual posture: he is asked to stand comfortably, taking into account the natural turn of the feet and the distance between them. Next, bending his leg, he raises the foot, and the doctor moves a frame with paint applied to the back side and a sheet of paper and places the foot on the film in the same position. The load on both limbs should be equal.
To avoid involuntary movements of the foot, especially in young children, the outline should be done immediately, or even better, before plantography, simply outline the foot on the table and familiarize the child with the sensations that he will experience. This preliminary manipulation will help prevent the print from shifting during delineation. In addition, before delineation, the subject must be warned to stand straight at all times; Typically, children lean forward and supinate their feet during delineation in order to better follow the procedure. As a result, the contour line and the outer edge of the print merge, increasing the width of the print. The same thing happens if there is no support for the arms and it is difficult to maintain balance.
Plantography data characterizing flat feet in adults cannot be the basis for diagnosing flat feet in children. Children of preschool and school age have their own typical prints. Figure 10 shows the age standards of fingerprints (their extreme boundaries), with which it is necessary to compare the plantograms of the subjects for orientation. The perpendicular CD drawn to the middle of the tangent AB is divided into 3 equal parts. For 3-4 year old children, the typical width of the print will be limited to the middle of the first (from the tangent) third of the perpendicular CD. In children aged 5–7 years, the border of the imprint will pass between the first and middle thirds of the perpendicular CD, and from eight to eighteen years old – through the middle of the CD. The width of the prints, exceeding the limits indicated for a given age, may be an indicator of flattening of the foot.
Rice. 11. Maximum limit of standard print width by age
Considering that plantography very roughly reflects the condition of the arch, it should be combined with a more accurate method - podometry (measurement of the height of the tuberosity of the scaphoid bone).
If flat feet are detected, the height of the internal longitudinal arch should be measured. The apex of the internal longitudinal arch is the talonavicular joint, and the apex of the external longitudinal arch is the calcaneocuboid joint. Therefore, accurate data on the height of the longitudinal arches can only be obtained from an X-ray examination of the feet, which is not always possible in a clinic setting.
The tuberosity of the scaphoid can serve as an anatomical landmark that is easily determined and most accurately reflects the height of the internal longitudinal arch. To measure the distance of the scaphoid tuberosity from the floor, you can use a measuring tape or a special device.
Rice. 12. Measuring the height of the scaphoid tuberosity
The position of the feet is very important. The height of the navicular tuberosity will vary in the same person depending on the distance between the feet. If your feet are too far apart, the height of the tuberosity will be lower than if there is a small distance between them. The examinee is asked to assume normal posture, stand comfortably, and in this position, the height of the tuberosity of the scaphoid is measured. In order to judge the height of the arch, it is necessary to compare the measurement data of the subject with its standard height, that is, typical for his age. The average variation in vault height for each age is 4–5 mm.
Average height of the scaphoid tuberosity depending on age and gender (in mm)
To determine the degree of flatfoot, the “Podometric Index” formula is used, in which H (foot height) is divided by L (foot length). The table shows indices for different degrees of flat feet.
Determining the degree of flatfoot using the podometric index
In the absence of typical or atypical symptoms of flat feet, as well as a significant discrepancy in the methods used, an X-ray examination of the feet is indicated.
To determine the degree of flatfoot, radiographs of both feet are taken in frontal and lateral projections with a load. The criteria for placement are the uniformity of the heads of the metatarsal bones and clear visualization of the talonavicular joint.
Longitudinal flatfoot is determined by an x-ray of the foot in the lateral projection with a load.
An X-ray of the foot in a lateral projection is taken in a vertical position on a cassette 18 X 24 or 24 X 30 cm. The subject stands on a wooden stand 5 cm high so that its outer edge is level with the outer edge of the stand, the other leg is pulled back, leaning on the chair with his hand . The cassette is placed with a long edge on the table along the foot at the inner edge of the stand and pressed tightly with a bag. The central beam is directed horizontally to the middle of the cassette through the outer surface of the foot.
In the longitudinal arch, the angle and height of the longitudinal arch of the foot are distinguished:
• the angle of the longitudinal arch is formed by lines connecting: the lower edge of the scaphoid-sphenoid joint, the top of the plantar surface of the calcaneal tubercle, the head of the 1st metatarsal bone; Normally, this angle is 125 – 130 degrees;
• the height of the longitudinal arch is the perpendicular descended from the top of the corner to the base; normally it is 39 mm.
Rice. 13. Longitudinal flatfoot – radiograph
Transverse flatfoot is determined by an x-ray of the foot in a direct projection with a load.
A radiograph of the foot in a direct projection is taken in a vertical position on a cassette measuring 13 X 18 or 18 X 24 cm. The subject stands with his foot on the cassette, leaning his hand on a chair. The central beam is directed vertically to the center of the cassette.
The X-ray shows the following (in different stages of flat feet).
In the initial stages of the process, the 1st metatarsal deviates inward and the 2nd metatarsal moves moderately in a plantar direction. As transverse flatfoot develops, the load on the foot is gradually redistributed, slowly moving outward. The main load falls on the 2nd and 3rd metatarsal bones. They hypertrophy.
With further development of the process, the 1st metatarsal bone deviates in the medial direction (inward), and the remaining bones move in the plantar direction, while all interosseous spaces are expanded.
Next, the deviation of the 1st finger outward (Hallux valgus) increases, and the 2nd, 3rd and 4th fingers begin to deviate successively in the same direction.
With pronounced transverse flatfoot, subluxation of the 2nd and 3rd metatarsophalangeal joints occurs with a displacement of the proximal phalanges laterally (outward) and to the rear. Hammer-shaped curvature of the 2nd and 3rd fingers often occurs. Degenerative-dystrophic damage to the head of the 1st metatarsal bone occurs; it becomes deformed, enlarges and often undergoes a carpal-shaped restructuring.
Rice. 14. Transverse flatfoot – radiograph
In the transverse arch determine:
• the angle between the axis of the 1st toe and the axis of the 1st metatarsal bone. Normally it is no more than 15 degrees;
• angle between the 1st and 2nd metatarsal bones. To determine it, draw axes through the middle of the diaphysis of the 1st and 2nd metatarsal bones. Normally it is no more than 10 degrees.
By the way, if we talk about X-ray examination for flat feet (especially when deciding to enlist in the armed forces), we must remember the following. On radiographs, despite the low external and internal longitudinal arches, the ratio of the bones of the foot skeleton and the width of the joint spaces of the tarsus remain normal, so there may be no radiological changes. Sometimes there are marginal sharpenings in the area of the talonavicular and scaphoid-sphenoid joints, which indicates overload of the upper parts of the tarsal joints. Signs of incipient deformity - flattening of the foot - are most often expressed as a “subsidence” of the internal longitudinal arch at the level of the scaphoid-wedge joint.
Types and methods of treatment
Treatment of flat feet at the initial stage
If you have already grown beyond preschool age, then, unfortunately, you cannot count on complete relief from flat feet, especially if the process is advanced. Still, one should not become discouraged. It is imperative to get treatment - and to be treated thoroughly, regularly and conscientiously. The earlier the signs of the disease are identified, the smaller the foot deformity, the more favorable the conditions for stopping the further development of flat feet and for its correction.
It should be remembered that the treatment of this disease is long-term and requires the direct participation of the patient. The main efforts of doctors are aimed at relieving pain, restoring joint mobility, strengthening the muscles and ligaments of the foot and ankle.
Conservative treatment of flat feet is carried out in a complex manner.
A major role in the conservative treatment of flat feet is played by manual therapy, arch support insoles, orthopedic shoes, special exercises, acupuncture, load limitation, laser therapy, etc. - these methods are widely used in clinical practice and contribute to the speedy rehabilitation of the patient.
There are other methods of conservative treatment of flat feet: hydrotherapy, shock wave therapy.
At the initial stage of flat feet, pain in the legs can be eliminated within 1 to 2 months by using daily warm foot baths with sea salt, manual massage and therapeutic exercises.
As for daily baths , the requirements for them are simple: water temperature +40 - 50 C, procedure duration 15 - 20 minutes, and the proportions of medicinal bath salts are indicated on the packaging and vary depending on the concentration of dry matter.
Massage will have a very effective effect it is best if it is carried out by a certified specialist. Self-massage will also bring benefits - fortunately, there are many devices for it (special mats, balls, massage rollers). Exercises with them are performed arbitrarily (you need to walk on a massage mat, roll a massage roller with your feet, etc.). As a result, blood circulation improves and muscle tone normalizes.
gymnastics in the morning, when the muscles are not yet tired. If gymnastics is prescribed to a child, then it is better to show him the technique and pace of the exercises by example. The room should not be stuffy or drafty, and you should exercise in comfortable clothes that do not restrict movement.
physiotherapy (paraffin-ozokerite applications, electrophoresis, etc.) is often used
Massage and physiotherapy are prescribed in courses, usually 10–15 procedures. It is advisable to conduct 2–3 courses per year.
However, the effect of most procedures used in conservative treatment does not last long.
Surgical treatment includes surgical interventions in combination with some conservative methods.
Unfortunately, sometimes even with surgical interventions it is not possible to achieve the desired result. In addition, after surgery, patients are forced to limit their movement, since an immobilizing (fixing) device is applied to the operated area.
In addition, world orthopedics is already using new, modern, advanced developments to combat flat feet, such as the Ponseti method, the Dobbs treatment course, and Wikler’s recommendations.
And only to combat severe, severe pain is it permissible to use painkillers. Patients are prescribed analgesics and non-steroidal anti-inflammatory drugs. However, medications only remove symptoms, but do not affect the cause of the disease and do not inhibit its development.
When treating the initial stage of flat feet, simple accessible methods are used.
1. After exercise, it is recommended to hold your legs horizontally (sitting on a sofa, stretch your legs on it, sitting in a chair, place a chair under your feet, etc.).
2. Massage (see below).
3. Warm foot baths (see below).
4. Exercises to strengthen the muscular-ligamentous apparatus:
• flexion and extension at the ankle joint, inward and outward movements of the foot, rotation of the foot;
• movements of the toes;
• rolling and wrapping your foot around a tennis ball;
• picking up pencils scattered on the floor with your toes, you can crumple a lying towel;
• walking on toes;
• walking on the outer edges of the feet.
5. Combination of the above exercises with general strengthening gymnastics.
6. Physiotherapy - paraffin-ozokerite applications, hydrocortisone phonophoresis, novocaine electrophoresis (all this for severe pain), magnet, laser, UHF, pressure chamber.
7. Orthopedic shoes.
Massage is a procedure known since ancient times. It relieves muscle fatigue, improves metabolism and blood circulation. It is no coincidence that traditional healers said when massaging a patient: it is necessary to “disperse the blood.”
Massage is an excellent remedy for flat feet. It reduces pain, improves lymph and blood circulation, and strengthens weakened muscles.
Massage is carried out in combination with therapeutic exercises.
The massage should be carried out in the following sequence:
1. Massage the calf muscle.
2. Massage the Achilles tendon.
3. Massage the outer side of the lower leg.
4. Massage the back of the foot.
5. Sole massage.
6. Massage the calf muscle.
7. Sole massage.
1. Calf muscle massage
To perform massage techniques on the calf muscle, the person being massaged should be placed on his stomach, and a roller should be placed under his ankle joints.
The following steps must be taken.
b) double ring;
d) circle-shaped with phalanges of bent fingers, first with one and then with two hands;
e) circular beak-shaped, first with one and then with both hands.
4. Stroking is straightforward.
2. Achilles tendon massage
a) straight pincer-shaped;
b) spiral-shaped forceps;
c) straight with tubercles and pads of the thumbs;
d) circular phalanges of bent fingers;
e) circular beak-shaped;
f) circular edge of the thumb.
3. Massage of the outer side of the lower leg The person being massaged should be placed on his back, with a cushion placed under his knees.
a) circular with the pads of four fingers;
c) circular beak-shaped;
d) circular edge of the thumb.
Near hand Squeeze with the heel of the palm.
4. Massage of the back of the foot Without changing the position of the person being massaged, you should grab his foot from the side of the sole with your near hand and perform massage techniques with your far hand.
1. Stroking is straight in the direction from the fingertips to the ankle joint.
a) rectilinear pads of the four fingers of the intermetatarsal spaces;
b) circular pads of the four fingers of the intermetatarsal spaces;
c) straight with the pad of the thumb;
d) circular with the pad of the thumb;
e) straight with the pad of the middle finger;
f) circular with the pad of the middle finger;
g) circular with the edge of the palm.
3. Stroking (on the back of the shin).
4. Squeeze (on the back of the shin).
5. Sole massage
1. Stroking the sole with the back of the hand.
2. Rubbing in the direction from toes to heel:
a) circular with the pad of the thumb;
b) circular with the pads of four fingers;
c) straight with a fist across and along;
d) circular ridge of the fist.
3. Compression of the foot.
6. Calf muscle massage
1. Stroking is straightforward.
2. Squeeze beak-shaped.
b) circle-shaped by the phalanges of bent fingers;
c) circular beak-shaped.
7. Sole massage
a) straight with a fist;
b) circular with phalanges of bent fingers.
It is not difficult to master some self-massage techniques by correctly following the basic recommendations. Self-massage is best done after therapeutic exercises, with complete muscle relaxation. For self-massage, it is useful to use special rubber mats and massage rollers.
The main techniques of self-massage are:
• the shin should be stroked, rubbed with palms, kneaded, and patted with fingertips. Massage the shin from bottom to top, from the ankle to the knee, mainly the inner surface of the shin;
• the foot should be stroked and rubbed with the dorsum of bent toes. The plantar surface of the foot should be massaged from the toes to the heel.
Hydromassage is a fairly strong effect of water jets on the human body as a whole or on individual parts of the body.
Today there are two types of hydromassage. These are general and local hydromassage. In the case of general hydromassage, water affects the entire body. If we talk about local hydromassage, then we mean directing a stream of water to a specific area of the body. This could be the arms, back, chest, stomach, legs, etc.
Hydromassage is actually a combination of thermotherapy and massage, water and movement.
For hydromassage to have a therapeutic effect, it is important not only to correctly adjust the movements of the jets from the nozzles, but also to relax.
Hydromassage is a wonderful relaxant. It is able to completely disconnect from the outside world, while relieving not only stress, but also tension and fatigue. After the hydromassage procedure, the feeling of freshness and vigor will return.
Moreover, hydromassage tends to have a healing effect. With its help, the functioning of the venous and lymphatic systems is normalized, the process of blood circulation and metabolism is activated, and the walls of blood vessels are strengthened. It is worth paying attention to one more quite important thing - foot hydromassage effectively combats such troubles as abrasions, calluses and corns. Pain, spasms, excessive agitation - all this can also be eliminated with the help of hydromassage.
If you love heels and at the end of the day you just can’t feel your feet, hydromassage will help in this case too.
You can also use hydromassage to prevent varicose veins. But in case of existing varicose veins, it is better to refuse this procedure. Hydromassage is strictly contraindicated in case of fever, skin infectious diseases, thrombophlebitis, hypertension of the third degree and ischemic disease of the second and third degree. It is better to refrain from hydromassage in case of acute infections, urolithiasis, and cancer. Myocardial infarction is also a contraindication for this procedure.
Hydromassage of the feet can be carried out in various ways: using a stream of water from a hose or shower, using a shower with special nozzles (Charcot shower), in a hydromassage bath with special jets for the feet or in a hydromassage bath for the feet.
In a hydromassage bathtub with a “foot massage” function, an additional pair of nozzles are installed in the side panel of the bathtub, where the legs are usually located, which carry out a targeted massaging effect on the acupuncture points of the legs with a stream of water, promoting the restoration of the body.
A hydromassage foot bath is a good solution for those who cannot afford a hydromassage bath, but do not want to be limited to simply exposing their feet to a stream of water from a hose or shower. It can be used not only in the bathroom; you can combine massage with household chores, watching TV, reading, etc.
In addition to hydromassage, the device provides vibration massage using spikes at the bottom of the bath. Some models are equipped with special replaceable nozzles that stimulate specific areas of the feet, a function for heating water and maintaining its temperature at the desired level, as well as an infrared lamp to stimulate blood circulation in the feet and relax the leg muscles.
Water heating is provided by a heating element located under the bottom of the bath. The heating effect makes the skin more elastic and soft, muscles relax and joint mobility increases. Air bubbles give a feeling of lightness and comfort.
Therapeutic foot baths
For both children and adults suffering from flat feet, it is useful and necessary, along with other types of treatment, to take a medicinal foot bath before bed.
Take two basins: with hot water (as soon as your foot tolerates it) and with cold water. First, steam your feet in a hot bath, then place them in a cold one. And so alternately 2 - 3 times. The skin will turn red and your legs will feel pleasant. You can add a little sea salt or baking soda to the water, or infusions of herbs - chamomile, sage, oak bark, immortelle flowers, peppermint. When the foot is steamed, massage it, as if “sculpting” the arches of the feet and as if collecting the foot “into a fist”. After such a procedure, both children and adults sleep well - the calming effect of baths through the reflexogenic zones of the sole is felt. This procedure not only relieves fatigue and stress, it is also important for foot hygiene.
Here are some recipes for such baths.
Oak bark decoction bath: Mix 100 grams of oak bark with 0.5 liters of water and boil for half an hour. Then strain the broth and add to the bath.
Bath of sage leaves and flowers. Leave 100 grams of sage in 2 liters of boiling water for about an hour and prepare a bath with this decoction.
Tincture of immortelle flowers Immortelle grows on dry forest edges, near country roads. Its inflorescences are collected from July to October, until flowering is complete, and cut off along with a two-centimeter stem. Then the immortelle is dried until the flowers, after squeezing in the hands, stop sticking together. Insist on alcohol for several days. Used externally for joint pain, radiculitis, and flat feet.
Peppermint infusion: Pour 100 grams of dry mint with boiling water until it covers it completely. Leave for 30 minutes. Then soak your feet in a warm bath prepared with this infusion for 15–20 minutes.
Infusion of mint and linden blossom
From 100 grams of a mixture of mint and linden blossom, taken in equal proportions, prepare an infusion, as stated in the previous recipe. This bath is good for relieving tired legs.
The use of foot baths is contraindicated in cases where softening of the skin of the feet is unacceptable. Such cases include eczema, ulcers, and allergic reactions. For polyneuropathy, it is not recommended to use foot baths, since this disease reduces temperature sensitivity and pain threshold.
Orthopedic products for foot correction
To correct the foot, either ready-made orthopedic shoes or orthopedic insoles-instep supports are used (there is an option for insoles that are attached to a regular sole, including shoes with high heels). The basic principle is to lift the inner edge of the foot in the middle and rear sections and the outer edge in the forefoot using special pads. At the same time, the longitudinal and transverse arches of the foot gain additional support, which makes it easier to endure prolonged physical activity. When the 1st finger deviates outward, a special insert is used between the 1st and 2nd fingers.
Full orthopedic correction can only be achieved with the help of individual orthotics. The design of orthopedic products should be determined by the mechanism of formation of flat feet. When the arches of the foot are underdeveloped, their task is to promote the formation and support of the arches.
Orthopedic insoles (or insoles-instep supports, as they are also called) are a technological achievement that allows you to effectively correct changes in the structure of the lower extremities. The functioning of insoles and arch supports is designed in such a way that they make the life of a modern person much easier.
Orthopedic insoles are designed to prevent various foot deviations or to return to the correct position of the feet. Their functions are similar to the actions of a simulator or regulator: the load on the muscles of the feet is distributed in such a way as to relax tense muscles and use those that were at rest - and then vice versa. This allows not only to reduce the load on the musculoskeletal system, but also to prevent its deformation.
For example, with flat feet, proper distribution of muscle tension allows you to avoid problems with joints and the spine.
To improve blood circulation in the capillaries in diabetic feet, it is also recommended to use orthopedic insoles. They are also used to reduce pressure on the affected joints of the feet when suffering from gout.
It is recommended that pregnant women wear shoes with orthopedic insoles - this reduces the load on the legs associated with the woman’s weight gain. This also includes people involved in sports when the load on the musculoskeletal system is very high, and those whose profession requires being on their feet for a long time: hairdressers, waiters, salespeople, doctors and others.
With serious disorders, the process of foot correction can be quite painful. Therefore, the orthopedic doctor prescribes a step-by-step correction, when orthopedic insoles are made with the possibility of increasing its corrective functions and properties. Step-by-step correction prevents severe pain, makes it possible to clearly monitor progress in treatment and restores comfort when standing for long periods of time.
For flat feet, arch supports are prescribed to stop the process of foot deformation, correct it and return it to its normal position. The causes of the disorder can be either congenital abnormalities or acquired during professional activities, as a result of injuries or illnesses.
In order to prevent pain in the joints of the legs, back, curvature of posture and other problems that flat feet entail, arch supports are simply irreplaceable. Their properties are difficult to overestimate: from the prevention of deformation of the forefoot to the correction of the anatomically correct relationship of the joints.
Orthopedic insoles are used already for the first degree of flat feet. They help relieve painful areas of the foot and correct deformities at the initial signs of flat feet. They need to be inserted into both street and indoor shoes to make life easier for both adults and children when they have to be on their feet for a long time.
Properly selected arch support insoles not only relieve pain, but also, with their shape, regulate muscle tone, forcing the most “lazy” ones to tense up. By distributing pressure evenly, arch support insoles prevent possible foot injury.
It is best to purchase insoles from prosthetic and orthopedic companies, orthopedic centers, or order them individually. Only in this case are the products guaranteed to meet the standards.
The materials from which instep supports are made have undergone a noticeable evolution: from cork, the most ancient and quite effective, to synthetic ones (from Europlastic, supralene, silicone), as well as from soft foam material. The highest quality arch supports are made to order after examining, taking the measurements of the foot and establishing the level of flattening of the arch.
Arch supports must be worn everywhere: at home (in slippers), on the street, at work.
There are different types of insoles:
• inserts under the forefoot are used to flatten the longitudinal arch;
• heels help reduce the load on the heels and pain in them;
• intertoe inserts allow you to move the big and second toe apart, thereby preventing the progressive deviation of the big toe outward;
• the best option is an insole with an instep support under the heel and a pronator under the anterior section; such an insole seems to twist the foot, while the muscles are subjected to less tensile forces and therefore are in comfortable conditions for work.
The main functional features of correctly selected individual orthopedic insoles and arch supports:
• supports the transverse and longitudinal arches of the foot;
• increases stability when standing and walking;
• improves blood circulation in the feet;
• prevents foot fatigue and reduces discomfort when walking and standing for long periods of time;
• prevents the development of flat feet and other disorders associated with weakening of muscles and ligaments, thanks to the ability to place the feet in the correct position, regulate the activity of individual muscle groups of the foot;
• reduces the load on the spine, hip, knee and ankle joints - thanks to shock-absorbing properties;
• improves overall well-being;
• allows you to wear shoes comfortably.
There are also orthopedic half-insoles, the advantage of which is that they can be successfully used in ordinary, often pointed-toed boots, but with a rigid, well-fixed heel. Such half-insoles do not have a front section, which also allows them to be used with open-toed shoes, which is especially important in the summer. And at the same time, half-insoles allow you to correct all arches of the foot.
The best part is that orthotics allow you to use your own shoes without any restrictions. For those who want to keep up with fashion while simultaneously taking care of their own health, orthopedic insoles are, in fact, the only way out of this situation.
However, there remains one more point regarding the correct choice. For example, flat feet, having common indications for all patients, necessarily requires that treatment be carried out using individual means. This means that with different degrees of development of flat feet, completely different insoles may be needed. This applies to a variety of cases - even children's insoles can differ dramatically in situations where the development of flat feet has taken different paths.
Another problem is different leg lengths. In this case, pain occurs when moving, as the biomechanics of walking are disrupted. The shorter leg experiences overload, as a result of which its longitudinal arch is shortened or does not change, and its transverse arch is flattened. The other foot experiences directly opposite loads, that is, the foot lengthens due to a decrease in the longitudinal arch, and the transverse arch is less stretched.
In this case, altered movement of the pelvic bones is observed. The rotation of the vertebrae is of the same irregular nature. Points are formed in the muscles of the lower limb (gluteal, calf), which in the future can be an additional source of pain and which require treatment, including with the help of manual therapy.
To eliminate all these violations and prevent their recurrence, it is necessary to correct the disturbances that occur when walking. This can best be achieved with the help of properly manufactured individual orthoses (orthopedic arch supports).
Such patients need to put a heel pad into their shoes, or better yet, individual instep supports, one of the tasks of which will be to compensate for the shortening of the leg. This is done to relieve the affected spinal motion segment, reduce nerve root pressure and stabilize the results of treatment.
However, this issue should be approached with caution and compensation on the instep supports should be increased gradually.
For diseases associated with foot disorders, as well as for the prevention of such diseases, there are special orthopedic shoes. Its use reduces the load on the spine and joints of the lower extremities, prevents flat feet and the appearance of heel spurs, corns, deformation of the toes and improper development of the feet.
Wearing orthopedic shoes is recommended for people of all ages, especially those who experience increased stress on their feet: professional people, during pregnancy, as well as the elderly and small children.
The differences between orthopedic shoes and regular ones are the increased requirements for their functionality and structure, mandatory registration with the Russian Ministry of Health.
It is made exclusively from natural raw materials (leather, cotton, viscose), the sole should not be slippery. The rear and midfoot should be firmly locked in a mid-foot position between the high, rigid heel counter and the upper stabilizers. Special insoles-instep supports that support the arches of the feet are an integral part of orthopedic shoes. Such insoles can be made to order, taking into account the characteristics of the customer’s feet.
Children's orthopedic shoes provide for the structural features and development of the child's musculoskeletal system. Therefore, the inner part of the heel is modeled in such a way as to strengthen the muscles where the pressure is highest. The widened sole, thanks to reliable stabilization, allows the child to feel more confident.
Many people experience health problems, knowing from their own experience the consequences of not very pleasant diseases, such as achillobursitis, tendonitis, epicondylitis or the equally dangerous, but more common flatfoot. Very often you have to resort to complex treatment and surgery. This happens because patients delay taking preventative measures that can significantly improve their well-being, preventing further development of the disease.
It is orthopedic shoes and orthopedic insoles that turn out to be a real salvation for people who experience pain when walking.
Orthopedic therapeutic shoes have a positive effect in many cases. The whole point is that the effect on the body is as balanced as possible. And if you have diabetic feet, then orthopedic shoes are a must.
Basic requirements for shoes
• Definitely a leather upper.
• The heel is low, in children's shoes it should occupy at least a third of the sole in order to support the heel and the rear segment of the arch, the toe is wide.
• Good leather quality: no unpleasant odor, shedding of the outer layer, no cracks. Well-treated and dyed leather will not stain your hands when you pick it up or your socks when you put it on. It does not cause allergies, abrasions and, oddly enough, orthopedic diseases: bad skin does not support the foot well.
• The sole is flexible, preferably leather.
A splint (French tuteur) is a fixing orthopedic device consisting of sleeves (sometimes a shoe) connected by tires without hinges. It resembles a plaster cast and is designed to provide joint immobility and stabilization of a segment or the entire limb.
The main types of diseases for which leg splints are prescribed are spastic and flaccid paralysis, muscle paresis, looseness and dislocation of joints, false joints, variants of flat feet, clubfoot, shortening of one of the legs, arthrosis of the joints.
The splint must be made from a plaster cast or directly on the patient. The impression is usually taken while lying down or sitting. Making braces from a plaster cast makes it possible to obtain an orthosis that completely replicates the anatomical shape of the affected limb, and to fix individual segments of the limb in the position necessary for the therapeutic effect (at a certain angle), which is impossible when using industrially produced orthoses.
The splint is put on a cotton stocking, then the limb is given a given position, placed in a rigid sleeve of the product and the fastening elements are fixed. The affected area of the leg should be held tightly in the sleeve of the splint, and there should be no pressure on the protrusions of the bone and soft tissue.
The splint is used only during night and daytime sleep; walking in it is strictly prohibited.
It is recommended to treat the inner surface of the splint sleeve with a damp cloth, previously soaked in a soap solution. However, in order to prevent corrosion, it is necessary to ensure that water does not get on the metal parts of the splint.
The use of a brace should be combined with daily performance of a set of special exercises recommended by an orthopedic surgeon.
The splint is not recommended for use in case of individual intolerance to the materials from which it is made, as well as in case of impaired blood supply in the lower extremities and after applying a warming ointment.
To wash the splint, it is advisable to use a special bag; after washing, the splint should be left to dry, but not near heating devices.
To choose the correct splint size, you need to measure the circumference of the knee joint.
Therapeutic exercises for flat feet
Therapeutic gymnastics is used to achieve a corrective effect in the first degree of flat feet; it trains the muscles, strengthens the ligaments, corrects the defective alignment of the foot bones, and forms the correct walking pattern.
There are different complexes of therapeutic gymnastics and therapeutic exercises to combat flat feet. We present some of them below. Each of these complexes is undoubtedly useful for sore legs, and improvement in well-being will depend only on your diligence. These exercises actively strengthen the muscles of the foot and lower leg that support the arches.
It should immediately be noted that they are all similar in some ways, but different in others. It is not at all necessary to use all the complexes. You should choose 1 – 2 most convenient, most comfortable for you or your child, corresponding to your rhythm and lifestyle.
Minimum course of exercises for the foot with longitudinal transverse flatfoot
The preparatory stage is manual therapy of the foot. Before exercises to develop stagnant joints, it is useful to perform manual removal of stiffness of the joints of the foot (joint mobilization):
• stretch each toe with your hands;
• forcefully bend and straighten each joint of the toes with your hands.
Each exercise is performed until a feeling of fatigue occurs in the muscles with a gradually increasing load. It is recommended to conduct two to four sessions per day.
1. Bend and straighten your toes with tension until tired.
1a. Exercise option No. 1, for initial deformation of the thumbs. Tightly bend and straighten all your fingers, stretching the rubber ring between your thumbs.
2. Static exercise. Bend your fingers as much as possible and hold them in this position until fatigue (20 - 40 s).
3. Working with the muscles of the foot, shorten the longitudinal arch (do not bend your toes!). The foot should contract by 3 - 4 cm. Release the muscles, returning the foot to its original position.
4. Contracting the muscles of the foot and without bending the toes (!), shorten the longitudinal arch and hold in this tense position for some time until fatigue (20 - 30 s).
5. Holding a pencil between the first and second toes, make circular movements from right to left and back. For children, the goal is to draw circles on paper.
6. When walking and jumping, try to push off the floor not with the heads of the metatarsal bones (they are also called metatarsophalangeal joints), but with the toes.
No need to overload yourself. It is enough to first do a set of exercises for 1 minute, then the duration of classes can be increased to 5 – 10 minutes.
Since flat feet progresses in people who are physically less developed or weakened, combine therapeutic exercises for the lower extremities with general strengthening exercises.
Training should be repeated 3 – 4 times a day. Only then will there be an effect.
After doing exercises or any other activity, it is good to take a warm foot bath with sea salt or pine extract, which relieves fatigue and pain.
Basic complex of therapeutic exercises for flat feet
Therapeutic exercises 1 In the starting position, sitting with straightened legs.
Rice. 15. Exercises while sitting
• Knees and heels are connected, the right foot is strongly extended; bring the forefoot of the left foot under the sole of the right, then repeat the exercise, changing legs. • Stroke the inner edge and plantar surface of the right foot to the left shin, then repeat the exercise, changing legs.
Sitting with legs bent.
• Flexion of toes.
• Bringing the feet inward.
• Circling with your feet inward.
• Grabbing and lifting a ball (volleyball or medicine) with your feet.
• Grasping and lifting a pencil with your fingers.
• Grasping and lifting the sponge with your fingers.
• Using your toes to pull up a thin mat.
In the starting position standing. • Vigorously pressing your toes onto the floor – legs apart, forefoot adducted; alternate turns of the body to the right and left with the feet moving to the outer edge.
Rice. 16 Exercises while standing
• Standing on your toes, feet parallel; moving to the outer edge of the foot and returning to the starting position.
• Feet parallel. Trying to bring your feet in, pressing them on the floor.
• Walking barefoot on sand or a foam mat (possibly with a large pile) resting on the outer edge of the feet and with bent toes.
• Walking on a sloped surface with support on the outer edge of the foot.
• Walking on a log sideways (barefoot).
Therapeutic exercises 2
• In the initial position, the legs are apart, the toes “look” inward: alternate turns of the body to the right and left with the rotation of the corresponding foot to the outer edge.
• Then walk on your toes for a few minutes.
• Then walk on your heels for the same amount of time.
• Walk around a little with your toes tucked.
• Then walk around with your fingers raised.
• Several times a day for 10-15 minutes, walk on the outer edges of the foot, like a “club-toed bear.” Such excess varus compensates for the valgus spreading of the foot and again, as it were, gathers the foot “into a fist.”
• Standing on your toes, shift from foot to foot.
• Sitting on a chair, lift one straight leg at a time as high as possible.
• Do the same with both legs together.
Therapeutic exercises 3
1. Starting position – sitting on a chair, feet on the floor. Tuck your toes, repeat 3 – 5 times; Without lifting your heels from the floor, alternately lift your feet towards you (3 – 5 times); Without lifting your fingertips from the floor, raise your heels (3 – 5 times); alternately lift only the big toes (3 – 5 times); lift all your toes one by one, with your feet slightly turned inward and do not lift your heels off the floor (3 – 5 times).
2. Starting position – sitting on a chair, feet on the floor. Run the big toe of your right foot along the front surface of the shin of your left leg from bottom to top (3 – 5 times). Repeat the same with the big toe of your left foot (3 – 5 times). You can complicate the exercise and try to pull the knee socks onto the shin of your left leg with the big toe of your right foot. Then change legs.
3. Starting position - sitting on a chair, one foot on the ball, the other on the floor. With your foot on the ball, swing it left and right, back and forth 3 to 5 times. Change legs and repeat the exercise. Then grab the ball with your feet and hold it suspended for several seconds, lower it to the floor, and then lift it again (3 - 5 times).
4. Starting position – sitting on a chair. You can put a piece of fabric, small objects (checkers, elements of children's construction sets, river pebbles, etc.) or a rolling pin under or near your feet. Task: gather fabric with your fingertips, grab and move small objects, roll a rolling pin. You can also roll the rolling pin over the entire surface of your feet.
5. Starting position – standing. Stand on your toes (3 – 5 times). Turn your feet inward (3 – 5 times). Walk in place. Walk forward, standing on the outer edges of your feet. Walk along the line.
6. Starting position – standing. Squat without lifting your heels from the floor (3 – 5 times). If possible, walk on rungs or walk on uneven, bumpy surfaces. You can also balance on a ball. (Attention! In this case, adults must insure the child!)
7. Starting position – standing on a block placed on the floor. Squat on a bar (3 – 5 times). Stand on the block either on your right or left foot. The feet should be placed across and then along the bar. You can also walk several times with side steps across the block and walk along it.
Therapeutic exercises 4
While walking (these exercises are performed for 20–30 seconds each).
Hands raised up, walking on toes.
Hands on waist, walking on heels.
Hands on the waist, walking on the outside of the feet with the toes bent.
Leaning on the outer arches of the feet, perform torso turns (6-8 times).
Raises on toes, leaning on the outer arches (10 - 12 times).
Curling your toes (15 – 20 times).
Straighten your knees, pull your toes towards you (15-20 times), then, if possible, connect the soles of your feet (15-20 times).
Circular movements of the feet (10 - 12 times in each direction).
Insert cotton or foam balls between your fingers and try to squeeze them with your toes (10 - 15 times).
Put an elastic band on your toes and, spreading your toes, try to stretch it (10 - 15 times).
Place the elastic band on the big toes of both feet and stretch it (10 - 15 times).
Grab small objects lying on the floor with your toes and lift them to a small height (10 - 12 times).
Straighten your knees, grab a small ball with your toes (10-12 times), then try to throw it up and catch it with your foot (10-12 times). Rolling a small massage ball under the arches of your feet.
Holding a ball or a special massage roller with your foot, roll it along the sole from foot to heel (10-15 times). Spread a towel and crumple it with your toes to form folds, then straighten them and lift the towel with your toes (5 to 10 times).
Walking on a log or sloping surface, when you have to transfer the load to the outer edge of the foot, also helps treat flat feet. If you don’t have the necessary attributes, you can fill a box with sand or find a foam mat and walk on it, leaning on the outside of your foot.
Therapeutic exercises 5
Here are some more exercises that are useful for flat feet. They are advised to be performed by the Moscow Institute of Yoga and, in particular, by guru Ar San-tem.
1. Foot turns are performed first while sitting on a chair, then standing. The feet should be turned perpendicular to each other: first heel to heel, then toe to toe.
2. Sitting on a chair, place your feet shoulder-width apart and turn parallel to one another to the right and left; the same must be done while standing, holding the back of a chair.
3. Sitting on a chair and then on the floor, rise to your feet, resting on the outer edges of your feet. When rising from the floor, you can help yourself with your hands.
4. Standing on your toes, shift from foot to foot.
5. Sitting on a chair, lift one straight leg and then the other as high as possible.
6. Do the same with both legs together.
7. Sit down and, dragging your feet along the floor, take 30 - 50 steps.
All exercises should be performed at least 10 times.
Therapeutic exercises 6
Exercises that strengthen the muscles of the feet.
You will need a chair high enough so that the entire surface of your feet touches the floor, and the angle between your shins and thighs is 90 degrees. It is better to put a rug under your feet.
Starting position: sitting on a chair (try to keep your back straight), legs slightly apart, soles completely touching the floor.
a) bend and straighten your feet (movements are made at the ankle joint);
b) move your feet outwards, bring them inwards;
c) bend and straighten your toes;
d) grab the ball with your feet, lift it, return to the starting position;
e) roll the rolling pin with your feet on the floor;
f) pull the towel with your toes.
The following exercises are recommended to be performed in conjunction with exercises for the shoulder girdle area that shape posture.
a) on the outer edge of the foot, performing circular movements with your hands;
b) on the inner edge of the foot, hands behind the head;
c) on tiptoes, placing a book on your head and trying not to drop it;
d) on the heels, hands on the belt.
What is manual therapy?
Manual therapy (from the Latin manus - hand) is an ancient science that has absorbed the experience of thousands of years. As such, manual therapy has been known since the 5th century, since the time of Hippocrates. It is a set of mechanical effects aimed at curing diseases of the musculoskeletal system: this is the main core of the body, which is why it is so important to pay special attention to it. Very often it is mistaken for a massage, but it has a much deeper and more effective effect on both muscles and joints, while a simple massage affects exclusively the muscles.
The advantage of manual therapy is its non-drug effect. These factors influenced the popularity of this method: today this procedure, along with reflexology, is actively used in various countries around the world. A competent manual therapy specialist can relieve pain and eliminate pinched nerve roots.
Manual therapy, as one of the popular and progressive methods of treating flat feet, is indicated for patients of all ages (including children). Using gentle soft-tissue manual therapy techniques and special therapeutic massage, impressive results can be achieved. Manual techniques are aimed not only at restoring joint mobility, but also at strengthening the muscular system. Using certain techniques, it is possible to return a deformed foot to its normal shape. Additionally, physical procedures are carried out to help consolidate the results.
Manual therapy has proven itself in the complex treatment of flat feet. It is known that the human body is a single system and there is a close relationship between the spine and feet.
Principles and features of manual therapy
Diagnosis and treatment of diseases using manual therapy is carried out through physical influence on the patient’s body. As a rule, no mechanical devices or tools are used. The entire “toolbox” of a chiropractor is his hands and fingers. During treatment, the main attention is paid to restoring the normal position of the vertebrae, intervertebral discs, joints, and their natural mobility.
Diagnosis and treatment by a chiropractor includes four stages.
I. Initial appointment with a chiropractor.
P. A course of treatment conducted by a chiropractor.
III. Rehabilitation treatment.
IV. Repeated appointment.
Treatment of foot diseases (flat feet)
As is known, the consequences of flat feet are disruption of the activity of the entire musculoskeletal system, including the spine, as well as disruption of the activity of many organs and systems. Therefore, treatment of flat feet is one of the stages of complex treatment of diseases of the musculoskeletal system using manual therapy.
Stage I. Initial appointment with a chiropractor
The initial appointment with a chiropractor (diagnosis of the patient) has its own specifics and consists of the following.
1. Inspection and visual diagnostics
A thorough study of the patient's complaints and medical history is carried out to make the correct diagnosis and determine treatment tactics.
To prepare for a doctor's appointment you must:
• be fully confident in the qualifications and experience of the doctor;
• come to the appointment in closed underwear (closed swimming trunks, closed top).
2. Manual diagnostics, or manual muscle testing A manual examination of the patient is performed: palpation of the neck and back, especially in areas of pain. The mobility of the neck and lower back, skin sensitivity in various parts of the body, muscle strength in the limbs, tendon reflexes, symptoms of tension in the nerve roots, etc. are examined.
3. Podometric diagnostics
Computer diagnostics are carried out to study the parameters of load distribution under the foot, including the load on the right and left limbs in a standing position; load on the forefoot and rear foot; foot support area; average pressure under the foot.
Diagnostics is carried out using a computer system consisting of a baropodometer connected to a computer with 1024 barosensitive elements (on which the patient stands). This system allows you to obtain a complete picture of the pressure distribution under the foot in a standing position and when walking in the form of a color image, in which each color corresponds to a certain pressure value.
The diagnostic results show a shift in the patient’s center of gravity and make it possible to identify the causes of its occurrence (including damage to certain parts of the spine, as well as damage to the joints).
4. Visceral manual diagnostics The presence of restrictions in the mobility and interchangeability of internal organs in one or several directions is examined, and in some cases, the presence of excessive mobility of some organs.
5. Craniosacral manual diagnostics
The craniosacral system of the body is diagnosed, which includes the skull, central and peripheral nervous system (brain and spinal cord), cerebrospinal fluid, dura mater and sacrum.
Stage II. A course of treatment conducted by a chiropractor
The course of treatment with manual therapy techniques has its own characteristics and includes 4 one-day sessions.
1st day. Manual therapy A gradual painless or low-painful restoration of range of motion in various structures of the musculoskeletal system is performed by eliminating a functional block or muscle spasm. During the treatment, compression is eliminated, blood circulation of soft tissues is increased, which helps restore nutrition to painful areas of the musculoskeletal system. The type of treatment using manual therapy depends on the disease and the individual characteristics of the patient’s body.
2nd day. Craniosacral therapy
A complex of biomechanical effects is carried out with the hands on the rhythm and symmetry of the pulsation of the bones of the skull or sacrum, while slow pressure or stretching is performed.
This complex of influences is carried out for the following purposes:
• increased range of motion in the joints of the bones of the skull and sacrum with limited mobility;
• reduction of tension in brain membranes;
• improvement of cerebral vascular circulation;
• normalization of nerve functions and reduction of the possibility of neural entrapment when cranial nerves exit the cranial cavity.
3rd day. Manual therapy. Working with Emotions
The complex of treatment started in the first two days continues. Work with emotions is also carried out from the point of view of a certain theory of understanding the essence of a person, which is as follows.
Man is an integral structure of the unity of three components, inextricably linked with each other.
• Physical component (body).
• Chemical component (what animates the body: blood, lymph, cerebrospinal fluid).
• Emotional component (spirit). Damage to or change in the function of any
of three components (physical, chemical or emotional) will have consequences for the integrity of the entire structure, which will instantly affect the state of human health. At the same time, the emotional (spiritual) component is a kind of regulator of all other processes.
4th day. Selection of individual homeopathic medicines to consolidate treatment results
Homeopathy is a harmonious and precise medical science that treats not only the patient’s illness, but also the body as a whole, with all its many medical problems. Homeopathic medicines contain only natural raw materials - herbs, minerals and animal materials. Therefore, they are harmless, have no side effects, and do not cause allergic reactions.
To individually select homeopathic medicines, the doctor conducts a long, thorough and detailed conversation, which allows us to reveal the individuality of the patient: his psycho-emotional characteristics, temperament, and identify concomitant diseases. In this case, all the patient’s complaints, the history of his life and the development of the disease, and the features of its course are taken into account. Associated problems, the possibility of manifestation of hereditary diseases, and the patient’s character traits are also important.
Individually selected homeopathic medicines can cure most of the patient’s diseases, increase the regenerative abilities of the injured area of the musculoskeletal system, and help correct damage to the spiritual sphere of a person (if any).
Stage III. Rehabilitation treatment
Rehabilitation treatment includes a course of medical procedures consisting of 5 – 15 sessions, depending on the doctor’s prescription.
Massage is considered one of the effective methods of treating the musculoskeletal system. The massage technique depends on the nature of the pathological focus and the area of massage, which is prescribed by a chiropractor. The massage can be general (the whole body is massaged) or local (neck area, thoracic region, lumbar region, upper and lower limbs, etc.).
Massage increases the circulation of blood, lymph, interstitial fluid, improves metabolism and skin respiration, and relieves congestion in muscle tissue. The effect of massage is determined by the interaction of a number of factors: the nature of massage techniques, their strength and duration. Massage is a powerful means of influencing both the entire body as a whole and its individual systems.
Professional traction of the spine is also carried out using a universal device for dosed traction, vibration massage and mechanical local impact on the muscular-ligamentous apparatus and osteo-articular elements of the spine.
Simultaneously with traction under the influence of massage rollers, local stretching of the spine occurs, existing curvatures are corrected and, as a result, compression of the nerve endings located near the spine disappears, and the functions of internal organs are normalized. The structure of the spine adapts to the movement of the massage rollers, straightening and proper alignment of the spine occurs, its mobility is restored, external ligaments and muscles are strengthened, and at the same time the regulatory function of various body systems.
As a result of treatment, muscle spasm is relieved and normal mobility of the vertebrae is restored. A muscular corset of the spine is formed, pinching or compression of nerve endings is eliminated. The conduction of nerve impulses to internal organs and tissues is restored, which ensures blood circulation in the brain stem.
Stage IV. Repeated appointment with a chiropractor
A repeated appointment with a chiropractor is carried out after a certain period of time, prescribed by the doctor (usually 6–8 months), after the course of treatment.
The patient is examined, control podometry is carried out, the results of treatment with homeopathic medicines are analyzed, and the degree of consolidation of the therapeutic effect is examined. Further recommendations are given.
Quite often, after a manual therapy session, muscle pain appears in those areas of the musculoskeletal system where the manipulation was performed. This is completely natural. Some muscle groups began to work, strain, and hurt in the same way as muscles after intense training. Other muscles, on the contrary, got rid of the constant excessive load.
When receiving treatment from a chiropractor, it is necessary to remember that treatment gives a positive effect only with the joint efforts of the doctor and the patient. Upon successful completion of a course of manual therapy (following the recommendations and performing exercises prescribed by the doctor at home), great changes occur not only in the area of the musculoskeletal system where treatment was carried out, but also in the entire appearance of the patient: the gait changes, the posture straightens, Many health problems that have already become common go away.
Shock wave therapy (SWT)
Shock wave therapy is a treatment method using acoustic (shock) waves.
A revolutionary breakthrough in the treatment of a fairly wide range of diseases was the development of the shock wave medicine method in Germany and Switzerland in the 1990s. It is based on the short-term application of a high-energy, low-frequency shock wave to the diseased area.
Thanks to the pulsed effect, the pain syndrome is reduced, blood circulation at the site of the disease is radically improved, calcified areas and fibrous foci are loosened, and their fragments are then gradually resolved.
It is the shock wave method of analgesic therapy that allows the doctor to carry out targeted effects on the source of the disease without injuring the skin and soft tissues. When treated with shock wave therapy, there are no problems typical for surgical treatment of diseases of musculoskeletal tissue. The shock wave therapy method does not cause complications. In 87–93% of patients, a lasting positive effect is observed.
SHOCK WAVES – shock waves (SW) are acoustic in nature in the infrasound spectrum and have a frequency lower than that perceived by the human ear (below 16 – 25 Hz). In our everyday life, infrasound is caused by natural (earthquakes, storms, hurricanes, tsunamis) and man-made (machines, transport, underwater and underground explosions, wind power plants) causes. SW are fundamentally different from sound waves from other sources in their higher energy amplitudes and short pulse duration.
The action of so-called shock waves in modern shock wave devices is based on the cavitation effect. The acoustic resistance of liquid media and soft tissues is almost equal and significantly less than the acoustic resistance of bone tissue. As a result, HCs spread in soft tissues without damaging them, and have a direct effect on bone and cartilage tissue, calcifications, ossifications and other acoustically dense formations.
The essence of the device is that a shock wave of a certain frequency affects the affected tissue, destroys microcrystals of calcium salts, increases microblood flow tenfold and helps “wash out” salts from the ligament or tendon. The ligament gets rid of “ballast” - it seems to become younger and becomes able to bear the necessary loads again.
In addition, hydrocarbons, penetrating into the tissues of the body, restore natural metabolism, trigger processes of cell restoration and renewal, and improve metabolic processes in tissues.
Therapeutic shock waves can be generated from a variety of sources. Based on the type of source, ESWT devices are divided into electromagnetic, electrohydraulic, piezoelectric and pneumatic.
Treatment is preceded by a preliminary examination: all patients are necessarily examined by an orthopedic surgeon and, if necessary, prescribe an additional examination. All patients undergo an X-ray examination, sometimes an ultrasound scan of ligaments, tendons and joints, magnetic resonance computed tomography, and the condition of the blood coagulation system are determined.
The session itself looks harmless. Emitters are placed on the skin lubricated with gel, and the device begins to send impulses. The patient does not experience any unpleasant, let alone painful, sensations. But not in all cases. The pain decreases significantly within a few hours after the session, but then it may reappear and last for 2 to 3 days. Then the pain weakens and disappears almost completely in the next 2 weeks after the end of the course of treatment.
A course of shock wave treatment usually consists of 5 - 6 procedures of 15 - 30 minutes each, carried out once with an interval of 5 - 7 days, in contrast to physiotherapy, which must be carried out daily. The duration of the procedure depends on the nature of the disease and takes from 15 to 40 minutes.
Shock wave therapy is used mainly in the complex treatment of diseases and injuries of the musculoskeletal system.
There are quite a lot of diseases that can be affected by shock wave therapy. There are also many indications for using the method - just the listing is reminiscent of an anatomical atlas: fresh fractures, hypertrophic false joints, flat feet, heel spurs, aseptic bone necrosis (the presence of metal structures, by the way, is not an obstacle to shock wave therapy), decalcification of the shoulder joint. Not to mention various degenerative changes and inflammatory processes in the areas of tendon and bone joints on the muscle cuffs with bursitis, fasciitis, inflammation of the greater trochanter of the femur.
In addition, the device is used to treat most sprains, partial injuries to ligaments and muscles, as well as old injuries in the area of any joints of the upper and lower extremities. And at the same time, as a rule, three to four sessions lasting 4–5 minutes each with an interval of 5–7 days are sufficient.
There are actually few of them:
• impact on the bones of the skull (except for the area of the temporomandibular joint);
• effects on nerves, intestines, large vessels (due to the risk of thrombosis), lung tissue;
• presence of infection or oncological processes in the affected area;
• blood clotting disorders;
• growth zones (metaphyses) of bones - shock waves can cause irreversible damage to the growth zone and affect the further development of the skeleton, therefore, ESWT is not advisable to prescribe to patients under 18 years of age and treat patients from 18 to 25 years of age with special caution, since it is by 22 - 25 The final formation of the skeleton takes place over the years.
In addition, the device is not used in patients with cardiac pacemakers (with electromagnetic, hydraulic and piezoelectric principles of the generator design). They cannot treat those who suffer from exacerbation of diseases of the cardiovascular system.
The shock wave method is also not used when treating ribs and vertebral bodies.
In children and adolescents, they are afraid to treat injuries in the area of the growth zones of long tubular bones with this method.
However, as a rule, there are no complications when using the method, but this is only with strict adherence to the method.
The effectiveness of the method, according to doctors, is 85–95%. It is often possible to avoid an already planned operation. In this case, the functions of the injured limb are completely restored.
But treatment with the new device also has several other useful consequences.
The effectiveness of treatment using the method of extracorporeal shock wave therapy is based on the special properties of the shock wave. They are the ones who can cause positive changes in tissues. The effect of treatment appears immediately after the course of treatment and also has a long-term positive effect.
Early effects include:
• improvement of microcirculation in tissues during and after the procedure;
• acceleration of metabolism;
• local anesthesia during the procedure.
Long-term effects of shock wave therapy:
• loosening of microcrystals of calcium salts and areas of fibrosis formed as a result of acute or chronic injury; increasing blood flow in damaged tissues and stimulating their regeneration; restoration of the structure and elasticity of ligaments, elimination of pain;
• synthesis of vascular endothelial growth factor in tissues, which leads to the proliferation of microcapillaries and, accordingly, to the restoration of blood supply in tissues;
• increased mobility in the damaged body segment;
• increasing the resistance of ligaments and tendons to physical stress and injury.
In all countries, ESVM is used as monotherapy. As a rule, it does not require additional drug treatment, injections, physiotherapy, massage, manual therapy, etc. And most importantly, it allows you to simply and effectively treat a wide range of diseases and injuries of the musculoskeletal system!
Relieving pain with medications
Medications can help you get rid of severe pain in your feet and legs. The range of painkillers is quite wide.
Aspirin, diclofenac, indomethacin will relieve pain, but if taken frequently they can cause stomach ulcers.
Ibuprofen or are safer in this regard .
For hypertensive patients, flugalin is more suitable.
But all these medications must be taken under the supervision of a doctor.
For local anesthesia, you can use Dolgit cream, voltaren gel, indomethacin ointment. These ointments will relieve the pain today, but tomorrow it will return again. They have to be used in cases where the pain does not subside when using other methods.
To relieve pain, clinics use special treatment procedures: phonophoresis with hydrocortisone, novocaine electrophoresis, paraffin-socerite applications.
Surgical treatment of flat feet
Surgical intervention is forced to resort to in cases where conservative treatment methods are ineffective or cannot help a particular patient.
Unfortunately, a significant number of patients who are candidates for surgery abstain from it. This is due to the large number of unsuccessful operations, after which the deformity occurs again.
Given the number of reconstructive surgeries, preoperative planning should be mandatory. It is necessary to select the most optimal surgical intervention, taking into account the degree of deformity and type of foot. Planning the operation minimizes the likelihood of recurrent deformities.
Currently, there are more than 400 surgical techniques for correcting foot deformities. Conventionally, they can be divided into the following types.
• Surgeries on soft tissue structures (skin, muscles, tendons, ligaments, nerves, blood vessels).
• Surgeries on bones and bone structures.
These operations are quite complex and are carried out after a thorough examination of the patient.
Soft tissue operations
Cutting off the tendon of the adductor muscle of the first finger (Silver's operation) or cutting off followed by transposition and capsuloplasty (McBride's operation).
These operations, as a rule, are supplemented by the removal of the inflamed subcutaneous mucous bursa and osteochondral growth, which together form an ugly and painful lump (Schede operation).
These operations guarantee a positive cosmetic and functional effect in young patients with soft feet. The condition for these operations is a normal or slightly increased first intermetatarsal angle.
Bone operations
A significantly increased first intermetatarsal angle, rigid feet, and a long first metatarsal bone are indications for combined operations. If only soft tissue operations are used for such foot deformities, the deformity may recur in the postoperative period.
There are a great many operations on bones, all of them have the goal of reducing the first intermetatarsal angle to normal values. The Scarf osteotomy is most often used. It allows you to easily correct the deformity and preserve the blood supply to the head of the first metatarsal bone, which promotes rapid fusion of the bone in a physiologically and biomechanically correct position. The presence of an artificial fracture does not mean the need for plaster immobilization and crutches in the postoperative period. After the osteotomy, the fracture is fixed with two special compression screws.
Thanks to stable osteosynthesis, the fracture heals in 3.5–4 weeks. There is no need to remove screws made from a biologically inert alloy, titanium.
The first and second operational methods given above are combined.
There is another method for correcting flat feet - these operations are quite gentle, they are done under local anesthesia.
During surgery, the flattened arch of the foot is corrected by inserting a titanium implant into the right place, which follows the shape of the arch and subsequently takes on the effort to give the foot the desired shape.
The patient is activated on the 2nd day after surgery, without additional support and plaster immobilization. The load falls on the heels and outer parts of the feet. To make walking easier in the early postoperative period, there are special shoes that completely relieve the front of the feet and make walking comfortable and painless.
An additional set of procedures used in the treatment of flat feet
Osteopathy is a soft, gentle technique that is aimed primarily at restoring the normal mechanics of the musculoskeletal system, as well as relieving the pathological stress that muscles and ligaments are exposed to when flat feet occur.
Electrophoresis - this painless method involves the introduction of non-steroidal anti-inflammatory drugs into cartilage tissue using a low-intensity constant magnetic field.
Mud applications - thanks to the use of the famous medicinal mud of Lake Tambukan and Lake Saki, our doctors strive to strengthen the ligamentous apparatus and muscles of the foot. In combination with osteopathy, mud therapy allows for deeper penetration of medicinal substances into the affected tissues.
Reflexology, or acupuncture, is an effect on biologically active points of the body with the help of special acupuncture needles, due to which physiological processes in the affected soft tissues are normalized, muscle tone and lymphatic drainage are improved.
Treatment with leeches (hirudotherapy) is a natural and very effective method of treating arthritis and arthrosis; leeches can relieve swelling, eliminate pain, improve microcirculation in tissues and restore the structure of soft tissues.
Features of treatment of flat feet in children
What is the principle of treating flat feet in children? It is almost no different from the treatment of flat feet in adults, just in childhood, let us remind you that it can be cured, and, as a rule, by conservative methods, without the intervention of a surgical scalpel, but in adults, conservative methods can only alleviate suffering, and can only be cured radically operation.
In order for the ligaments and muscles to hold the arches of the feet, they need to be strengthened. This is achieved through physical therapy exercises and massage. Therapeutic gymnastics with children should be done daily for 10-15 minutes - regularly for a long time. To cure flat feet, training is required for 1 - 1.5 years. Flat feet cannot be corrected in a month.
It is better to start classes at the age of 4, but even at the age of 10–12 it will not be too late. For children older than this age and adolescents, when the formation of the skeleton of their feet ends, physical therapy will no longer help.
The most correct decision is to consult an orthopedic doctor at a medical center, where the child will be examined and diagnosed. And based on the results, the correct treatment will be prescribed, and if necessary, then insoles for children.
An important factor is the selection of the right shoes, which should be loose, with heels up to 1 centimeter and a tight high back (shoes, boots), and if necessary, in some cases, wearing orthopedic shoes.
Be sure to stock up on replacement shoes for your child: this gives the foot a chance to rest from its usual position and the shoes to be properly ventilated. Walking in wet shoes or slippers is the key to an upcoming encounter with fungal diseases of the skin of the feet and nails.
Now let's turn our attention to instep supports - a device for correcting and caring for the condition of the arches of the feet. They can be built into ready-made shoes or specially made and additionally embedded.
Remember, children's insoles must be made directly from a cast of the child's foot. It is individual children's insoles-instep supports that give positive results in the treatment of children's flat feet.
The arch support insole returns the child’s foot to the correct position and during the day works as a kind of simulator of the foot muscles - those muscles that were previously hypertonic rest, and those that did not work begin to gain shape. The correct selection of orthopedic insoles leads to alignment of the arches of the feet and normalizes the position of the heel.
With a justified diagnosis of “flat feet” and serious deformities of the foot, as well as accompanying migraines or pain in the legs and back, wearing arch supports (orthoses) becomes mandatory for a long time or forever.
But the temporary use of orthoses to correct minor deviations from the norm is also quite advisable: children are usually prescribed to wear shoes with special insoles for up to several hours a day for a certain period of treatment. Remember that with the constant, unnecessary use of insole inserts, the arches of the feet become “spoiled” and cease to independently and adequately perform their functional duties.
If your child needs to use orthoses, consult with an orthopedic doctor who works directly in this area. An experienced specialist will definitely draw the attention of parents to the need to regularly adjust the shape and size of insoles in children, taking into account the growth rate of the feet, and will give a lot of other professional advice.
An excellent effect - both preventive and therapeutic - is achieved when a child walks barefoot on small pebbles, sand or grass.
But the summer period is over, and the baby will most likely be able to walk with his bare feet on sea sand or fresh grass only next summer. Therefore, we will analyze gymnastic exercises that are convenient to include in the general complex of hygienic gymnastics at home.
In addition to the exercises given earlier in the book, designed for adults and children, in this section we give several more gymnastic complexes for children.
It will not take much time to perform daily preventive exercises with your child that strengthen the muscular-ligamentous apparatus of the foot and lower leg. All that is needed is awareness of the need on the part of the parents and consent to “play” on the part of the child.
The equipment you will need is the following: massage balls - small hard and larger soft ones, as well as a massage mat and/or massage roller. And a gymnastic ball with a diameter of 26 cm.
We repeat each exercise 8–10 times, slowly. In order for your child to understand the task well, first show him the technique and pace of the exercises. This will get his attention and will feel like a game. Make sure that the baby does not experience any inconvenience (draft or stuffy room, clothes that are too warm, a TV playing nearby or an unstable chair, etc.).
"Happy Paws" Starting position (hereinafter referred to as IP) sitting, heels on the floor, toes pulled towards you. Alternating movement of the feet up and down.
"Let's build a bridge." (For kids, this exercise can be called “Let’s build a house for a mouse .”) I. p. the same. Touch the floor with your toes, but the middle part of your foot should not touch the floor. Return to i. P.
"Caterpillar". IP sitting, feet pressed to the floor. Bend your fingers and gently pull up your heel. We try not to lift our feet off the floor! Performed at a slow pace.
"Frog". I. p. sitting. Roll from heel to toe, pulling your heels up. Performed simultaneously with two feet, at a slow pace.
"Twin Brothers" I.p. the same. Heels on the floor, toes raised. Spread your fingers as wide as possible, then relax them. On the right foot the toes work, on the left they are relaxed, and vice versa.
Exercises with a hard massage ball
№ 1. I. p. sitting. Roll the ball with the plantar surface - from heel to toe, alternately with the right and left feet, very gently touching the surface of the ball. A common mistake when performing this exercise is to press hard on the support - you must remember that this is not useful. The exercise can be performed on a massage mat or with a massage roller.
No. 1a. With one foot, smoothly, without pressure, roll the ball over the foot of the other leg (along the instep) back and forth.
№ 2. I. p. sitting on a chair. The inner surface of the feet, closer to the ankle joints, holds the ball. Using your fingers on the floor, you raise and lower your heels while holding the ball.
№ 3. I. p. sitting on the floor. We grasp the ball on both sides with our feet, hold for 5–10 seconds, alternating with relaxation. Young children can help themselves with their palms at first.
No. For. I. p. sitting on the floor. Ball between feet. Spread your toes out to the sides, your heels holding the ball.
Exercises with a soft massage ball
№ 4. I. p. sitting. Rolling the ball is performed simultaneously with both legs using the plantar surface of the foot - from the heel to the toes.
№ 5. I.p. the same. Feet on the ball. We perform circular rotations left and right with light pressure on the ball.
№ 6. I.p. the same. Toes on the floor, arches and heels on the ball. We press down on the ball with our heels. You can alternate with each leg or both at the same time.
No. 6a. Heels on the floor. Press the ball with your fingertips.
No. 6b. We press on the ball with the pad and base of only the thumb (right and left at the same time, and alternately).
Exercises with a gymnastic ball (26 cm)
№ 7. IP lying on your back, hands behind your head. The legs rest with their shins on the ball. We perform movements only with our feet: we pull the toe towards ourselves, alternately with each foot.
№ 8. I.p. lying on my back. Feet resting on the ball, legs bent at the knees at an angle of 100 - 120 degrees. At a slow pace, we lift and lower the pelvis. While balancing, keep your feet on the ball.
№ 9. "Watch." I.p. the same. Ball between shins. Simultaneous movement of the legs left and right. Keep your feet vertical. The pace of execution is average.
"Now let's play"
"Jellyfish". I. p. lying on his stomach, arms spread to the sides. Legs are straightened and spread shoulder-width apart. Bend your knees and connect your feet with the soles of your feet facing each other. Then we return to i. P.
"Artist" (a). I. p. sitting. With our toes we “draw” circles on the carpet or floor - large, medium, smaller and the smallest.
"Artist" (b). I. p. sitting (on a small chair or on the carpet). We hold a pencil with our toes and try to draw simple shapes: a triangle, a circle and a square. Performed alternately with the right and left legs.
"Skillful fingers". I. p. sitting. Imitation of picking up sand with your toes and raking it away (you can use safe small objects, beans, peas).
“Football” (this will require the participation of mom or dad). The child sits on the floor, legs wide apart - this is the “gate”. The task is not to let the ball hit the goal! One of the parents slowly (!) rolls a light gymnastic ball towards the “goal”. The child “hits” the ball with his feet, without using his hands. Ask your child to alternate between his right and left foot.
If a child’s flat feet are accompanied by pain, the painful areas should be rubbed with distracting ointments and warmed with dry heat. This will help ease the suffering. To raise your children healthy, do not delay treatment under any circumstances. And once you start it, be persistent and consistent. This is the only way to overcome flat feet.
Foreign experience in combating flat feet
Orthopedics is a conservative branch of medicine, and changing an established method to a new, more effective one is extremely difficult. Suffice it to recall the pains with which the Ilizarov and Bliskunov devices were introduced in our country. And pediatric orthopedics is doubly conservative. After all, to truly evaluate the result, you need to wait 15–20 years until the child grows up, graduates from school, university, and starts working. It is not enough to be sure that the shape and function of the foot has improved; years of observation are needed to get answers to the most important questions - does the patient have pain and stiffness in the feet, what is the condition of the operated joints and talus? Long-term observations lead to a clear conclusion - major surgical interventions on the foot should be kept to a minimum.
Dr. Mosca's opinion on flat feet problems
Vincent S. Mosca, MD, head of the department of orthopedics at one of the regional medical centers, is recognized as one of the leading researchers in foot problems in the United States. According to Dr. Mosca, flat feet are a very common foot shape in infants (which, however, is also known in Russia). “Almost all babies and at least 20% of adults have flat feet,” he says. – The shapes of the bones and the weakness of the ligaments are genetically programmed and determine exactly this shape of the foot. It is not determined by muscle strength, nerve function, or external forces.”
American researchers in the late 40s of the 20th century identified flat feet in 23% of adults and divided them into three types: flexible (or hypermobile), flexible, but accompanied by contracture of the Achilles tendon, and hard.
The flexible type of flatfoot affects most adults and even more children. Researchers have concluded that flexible flat feet are a normal and common foot shape.
More recent research has expanded the understanding of flat feet in children. “Most babies suffer from flat feet. The average height of the arch of a child's foot is lower than that of an adult, says Dr. Mosca. – Corrective shoes and orthoses do not affect arch development in children – there is no scientific evidence that shoes can create an arch in a child’s foot. Surgical correction of flexible flatfoot in children is almost never used.”
Flexible flat feet with a short Achilles tendon can be painful for teenagers and adults. Surgery is used to correct Achilles tendon contracture in this small group of people only when conservative treatment for pain relief is ineffective.
Dr. Ponseti's method and Dr. Dobbs' treatment
The method was developed by American orthopedist Ignacio Ponseti (Iowa, USA) back in the middle of the 20th century. Unsatisfactory results in the treatment of clubfoot (in fact, the reverse of flatfoot) in children led him to the idea of developing a new casting technique that uses the elasticity of the soft tissues of the newborn. He showed that the child's ligaments can be stretched as much as possible in the required direction without causing pain.
I. Ponseti, MD, Professor Emeritus of Orthopedics at the University of Iowa, introduced a method that significantly reduced the need for surgery and improved long-term treatment outcomes for clubfoot patients.
However, the Ponseti method is not only used for clubfoot. Flat valgus feet and pronounced inward pronation of the foot (in the USA it is called “vertical talus”) can also be treated with this method, only the efforts in this case are directed in the opposite direction: the foot visually turns into a clubfoot, and the subluxation of the talonavicular joint is reduced.
The patriarch of this method is M. Dobbs (Philadelphia, USA), who has the world's largest experience in treating vertical rams with the Ponseti method. According to him, up to the age of 4, any vertical ram can be treated conservatively.
Matthew B. Dobbs, MD, associate professor of orthopedic surgery and surgeon at St. Louis Children's Hospital, has developed treatment for pes planovalgus using gentle foot adjustments and long strides weekly for 4 to 6 weeks to gradually correct the deviation. In this case, the main points of support are the head of the talus and the head of the 1st metatarsal. As recovery progresses, the foot rotates outward around the talus and the subluxation in the talonavicular and subtalar joints is reduced. Correction of the varus position of the calcaneus does not require special manipulations and occurs independently - the heel returns to its normal position. After treatment, Dobbs and his colleagues take x-rays to determine the success of the correction.
“Most of the correction happens after the first year,” says M. Dobbs. “When the defect is not completely corrected, we complete the correction using minimal surgical intervention.” During a minor operation, Dobbs inserts a small rod where the ankle joins the ankle joint to help the joint move into the correct position within about two months. After this, patients wear splints or a brace (a splint with a boot attached) for several years to prevent recurrence.
The difference between the Dobbs method and conservative treatment methods is the use of new knowledge about the way in which the normal stride is formed. The fundamental difference is different points of fixation during foot restoration, based on a new understanding of its biomechanics, as well as the gradual elimination of deformity components. “What was previously missing in the treatment of flat feet and its variants was podiatrists' understanding of how the joints in the foot move and interact,” says M. Dobbs. “Now, thanks to the work of Ignacio Ponseti, we actually have a better understanding of the mechanics of the foot and ankle, which has allowed us to figure out how best to gradually correct abnormalities in the development of the foot.”
Plastering using the Ponseti method begins immediately after the child’s umbilical wound has healed. Plastering begins with correction of the hollow foot. Then varus, inversion and adduction (heel area pulled up) are corrected simultaneously, because the tarsal joints are closely interconnected and can only be corrected together. Plaster casts are applied with fixation of the knee joint to the upper third of the thigh; they are changed with gradual correction of the foot after 7 days. As a rule, for complete correction of the foot, 4–6 changes of plaster casts are necessary with gradual correction of deformities. Staged plastering takes from 4 to 6 weeks. After the casting is completed, the child must wear a brace (brace) that provides for a certain position of the feet. Braces should be used up to 3 – 4 years.
An important component of the Ponseti method is relapse prevention. It is based on the use of braces and re-plastering. At the slightest deformation of the foot, the slightest hint of relapse, one cast is applied for a week. This is a tall cast, the child cannot be washed, but he and his parents are freed from constant trips to the clinic and the “white coat” syndrome - when, upon seeing a doctor, children immediately begin to cry.
Today, no other method of treating clubfoot and planovalgus foot provides such impressive effectiveness in such a short time.
The traditional approach, used in Russian clinics for decades, is based on massage, physiotherapy, physical therapy, wearing orthopedic shoes, and electrical stimulation. The child is literally healed, but all these methods in total provide no more than 5% effectiveness compared to plaster casting. However, despite the pronounced conservatism of domestic medicine, in some cities of Russia, in particular in Vladimir and Yaroslavl, since 2002, orthopedic doctors, having completed a training course in the USA, were the first in the country to use the Ponseti method. And now dozens of enthusiastic reviews about the effectiveness of this method have been posted on the Internet on parent forums, and children with clubfoot and flat feet are being brought to Yaroslavl not only from different regions of Russia, but also from Belarus, Kazakhstan, and Ukraine. However, orthopedists using the Ponseti method now work in many cities - Chelyabinsk, Kazan, Orenburg, Volgograd, Ufa, Irkutsk. They appeared in Moscow and St. Petersburg.
Dr. Wikler's Special View
American orthopedic surgeon, pediatrician, MD Simon Wikler, in his book “Take Off Your Shoes and Walk,” spoke about his view on the problem of flat feet and walking barefoot as a preventive measure for flat feet.
Most Americans have foot problems and don't even know it. Due to foot diseases, Americans experience poor posture, get tired easily and become susceptible to various diseases. So says Dr. Wikler.
“I discovered that getting strong, healthy feet was easy,” he said in his book. “I’ll tell you what you need for this - may your legs and the legs of your relatives be healthy.”
Most of those who came to see him suffered from one degree or another of flat feet. Massage and bandages brought temporary relief to some of them, but could not cure any. And commercial companies found it profitable to sell arch supports to people suffering from flat feet. Unfortunately, wearing these instep supports rarely gave a satisfactory effect. People hoping to get rid of foot problems with the help of such devices went from one shoe store to another, from one doctor to another - all to no avail.
Every child who wears modern shoes has feet that are deformed to some degree. Realizing this, parents do not know which shoes to choose, and stores offer orthopedic shoes not always in accordance with the indications. This is especially unfortunate since it has been established that children's feet that are allowed to develop naturally (for example, by walking barefoot) will grow normal.
Experts admit that the causes of foot deformities have not yet been precisely established, and there are many medical opinions on this matter, sometimes diametrically opposed, but therapists, pediatricians and orthopedists have to reckon with these specialists. If even doctors are baffled by foot diseases, then how much more difficult it is for a layman to understand them. One thing is clear: all common foot conditions are preventable.
Don't buy shoes for your child until he can walk. Although the shoes may seem nice and soft, they can seriously interfere with normal foot movements. Crawling is an exercise that is essential for your baby's development. Encourage him in every possible way. And don't try to speed up your baby's first steps. He will start walking when his feet and legs are ready.
In the first year of life, the best shoes for a baby are woolen booties. But they must be large enough so as not to restrict the feet and toes in any way. When a child begins to walk around the house independently, this means that he will soon walk on the sidewalk and his soles need to be protected. Now you can buy your baby's first pair of shoes. The best boots are flexible, roomy and simple. Remember, your baby's feet and toes should be able to grow freely without any restrictions. It is advisable that children's shoes do not have heels. The toe of the shoe should be at least the width of an adult's thumb from the child's toes. When purchasing shoes for your child, choose the widest pair available. To check the width, place your fingers between the edges of your feet and the side of the shoe and make sure there is some space there. Be sure to insert your fingers on both sides at the same time so that the boot does not move to one side when checking. The most severe deformities due to shoe pressure occur before the age of four, when children's bones are at their softest, says Dr. Wikler.
Young children should go barefoot as often as possible. Children should wear shoes outside only in cold weather, and at home only on rare special occasions. To prevent flat feet in children, parents should adhere to only one important principle: keep children without shoes as often as possible in the first year and a half of life.
If you follow these recommendations until the child is five years old, you will see that his legs are perfectly developed and practically not disfigured.
Babies' feet appear flat because they are covered with a thick layer of baby fat, which is completely normal. From this fat, the baby's muscles and bones receive the necessary nutrition as they grow. It begins to disappear towards the end of the third year. Until then, low arches are completely normal.
When your baby learns to walk confidently and develops flat feet, treatment can easily be carried out at home. The treatment method is simple, says Dr. Wikler. Remove all socks and shoes and allow your child to walk barefoot. You can help matters by playing with his fingers so that the child moves them, but in most cases this is not necessary. A two-year-old child will begin to use his toes himself as soon as the shoes that constrain them are removed. In a few weeks his feet will become fuller and stronger.
All children under six years of age suffering from flat feet need to recover is to walk barefoot. Moreover, their skin is sensitive to patches and special devices that prevent the child from swinging his legs in bed, stretching his muscles. There is no harm in delaying special treatment (bandages and exercises) until age six. Let your child walk barefoot and nature will probably take care of everything without medical intervention.
In conclusion, Simon Wikler writes:
“No matter how effective medical care is, the measures taken by parents are much more important. These measures are based on four main principles.
First: remember that shoes deform the foot. Don't buy it for your child until it is really needed; and then choose the right size.
Second: do not wait until the child begins to complain of pain if you see that the shoe is deforming his foot.
Third: the child should be able to walk barefoot for part of the day (preferably at least three hours).
Fourth, you can help your child by teaching him exercises to strengthen his feet.”
As for views on flat feet, now you and I understand: there is no common opinion about this disease and no uniform recommendations for its treatment among orthopedic doctors either abroad or in Russia.
One cannot but rejoice that medical conservatism (as a rule, unanimously rejecting any innovations) is losing ground in our country. It turns out that Russian doctors closely monitor the achievements of their foreign colleagues and adopt the best in order to help patients more effectively.
And what is surprising is that the most advanced treatment methods are first introduced not in cities such as Moscow or St. Petersburg, but, in a certain sense, on the periphery - in Yaroslavl and Vladimir, from where the experience of local doctors begins to spread throughout the country, ultimately convincing them of effectiveness new methods of treating flat feet and doctors from two Russian capitals.
Prevention of flat feet consists, first of all, in developing a correct gait - you should avoid spreading your toes when walking, so as not to overload the inner edge of the foot and the ligaments that support it.
Flat feet, due to the very nature of the disease, creates certain restrictions in choosing a profession. This is the very case when there is no truth in the legs. But a calling is a gift from God, which does not always coexist with sober calculations and medical prohibitions.
Remember, if you have to spend at least 7-8 hours on your feet at work , there is a real risk of acquiring flat feet over time, if you don’t already have them. If you have already been diagnosed with flat feet, then you should not choose to work as a waiter, cook, salesperson, hairdresser, priest, doctor, fireman, traffic police officer, operative, or military man. Managers and brokers, by the way, also run the risk of developing flat feet as an occupational disease. And even the now fashionable job of a bodyguard may well provide you with not only good income, but also flat feet (though in this case, a lot depends on the work schedule of the person being protected).
Of course, this is not a complete list of undesirable professions for flat feet. The reader, after thinking a little, is able to continue it himself.
Well, what about those who have already chosen an “undesirable” profession?
Of course, in each specific case, a person decides for himself who to be. Perhaps someone will want to retrain, but for others, leaving what they love is like death. For those who are obsessed with their work, we want to give some advice.
To avoid worsening your painful condition, try to follow these recommendations throughout the day.
1. First of all, buy shoes with thick, soft soles. Especially for women who work while standing, you should order open-toe shoes to allow your feet to ventilate. It's even better if the shoes have a fabric upper that covers the ankles. In this case, heels should not exceed 4 cm.
2. It is advisable that in these shoes you have corrective insoles and insoles.
3. In any free minute you should try to give your legs a rest. When no one sees you (since the pose is not very aesthetic), place your feet crosswise and lean on their outer edges.
4. In general, try to stand on the outside of your feet 3–4 times a day. You need to stand in this position for at least 30–40 seconds.
After a working day, warm baths (water temperature 35 - 36 ° C) , followed by massage of the arch of the foot and muscles. Massage the front and inner surface of your shins with smooth but fairly strong movements. When massaging your feet, pay special attention to the soles. Basic techniques: stroking, rubbing, kneading in different directions, tapping with fingertips. The duration of one course is 1.5 - 2 months, the time of one procedure is 10 - 12 minutes.
Special physical training techniques are of great importance: walking barefoot on uneven surfaces, on sand, walking on tiptoes, jumping, live games (volleyball, basketball, etc.). On the beach, walk longer along the shore, going into knee-deep water. If you are sufficiently hardened, then whenever possible, run barefoot on grass wet from dew or warm rain. You will get incredible pleasure and at the same time perform an excellent exercise not only against flat feet, but also to improve blood circulation in the legs.
It is very important to wear shoes that fit your feet exactly. The medial edge of the shoe should be straight so as not to move the 1st toe outward, and the toe should be spacious. No matter how beautiful and fashionable the shoes are, refuse them if they are even the slightest bit tight or narrow. The heel height should be 3–4 cm, the outsole should be made of elastic material. There's no doubt that high heels look great on your feet, but don't wear them every day. Otherwise, it may happen that after a while you will be doomed to wear only orthopedic shoes.
To prevent flat feet or relieve pain, there are also a large number of inserts and special shoes.
And these are recommendations for women who constantly or often wear high-heeled shoes.
• Limit the time you wear such shoes as much as possible.
• Perform the exercises for the legs and feet given above, walking barefoot on the grass, on small pebbles, on sand, warm baths.
• The rest of the time, wear shoes that fit your feet or arch supports.
• Maintain good physical shape (shaping, swimming).
• If you experience pain in your feet, consult a podiatrist.
Remember that treating flat feet, like any other disease, is a much more difficult process than preventing it. Therefore, spare no effort and time to prevent it!
If you are seriously concerned about the health of your child’s feet and your own feet, our book will be a good help in helping you thoroughly understand the essence of flat feet, the danger of its complications, its prevention and treatment. Then, even before going to the orthopedist, you yourself will be able to find out whether there is cause for concern and whether you need to see a specialist, you will be able to make the right decision and take the first (and, most importantly, the right) measures to prevent flat feet, and also monitor the effectiveness of the measures taken.
And when you see a doctor, you will be able to speak the same language with him, understand his explanations and evaluate the prescriptions prescribed for you or your child.
In addition, now you know what to do during pregnancy and what to do if you or your loved ones have diabetes. Now you know exactly what forms of flat feet your child will not be drafted into the army at all or will be considered limitedly fit.
In a word, from now on you are fully armed, and no types and forms of flat feet are scary for you and your loved ones.
Böhler's angle is the angle of the articular part of the tubercle of the calcaneus. Normally it is 20 – 40 degrees. (Editor's note)
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