The main task of the foot is to support body weight. It also acts as a kind of shock absorber. Therefore, as soon as a problem appears (injury or illness), a person immediately stops enjoying life.

The condition of foot deformation with loss of function and violation of the arches is called flat feet. People of all ages are at risk. According to statistics, the disease develops in a significant part of the world's population - more than 40%. Moreover, most of them (about 90%) are female.

Longitudinal and transverse flatfoot is a serious disease that causes significant discomfort, interfering with normal walking. Patients also cannot stand on their feet painlessly. Therefore, everyone is interested in the question: is it possible to cure flat feet?

Causes

Anatomically, the human foot has a transverse arch (it is located directly under the toes) and a longitudinal arch (it runs along the edge). When deformed, the load is redistributed between the spine and leg joints. As a result, a person has serious problems not only with his legs, but also with his back. To avoid unpleasant consequences, it is advisable to start treating transverse and longitudinal flat feet in time.

Causes of flat feet:

• Heredity.
• Weak ligaments, as well as foot muscles.
• Having excess body weight.
• Pregnancy.
• Work activities associated with excessive loads.

According to the nature of occurrence, the following types of flat feet are distinguished: acquired, congenital. In most patients the disease is acquired.

Disease in children

Congenital flatfoot is associated with impaired fetal development in the prenatal period. This type of disease is quite rare. Children are already born with a flat-valgus foot. The disorder can be caused by oligohydramnios during pregnancy, taking certain medications, or exposure to harmful radiation.

After birth, all children will have flat feet. The formation of its vaults is completed around the age of four. Therefore, starting only at this age, doctors can make a similar diagnosis and begin treatment for flat feet.

If both parents suffer from congenital flat feet, then such children have a high risk of being born with this pathology.

Therefore, it is necessary to carefully monitor the development of the child’s foot in order to detect violations in a timely manner.

One of the signs of possible flat feet in the future is clubfoot in children. Obvious congenital flat feet can be distinguished by the shape of the foot. In this case, the sole will be in contact with the surface over a larger area. In addition, there are the following distinctive features:

• Gait disturbance.
• Tired legs.
• Swelling in the lower leg and foot area.
• The child has difficulty maintaining balance.
• The lower leg muscles are disproportionate.

Since the signs appear gradually, it is almost impossible to identify flat feet in children in the initial stages. But the success of treatment will depend on how early this pathology was detected.

Congenital flat feet, which are inherited, cannot be completely corrected. Treatment in such cases consists of strengthening the muscles and ligaments of the musculoskeletal system. Prevention is also equally important.

Disease in adults

Acquired flat feet are usually caused by weakening of muscles, ligaments, and bone deformation. This type of flatfoot is called static. The disease can also provoke an ankle fracture, a fracture of the heel and tarsal bones, ankles, as well as other injuries not only to the arch of the foot, but to soft tissues.

Another reason for the development of flat feet in adults is rickets suffered in childhood. With this disease, the frame of the foot weakens and is therefore unable to withstand the load of the body. As a result, deformation of the bones that are located in the foot occurs, that is, flat feet appear.

Symptoms

The clinical manifestations of flat feet depend on several factors: the severity of the disease, as well as how strong the changes have occurred. Mild foot dysfunction, indicated by tired legs in the evening, is an early stage (otherwise called latent). In such cases, there are no visual signs of deformation.

Doctors distinguish 3 degrees of severity of this disease:

• Grade 1 is expressed in the presence of mild pain, which occurs if you even stand on your foot a little or lightly press on any area of ​​the foot. You may also notice swelling in your legs in the evening, which goes away on its own after sleep.
• Level 2 flatfoot is determined by the flatness of the arch. Please note that in such cases the vaults are practically not visualized. As a result of the disease, significant difficulties arise not only during running, but also during normal walking. In addition, painful sensations spread completely to all legs, the pain is pronounced and long-lasting.
• 3rd degree – feet with obvious deformation. A person experiences severe pain in his legs when walking, which causes some inconvenience. One of the signs can also be considered that the usual shoes are no longer suitable for wearing. Those with level 3 flat feet are exempt from military service.

Since the disease develops rapidly, it is recommended to seek help from a doctor at the first suspicion of flat feet. He will prescribe treatment to prevent possible complications. These may include arthritis, hernia, or curvature of the spine.

Often, the symptoms of flat feet do not manifest themselves in the early stages, which is why a person confuses them with other diseases that affect the condition of the lower extremities. It all starts with the fact that he feels tired and unwell in his legs. After some time, pain appears that becomes so strong that it radiates to the spine. The shape of the foot itself also changes: the bone “bump” at the base of the big toe enlarges, as a result of which it becomes deformed and changes its location - it moves under the second toe.

Constantly forming calluses and corns on the foot are also considered symptoms of flat feet. The disease is also characterized by the inability to stand on tiptoes.

Symptoms of flat feet also appear, such as:

• Shoes wear out prematurely (especially the inside) and change their shape.
• When walking in stiletto heels or high heels, a woman’s foot begins to hurt. Pain also occurs if you stand for a long time.
• Loads greater than usual provoke pain in the lower extremities.
• In the evening, the legs will be swollen, and sometimes cramps appear.
• The gait becomes clubfoot.
• The leg increases in length and width.
• Headaches and lumbar pains appear.
• The toes change their shape and length.
• The ankle and hip joints are deformed.

In children, a common manifestation of flat feet is fatigue and pain in the legs. As a result, curvature of the spine or even arthrosis may occur. With flat feet, some children complain of headaches.

Kinds

In orthopedics, certain types of flat feet are distinguished. Based on the type of arch violation, it is classified into:

• longitudinal-transverse flatfoot (combined);
• transverse flatfoot;
• longitudinal flatfoot.

Moreover, doctors say that in their practice patients with transverse flat feet often come.

The diagnosis of “Longitudinal flatfoot” is made if the patient complains of fatigue that quickly occurs in the legs. In addition, if you try to press even slightly on approximately the middle of the foot, pain will appear. Swelling of the foot is visualized on the back side.

Longitudinal flatfoot, among other things, is expressed by constant severe pain, which is localized in the ankle joint. In some patients, the pain radiates to the lumbar region. The ankle joint becomes immobile, the foot itself swells - this leads to difficulty walking. Patients complain that there are big problems with choosing comfortable shoes.

Transverse flatfoot, if adequate treatment is not started in time, will lead to serious complications. In particular, pain occurs in the kneecaps and pathologies of the spine.

Symptoms by which transverse flatfoot can be recognized:

• Pain occurs throughout the entire foot, but is worse in the front part.
• Coarsening of the skin on the outside.
• Deformation of fingers.
• The transverse arch of the foot is smoothed out.

When the disease enters its final stages, you may notice a slight increase in the size of the leg, not only in width, but also in length.

The gait changes - it becomes clumsy and heavy. Some patients have difficulty maintaining balance. As a result of circulatory failure, the skin on the foot begins to acquire a purplish-blue tint. This type of flatfoot is formed as a result of deformation of both arches of the foot.

Combined flatfoot is characterized by the same symptoms as both previous types, but they are only more pronounced. In addition to foot pain, it is characterized by swelling of the ankles, pain in the knees, and back. Lameness and blueness of the skin of the foot also appears.

Diagnostics

The basis for diagnosis is clinical manifestations and examination. Moreover, the doctor must examine not only the patient’s foot, but also his shoes - shoes wear out in a characteristic way. In addition, the color of the skin of the foot, the presence of corns, seals and calluses are important.

With a healthy foot, the skin will be pinkish. If it has a purplish-bluish tint, then this indicates venous stagnation. If the color is pale, this, on the contrary, indicates insufficient blood circulation.

There are also instrumental diagnostic methods:

1. Podometry. It is used to determine the arch index (for this purpose the foot is measured). The result is measured as a percentage. If there are no problems, then the longitudinal arch will be in the range of 29–31%, but the transverse arch will be a maximum of 40%.
2. Podography. Not only the biomechanics of walking are studied - the parameters of foot movement are also considered during diagnosis. This method allows you to analyze a person’s gait, study the characteristics of foot rolls and calculate the coefficient of gait rhythm.
3. Using X-rays, foot abnormalities are assessed and the degree of flatfoot is determined. In addition, radiographic examination is used to monitor the treatment process in order to track the dynamics of the disease.
4. Electromyography is a method for diagnosing the condition of the ligamentous-muscular apparatus of the foot. It is very effective, since the severity of the disease depends on the condition of the muscles of the lower leg and foot.
5. Pantography. When it is carried out, a foot print is left on special paper. To do this, specialists paint the lower part of the foot with various substances, and then make an imprint. This method makes it possible to find out what condition the arch of the foot is in. If some suspicions arise, then additional examination will be carried out using other methods.

It will be possible to diagnose pathology in children using plantography - this is taking a foot print on which the points of load distribution will be marked. Diagnosis using x-rays is not prescribed for children until they reach 4 years of age.

Treatment

People with a similar diagnosis have natural questions: how to treat flat feet? How to cure flat feet without surgery? What are the chances of completely correcting the pathology? Doctors believe that the treatment of flat feet and its success will depend on how early it was detected, that is, on the stage of the disease.

Treatment of flat feet in adults and children should pursue 3 main goals:

1. Relief from pain.
2. Restoration of foot functions impaired due to disease.
3. Strengthening muscles and ligaments.

There are two ways to correct your foot: conservative and surgical. Moreover, surgery is resorted to only in cases of severe deformation of the feet.

Today's medicine cannot completely cure the disease. Therefore, all treatment is aimed at preventing further development.

Prevention also doesn’t hurt, especially if a person has a tendency to have flat feet.

Conservative methods

As part of conservative treatment, various medications and procedures are prescribed - physiotherapy, massage, therapeutic exercises. In addition to them, it is recommended to wear special shoes and insoles.

Massage is especially effective in the early stages. It helps relieve pain and improve blood circulation.

Performing special exercises is advisable for the first degree of flat feet. With the help of exercises, you can correct the imbalance of the bones of the foot and strengthen the muscles and ligaments. Classes must be regular. The recovery will be long.

Shock wave therapy, paraffin baths and electrophoresis are used as physiotherapy. They are prescribed at all stages of the disease, and are especially effective in cases of severe pain and impaired motor ability of the joints. With the help of these procedures, foot mobility is restored, blood circulation and tissue metabolism are improved. Physiotherapy should be used in combination with other treatment methods.

Drug therapy will only help relieve pain. As such, it does not provide effectiveness in preventing the development of the disease.

Surgical methods for treating flat feet are used when other methods are ineffective and the disease is severe, which is accompanied by complications.

Prevention

If there is a risk of such a disease occurring in children, then as a preventative measure it is necessary to purchase special orthopedic insoles or orthopedic shoes. It is equally important to monitor the nutrition of children. It should be enriched with vitamins, as well as phosphorus and calcium.

Scientists have proven that among adults, even with a hereditary predisposition to the disease, flat feet are 3 times less common if they spent a lot of time barefoot in childhood. That is, walking barefoot on the grass is an effective prevention.

Orthopedic insoles and shoes are recommended by specialists at the first signs of the disease. They will also not harm women during pregnancy, athletes and people who, due to their profession, are on their feet for a long time. This method of treatment is also a method of prevention. It helps return the deformed foot to its normal position.

According to statistics, almost every child under 5 years of age who has deviations in the development of the feet (40-80%) is also diagnosed with “planovalgus deformity of the feet.” It is accompanied by the following deviations:

• flattening of the longitudinal arch;
• valgus position of the posterior section;
• abduction-pronation position of the anterior section.

The maximum percentage is observed in children of primary school and preschool age. Although there are cases when this diagnosis may be considered inappropriate.

The shape of the foot, formed during evolution, ensures an even distribution of body weight. The bones of the foot, connected by strong interosseous ligaments, form its arch, the role of which is to provide maximum shock absorption when running and walking. Convex arches are oriented in two directions - transverse and longitudinal. Therefore, normally, an adult foot has three points of support - the head of the first metatarsal bone, the calcaneal tubercle and the fifth metatarsal bone.

In children, flattening of the arch of the foot usually occurs during the period when the baby is just taking his first steps; This is due to quite serious loads on the legs when trying to take a step. Of course, you cannot expect your baby to have perfectly correct foot placement or a “hip-based” gait immediately after he first stands on his feet. You shouldn’t panic or immediately give up your sports or military career.

As a rule, the first complaints from parents arise when the child takes his first independent steps. In this case, it is necessary to clearly distinguish between the physiological flattening of the arch of the foot of a child who has not yet reached the age of three years, and the actual flat-valgus deformity, which already requires the supervision of an orthopedic doctor. Until the age of three, children have a “fat pad” on the plantar aspect of the foot, so the arch of the foot is not visible with a simple visual inspection. But it will be noticeable if you ask the baby to stand on his tiptoes. Bone tissue in a child continues to form until the age of 5-6 years, so only during this period does it make sense to start talking about the absence or presence of plano-valgus DEFORMITY in the child as such.

Although it is worth keeping in mind that flat-valgus feet in children can lead to such negative consequences as:

• severe curvature of the spine;
• constant pain in the legs;
• “adult” diseases - osteochondrosis, arthrosis.

In some cases, the diagnosis of “valgus feet” is made to the child while still in the maternity hospital. In this case, the disease is congenital (vertical ram).

Causes of foot deformities

1. Connective tissue dysplasia (78%). Polluted water and air, poor quality food lead to the fact that the connective tissue, which is the basis of the ligamentous apparatus of the joints (as well as all other organs), is formed incorrectly.

2. Incorrect children's shoes (soft models with flat soles that are not able to properly fix the foot).

3. The child does not engage in physical education in preschool institutions and in the family.

4. Genetic and endocrine (diabetes, thyroid diseases) disorders.

5. Osteoporosis (damage to the skeletal bones).

6. Various foot injuries.

Doctors identify a number of theories that can explain the etiopathogenetic mechanisms:

• anatomical theory;
• vestimentary theory;
• static-mechanical theory;
• theory of hereditary muscle weakness;
• theory of constitutional weakness of connective tissue.

Classification:

• hypercorrection in the treatment of clubfoot;
• congenital;
• paralytic;
• rachitic;
• traumatic;
• static.

Doctors distinguish three degrees of severity of planovalgus foot deformity: mild, moderate and severe. The so-called rocking foot (vertical ram, paperweight foot) is the most severe degree of deformity. It is detected immediately at birth, the incidence of detection is 1 in 10,000 newborns. The etiopathogenesis of this deformity has not yet been fully studied. As the most likely cause of the deformity, doctors identify a malformation of the embryo and a delay in its development at one of the stages of embryo formation.

Normal foot parameters:

• if you draw two lines - along the lower contour of the calcaneus and the first metatarsal bone - so that the apex of the angle is in the area of ​​the scaphoid bone, this angle should be 125°;
• height of the longitudinal arch - 39-40 mm;
• valgus position of the hindfoot - from 5 to 7°;
• the angle of inclination of the heel bone in relation to the plane of support is from 20 to 25°.

The height of the longitudinal arch of the foot in preschool children can normally be 19-24 mm.

The mild degree is characterized by the following parameters:

• the height of the longitudinal arch of the foot is reduced to 15-20 mm;
• the arch height angle is reduced to 140°;
• angle of inclination of the heel bone - up to 15°;
• valgus position of the posterior section - up to 10°;
• forefoot abduction (8-10°).

Average degree:

• the arch of the foot is reduced to 10 mm;
• the height of the arch is reduced to 150-160°;
• heel bone inclination angle up to 10°;
• valgus position of the posterior section and abduction of the anterior section - up to 15°.

Severe:

• the arch of the foot is reduced to 0-5 mm;
• the angle of the arch of the foot is reduced to 160-180°;
• angle of inclination of the heel bone - 5-0°;
• valgus position of the posterior section and abduction of the anterior section - more than 20°;
• severe deformity is rigid and cannot be corrected;
• constant pain syndrome in the area of ​​the Shopard joint.

The foot is the basis, the “foundation” of our body. And if the foundation is crooked, then a level, reliable house cannot be built on it. Plano-valgus deformity of the feet entails valgus (X-shaped) deformation of the knee and ankle joints, incorrect position of the pelvis, and poor posture. Curvature of the axes of the spine and limbs leads to overload of the muscles, which will unsuccessfully try to hold the body in the correct position. As a result, the appearance of pain, early development of arthrosis, osteochondrosis.

Prevention:

1. You shouldn’t put any weight on your baby’s legs before 7-8 months. You can use your baby earlier as an element of gymnastics, but only for a short time and always with support.
2. Prevent rickets.
3. The baby must wear the right shoes: those with a rigid high back (3-4 cm above the heel), which helps keep the heel on the axis of the shin, as well as a flexible sole and a small instep support.
4. It is imperative to undergo examinations by an orthopedist (1, 3 and 6 months of life, at one and three months of age, from 4 years old - annual visits).

Treatment

Taking into account all of the above, parents need to understand that flat feet are a serious problem only when the feet are not only flat, but also cause discomfort to the baby when walking or running. If, when rising on his toes, the arches of the baby’s feet look normal and do not bother him in any way, then treatment is not required.

If flat feet are also painful, rigid (stiff), this is a completely different situation. Here you need the help of an orthopedist who regularly deals with feet in order to correctly assess the severity of the pathology and develop adequate tactics for managing the patient. This can be either orthotics using specialized shoes, or surgical treatment in various options:

1. Grice's operation (subtalar arthroeresis).

Before treatment After treatment

2. Dobbs method for the treatment of vertical talus (staged casting followed by percutaneous fixation with a Kirschner wire).

The Dobbs method involves conducting 5-6 sessions (one per week) of gentle manual correction of foot deformities. Each session ends with casting of the involved lower extremities, aimed at reliably holding the feet in the position of maximum possible correction. In this case, a plaster cast is applied from the upper third of the thigh to the fingertips with the knee joint bent to 90°.

Soft tissues in children are quite extensible, which allows from session to session, gradually, without anesthesia, to eliminate dorsiflexion, pronation and abduction of the forefoot and bring them to a position of supination, varus and plantoflexion. In 5-6 sessions, the anatomical relationships in the joints of the middle and hindfoot are clinically and radiographically normalized. The last stage consists of two surgical procedures: fixation of the talonavicular joint using a Kirschner wire in the correct position (percutaneously, under the control of an image intensifier) ​​and a complete percutaneous achillotomy.

After these manipulations, a plaster cast is applied for up to 8 weeks. After the knitting needles are removed, the child is in plaster boots (without fixing the knee joint; with a longitudinal arch laid out; with the possibility of full support on the legs). Then, in order to prevent recurrence of foot deformities, children are prescribed an orthopedic regimen of wearing braces until the age of 4. As after treatment using the Ponseti method, children wear braces at the first stage 23 hours a day (for 4 months), then the wearing time is gradually reduced, and subsequently the braces are worn only during sleep (night and day). The difference from the Ponseti method is only in the angular adjustments of the foot abduction. Subsequently, children treated using the Dobbs method wear orthopedic shoes with a longitudinal arch.

3. Various soft tissue and arthrodesis operations.

It is necessary to understand that when making a diagnosis and treatment, all nuances must be coordinated with both the orthopedist and doctors of related specialties (massage therapist, exercise therapist, physiotherapist, etc.).

You can get a preliminary consultation with specialists on the condition of your child’s feet by filling out a form (for a child under one year old with photographs of the feet, over 1 year old with photographs of the feet and a video of walking).

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

What is clubfoot?

Clubfoot This is a pathology of the joints of the foot in which a person cannot place the sole of the foot flat on the floor: the foot seems to be turned inward and bent at the sole. The heel is raised up. This type of foot is called a “horse foot.”

The position of the bones and muscles of the foot in this disease is grossly impaired, and the mobility of the ankle joint is limited. The gait is specific: with support not on the entire sole, but on its outer edge.

Congenital clubfoot is mostly bilateral, and is half as common in girls as in boys.

Classification

Clubfoot is divided into congenital and acquired.

Congenital clubfoot:
1. Primary (typical):

• light forms;
• ligamentous (soft tissue) forms;
• bone forms.

2. Secondary (atypical):

• neurogenic clubfoot;
• amniotic clubfoot;
• clubfoot due to underdevelopment of the tibia;
• clubfoot due to arthrogryposis (congenital joint deformity).

Mild forms of typical congenital clubfoot respond well and quickly to treatment. Soft tissue forms (more common than others) can also be treated, but this process is longer. The most difficult treatment is for bone, rare forms of congenital clubfoot.

Correction of atypical clubfoot depends on the cause of the disease.

Causes

Congenital clubfoot can occur for the following reasons:
1. Mechanical: when the fetus is incorrectly positioned inside the uterus, when the uterine wall presses on the child’s foot, causing circulatory problems and deformation of the foot skeleton.
2. Neuromuscular: with improper development of muscles and ligaments, leading to a violation of the position of the foot.
3. Toxic: as a result of exposure, for example, to certain medications that a woman took in early pregnancy.
4. Genetic: There is a theory of hereditary transmission of clubfoot.

Registration is carried out at the place of registration of the child. An orthopedist gives a referral for registration of disability.

Previously, the child is sent for examination to a pediatrician and specialists (surgeon, ophthalmologist, ENT doctor), as well as for laboratory examination.

The collected documents are submitted to the head physician of the clinic. The chief doctor certifies them with his signature, after which the child must be enrolled in the MSEC (Medical and Social Expert Commission). It is this commission that makes a decision on assigning the child disabled status.

Typically, disability for clubfoot is issued for a period of one year (sometimes for two years, if clubfoot is combined with some other developmental defect). A year later, the procedure for registering disability is repeated.

Mild forms of typical congenital clubfoot respond well and quickly to treatment. Soft tissue forms (more common than others) can also be treated, but this process is longer. The most difficult treatment is for bone, rare forms of congenital clubfoot.

Causes

1. Mechanical: when the fetus is incorrectly positioned inside the uterus, when the uterine wall presses on the child’s foot, causing circulatory problems and deformation of the foot skeleton.

2. Neuromuscular: with improper development of muscles and ligaments, leading to a violation of the position of the foot.

3. Toxic: as a result of exposure, for example, to certain medications that a woman took in early pregnancy.

4. Genetic: there is a theory of hereditary transmission of clubfoot.

• improper healing of bone fractures after injury to the ankle joint;
• deep burns of the foot and leg;
• bone diseases (for example, osteomyelitis);
• neurological diseases (paralysis);
• tumors;
• diseases associated with impaired bone growth.

Atypical clubfoot

Valgus clubfoot

Treatment of congenital clubfoot

Conservative treatment methods

This method of treatment consists of applying plaster bandages-boots to the child’s deformed feet, after bringing the foot as close as possible to the correct position.

This method is close to plaster casting, but the feet are not fixed so rigidly, using bandages. It is used only for mild clubfoot, in combination with physical therapy exercises.

Such splints, or splints, are made from a material containing a nickel titanium compound. Each elastic design includes three separate parts: a splint for the thigh, a splint for the lower leg and a splint for the foot (on its back and front). Despite the fact that splints are very elastic and soft, they continuously act on the foot, bringing its position closer to normal.

Orthotics is a method of treating clubfoot using orthoses - removable orthopedic devices that fix the foot in a position as close as possible to the correct one. There are different types of orthoses: these include orthopedic shoes, orthopedic insoles, as well as splints - a device for rigidly fixing the ankle joint.

Massage for congenital clubfoot should be performed by a highly qualified specialist. With the help of massage of the lower leg and foot, as well as massage of segmental zones, the muscles and ligaments of the ankle joint are strengthened, which is very important in the complex treatment of clubfoot.

Physical therapy also plays an important role in the correction of congenital clubfoot.

Physiotherapy plays a supporting role in the treatment of congenital clubfoot, and is used in children over two years of age.

• electromagnetic influence (electrical stimulation of muscles and nerves);
• magnetotherapy (exposure to the ankle joint by an electromagnetic field);
• Electrophoresis, phonophoresis (medicines - for example, lidase, hydrocortisone - are introduced into the area of ​​​​the foot and lower leg through the skin, using electromagnetic or ultrasound radiation);
• paraffin applications on the ankle joint.

It is also an auxiliary treatment method to improve nerve conduction. Drugs such as B vitamins and prozerin are used.

Surgical treatment

Treatment of acquired clubfoot

Treatment of clubfoot using the Ponseti method - video

Orthopedic shoes

Disability

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Calcaneal valgus clubfoot in newborns, Calcaneal valgus clubfoot in newborns, congenital and acquired foot deformities

Congenital and acquired foot deformities

Clubfoot

The foot is shortened and in a supinated position due to subluxation of the ankle joint.

Etiology of clubfoot

Clubfoot can be congenital (among congenital malformations it ranks second - approximately 1-2%) and acquired. More often observed in males. Unilateral and bilateral clubfoot occur with equal frequency. Congenital clubfoot is considered a sex-linked developmental anomaly.

Acquired clubfoot can be the result of paralysis and damage to the soft tissues or bones of the foot.

Clubfoot Clinic

The clinical picture has the following 4 types of deformities:

Sharply defined longitudinal arch.

The position of supination is of greatest importance; other changes can be expressed to varying degrees. The outer side of the foot is subjected to the maximum load, and in severe cases of deformity, patients stand, even leaning on the back of the foot. The foot cannot be turned inward and the toe cannot be raised. Metatarsal adduction causes patients to walk with their feet turned outward to prevent the toe from sagging. Painful calluses form at the sites of abnormal load.

In acquired clubfoot, the listed deformities rarely occur in combination.

Treatment of clubfoot

Treatment for congenital clubfoot should begin immediately after the birth of the child. It is necessary to gradually retrain the leg manually, and then apply a plaster cast. It is especially important to eliminate subluxation in the ankle joint. Redressing plaster casts are initially changed every 3 days, and then the interval increases. After sufficient correction of the shape or position of the foot, the plaster casts are removed and special night splints are used to maintain the achieved effect. Treatment of clubfoot is considered complete if pronation becomes possible and if the foot has a normal shape. If this cannot be achieved by the time the child gets to his feet on his own and tries to walk, then a variety of shoe inserts are needed. Starting from the 3-4th year of life, therapeutic exercises for the foot can be prescribed. If these measures are ineffective, surgical interventions on soft tissues are indicated before the end of growth and formation of the skeleton. In severe cases, interventions on the bones of the foot are necessary, but they should be performed only after the formation and complete development of the skeleton.

Treatment for acquired clubfoot should be carried out in accordance with its cause. If it cannot be eliminated, then operations (arthrodesis of the foot joints) or the provision of orthopedic aids (and orthopedic shoes) are indicated.

External clubfoot with flat feet

The longitudinal arch of the foot is flattened, the dorsum is in valgus, and the forefoot is in supination.

Etiology of external clubfoot with flat feet

Congenital flatfoot is a true developmental defect; It is much less common than clubfoot. Acquired flatfoot develops mainly during life when the relationship between the load and elasticity of the muscles and ligaments of the foot is disturbed. In this case, body weight, occupational stress, injuries (bone fractures), paralysis or scar deformities are of a certain importance.

Clinic for external clubfoot with flat feet

Typical symptoms include flattening of the longitudinal arch of the foot due to torsion in the area between the forefoot and dorsum of the foot, as well as external clubfoot due to valgus position of the foot. The talus defines the contours of the medial malleolus ("double malleolus").

Treatment of external clubfoot with flat feet

Treatment is always conservative at first. It should be checked whether active straightening of the longitudinal arch is possible (postural defect). In a positive case, systematic gymnastic exercises for the feet, walking barefoot on the grass, and wearing suitable and well-fitted shoes are indicated. The so-called early childhood external clubfoot is eliminated in this way. If only passive straightening of the foot is possible, then shoe inserts are additionally used. In children, detorsion inserts according to Hohmann, etc. have worked well. Special insoles are also used if the situation cannot be corrected using the means described above. In severe cases, it is necessary to wear orthopedic shoes. Therapeutic exercises and physiotherapeutic measures should always be carried out.

If you have congenital flat feet, immediately after birth you should try to correct the defects step by step using redressal plaster casts. Later, inserts and night splints are used, and gymnastic exercises are performed regularly. In the absence of noticeable improvements or complete correction of the defect, surgical interventions are indicated, first on soft tissues, and later on bones.

Transverse flatfoot

We are talking about the expansion of the metatarsus due to the divergence of the heads of the metatarsal bones.

Etiology of transverse flatfoot

Transverse flatfoot develops gradually when there is an incorrect relationship between the load from body weight and the elasticity of the muscles and ligaments that stabilize the transverse arch of the foot.

Transverse flatfoot clinic

Due to the flattening of the transverse arch of the foot, the distance between the heads of the I-V metatarsal bones increases, and the head of the first toe shifts especially strongly to the medial side. The heads of the II-IV metatarsal bones are shifted to the plantar side and are additionally subjected to loads from body weight, which leads to the formation of painful calluses. In addition, the tension of the toe flexors increases, as a result of which they take an incorrect position (hammer toes, claw toes).

Treatment of transverse flatfoot

Treatment is carried out only conservatively: foot exercises are prescribed, depending on the situation, commercially available shoe inserts (butterfly rollers) are used.

Orthopedic boots are often necessary if the toes are not positioned correctly or if, along with transverse flatfoot, there is also external clubfoot.

Heel foot

The foot forms an acute angle with the axis of the lower leg and does not bend in the plantar direction.

Etiology of the heel foot

Heel foot can be congenital, but this pathology is not a true malformation, but rather it is formed as a result of the abnormal position of the fetus in the uterus. Heel foot can also be acquired due to the development of paralysis or traumatic injuries. Clinical picture. In newborns, the foot may be sharply deviated dorsally, occupying a position at the anterior edge of the tibia. The foot cannot be moved to the plantar side even passively. With fresh paralysis, passive movements in the plantar direction are initially not limited. Gradually, however, without appropriate treatment, outgrowth of the flexors may occur due to the predominance of extensor strength, and passive correction of malalignment of the foot becomes impossible.

Heel foot treatment

In newborns (there is only an incorrect position), it consists of gradually applying re-dressing plaster casts until the normal position in the plantar flexion position is restored, which in most cases is achieved within a few weeks. Often a simple splint is sufficient to immobilize the foot in the opposite position.

In case of acquired heelfoot, surgical interventions are performed on soft tissues and bones; it is also possible to use night splints or orthopedic shoes.

Horse foot

The foot forms an obtuse angle with the axis of the lower leg and cannot move in the dorsal direction.

Etiology of equine foot

In most cases, cauda equina develops as a result of flaccid paralysis of the triceps surae muscle. In spastic paralysis, it occurs as a result of the functional predominance of the strength of the toe flexors. It may be a consequence of improper immobilization of the leg or, for example, pressure of a blanket on the toe of the foot during prolonged bed rest. In this case, the triceps surae muscle and finger flexors are stretched.

Equine Foot Clinic

The foot cannot be actively brought into a position that makes a right angle with the axis of the lower leg. Depending on the cause of this pathology, as well as on the duration of suffering, this sometimes cannot be done passively (overextension and contracture of antagonist muscles). When moving, the patient stumbles, clinging to the floor with his sagging toe.

Treatment of equine foot

For fresh paralysis, along with conventional treatment, it is necessary to use orthopedic devices that fix the position of the foot at a right angle to the axis of the leg (night splints for heel feet). If it is impossible to carry out the correction passively, you should try to gradually eliminate the pathological position of the foot using redressing plaster casts, and then use night splints. Heel traction, heel splints, orthopedic shoes or braces are used for walking. By surgically lengthening the calcaneal tendon, restoration of muscle balance can be achieved. It is also possible to perform arthrodesis of the ankle joint to give the foot the most functionally favorable position.

Hollow foot

The longitudinal arch of the foot is sharply defined, making it look shortened.

Etiology of pes cavus

A hollow foot can be congenital or acquired as a result of paralysis.

Caval foot clinic

Due to the excessive elevation of the longitudinal arch, the contours of the joint on the dorsum of the foot are determined by the first wedge-shaped bone. The result is a high rise. When wearing regular shoes, pain occurs due to compression; with more severe disorders and in combination with an expansion of the transverse arch of the foot (hollow foot with a flat transverse arch), and sometimes with a claw-shaped position of the toes, depending on the load from the body weight, significant pain can occur.

Treatment of cavus foot

Along with the mandatory implementation of therapeutic exercises during the period of accelerated growth, inserts can be used, which, just as with clubfoot, do not give the longitudinal arch any special shape, but are adjacent to the heel bone and distal metatarsus, promoting flattening of the arch due to mass pressure bodies. Adults should put insoles in their shoes or wear orthopedic shoes.

Surgical interventions are indicated only for significant deformities.

Crescent foot

A crescent foot occurs due to adduction of the metatarsals.

Etiology of sickle foot

Sickle foot is predominantly a congenital pathology and can be considered a type of clubfoot. It is possible that this deformity may develop as a result of injury.

Sickle foot clinic

The adduction of the metatarsal bones in relation to the dorsum of the foot can be expressed to varying degrees, depending on this, more or less successful passive correction is possible. Exertion causes pain.

Treatment of sickle foot

Treatment for congenital deformities should begin immediately after birth. To do this, redressing plaster bandages are applied. As a rule, by the time the child stands on his own legs and begins to walk, the defect is completely eliminated. Otherwise, night splints with foot adductor inserts are used.

Only in exceptional cases may orthopedic shoes be required later.

Plantar heel spurs

A styloid bone growth forms on the lower surface of the calcaneal tubercle.

Etiology of plantar heel spur

Heel spurs should be considered a degenerative change at tendon fiber insertions that are subject to excess tension. Overload occurs as a result of the lowering of the longitudinal arch of the foot, which causes overstrain of the plantar muscles.

Plantar heel spur clinic

In most cases, the patient has no complaints. Changes are detected accidentally during X-ray examinations. Sometimes transient local pain may occur when pressing on the heel area.

Treatment of plantar heel spurs

Along with short-term immobilization and warm compresses, short-wave irradiation is used for acute pain, as well as local injections of anti-inflammatory and sedatives. In addition, the foot should be relieved of stress with a well-fitting insert to help correct the flattened arch and reduce plantar muscle tension. In this case, it is possible to move the load onto the longitudinal arch of the foot. For severe local pain, you can use inserts or insoles that are perforated in the areas of pain points. Surgical intervention is necessary only in exceptional cases.

Clubfoot and its treatment

Clubfoot is a persistent deformity of the foot and ankle joint, congenital or acquired, in which a person cannot place the sole flat on the floor due to the fact that it is “turned” inward and bent at the sole, while the heel is raised up.

The arrangement of the bones, muscles and ligaments of the foot in this pathology is grossly disturbed, mobility in the ankle is sharply limited. All this leads to disruption of the musculoskeletal function of the lower limb and a specific gait - with support not on the entire sole, but only on its outer edge.

Most often, clubfoot is congenital, but it can also be acquired and occur in adults due to injuries and other diseases of the musculoskeletal system and nervous system.

The congenital form of the pathology is 2 times more common in boys and, as a rule, is bilateral, in contrast to acquired variants of the defect.

With clubfoot, the development of the bones of the foot, its muscles and ligaments is disrupted

Classification

There are several options for classifying this defect of the musculoskeletal system. Let's take a closer look at them.

As already mentioned, depending on the cause of the pathology, two groups of clubfoot are distinguished:

ICD-10 (International Classification of Diseases, 10th revision) classifies clubfoot as a group of congenital foot deformities (Q66):

• Q66.0 Equina varus clubfoot.
• Q66.1 Calcaneal-varus clubfoot.
• Q66.4 Calcaneal-valgus clubfoot.

When talking about clubfoot, most experts mean varus deformities (when the sole “turns” inward). This pathology accounts for up to 85% of such defects. But there are also valgus variants of clubfoot, when the foot bends outward. If the first option is diagnosed from birth, then the second becomes noticeable at the age of 1–1.5 years, when the child begins to walk.

Acquired pathology variants are included in the category of acquired valgus (M21.0) and varus (M21.1) foot deformities.

It is important to understand that clubfoot is a collective term that includes not one disorder, but a whole group of foot deformities with its pathological setting.

Equine varus congenital bilateral clubfoot in a child

Congenital calcaneal valgus clubfoot in a child

Depending on the severity of the pathology, there are:

• Mild degree - in this case, clubfoot can be corrected at home, pathological changes in the bones are minimal, and mobility in the ankle is not impaired. All symptoms can be easily eliminated with massage and exercise therapy.
• Moderate severity - it is possible to completely remove clubfoot, but this requires professional help from a pediatric orthopedist. As a rule, treatment is conservative. In this case, there is damage to the ankle joint and more pronounced deformities of the foot skeleton, underdevelopment of muscles and ligamentous elements.
• Severe - such clubfoot can only be corrected surgically. In this case, pathological changes in the foot and ankle joint are pronounced.
• Very severe degree - unfortunately, it is almost impossible to cure such a pathology even with the use of modern methods of surgical correction. The child may remain disabled for life.

Classification according to Zatsepin, who proposed dividing all types of congenital clubfoot into two groups.

Typical (or primary):

• mild varus contractures;
• ligamentous (soft tissue) forms;
• bone forms.

• neurogenic form (caused by diseases of the nervous system);
• amniotic (damage to a child’s foot due to amniotic bands during fetal development);
• against the background of defects in bone development (for example, due to underdevelopment of the tibia);
• against the background of arthrogryposis (a congenital severe disease that is accompanied by damage to almost all joints in the child’s body).

It is the Zatsepin classification that is currently used by most orthopedists in the world.

Clubfoot is one of the signs of arthrogryposis

You can also often find a variant of the Ponseti classification of congenital clubfoot:

• untreated - a congenital or acquired form of pathology in a child under 8 years of age that has not responded to any therapy;
• corrected – cured using the Ponseti method;
• recurrent – ​​despite the presence of a full range of appropriate measures, the progression of the defect continues;
• resistant - is established in the case when clubfoot is combined with other serious diseases, due to which its correction is practically impossible, for example, with arthrogryposis;
• atypical.

Causes

The congenital form of the disease is polyetiological, that is, there are many negative factors that can cause the development of this form of foot deformity in a child. They can be divided into several groups:

• Mechanical effects - incorrect position of the fetus inside the uterus, amniotic bands.
• Neuromuscular disorders are abnormal development of the muscular and ligamentous components of the foot, which leads to the development of deformities.
• Toxic factors are the effects on the child’s body during intrauterine development of various medications and other chemicals.
• Genetic - there is also a hereditary theory of clubfoot, but, unfortunately, the pathological gene has not yet been identified.

The congenital form of the pathology can be unilateral or bilateral, be an independent disease or be combined with other malformations and ailments.

The acquired form is diagnosed in adults. It can develop due to:

• pathological fusion of fractures in the foot and ankle;
• soft tissue damage due to deep burns;
• diseases of bones and joints (osteomyelitis, rickets, arthrosis, arthritis, tumor lesions);
• neurological diseases (with brain damage and the development of central types of paralysis);
• ailments that are associated with impaired bone growth;
• increased loads on the lower limbs;
• obesity;
• choosing the wrong shoes.

Shoes for a child need to be orthopedic, otherwise the risk of developing clubfoot increases.

Symptoms

Typically, clubfoot is easy to recognize upon examination. Additional diagnostic methods help determine the degree of impairment, cause and form of the disease.

Congenital variants

Varus forms are characterized by pathological positioning of the foot immediately after birth. One or both legs are in a state of plantar flexion (equinus), the foot is turned so that the sole faces backward (supination) with the anterior part adducted (adduction). These 3 symptoms (equinus, supination and adduction) are pathognomonic symptoms of congenital clubfoot.

Additional signs that will help recognize the problem:

• the heel is raised up, and the forefoot is lowered and directed downward;
• the foot is atypically small;
• Adams groove is present on the sole;
• limited mobility in the ankle;
• the axis that passes through the heel bone is shifted relative to the axis of the lower leg (normally they coincide).

Adams' groove on the sole of a child with congenital clubfoot

Purchased options

This type of pathology usually develops in children aged 3 years and older, adolescents and adults for the reasons described above. In this case, the following symptoms gradually develop:

• change in habitual gait (“bear gait” - when walking, the patient seems to “rake” with one or two legs);
• bringing the knee joints closer together and the development of an X-shaped deformity of the lower extremities;
• decreased mobility in the ankle;
• acquisition of a valgus position by the first toe.

Acquired valgus clubfoot in an adult

It should also be noted that acquired forms of deformity are most often of a valgus nature, that is, with the deviation of the foot to the outside.

Diagnostics

The congenital variant of the disease can be diagnosed even during the intrauterine development of the child using ultrasound. The defect becomes noticeable already at 19 weeks of pregnancy. If clubfoot was not recognized before the baby was born, it is easy to do when examining the newborn immediately after birth.

The acquired form can be suspected based on the signs described above and upon examination by an orthopedic doctor.

X-rays, CT, MRI, and ultrasound will help confirm the diagnosis.

It is important to note that x-rays are not always informative, especially for young patients. In children, the bones of the foot are not yet fully formed; part of them is formed by cartilage tissue, which is not visible on x-rays.

Possible complications

If the problem is not recognized and treated early, the deformity may progress and complications may develop over time. It is generally accepted that the pathology must be eliminated before the child begins to walk a year, since the deformity will progress under the influence of the load during steps.

• scoliosis and other spinal deformities due to pathological placement of the feet;
• atrophy of muscles and ligaments of the lower limb;
• gait disturbance, inability to move independently;
• delay in the physical development of the baby;
• dislocations and subluxations of the feet, knee and hip joints;
• pathology of the knee and hip joints;
• persistent pain syndrome.

In some cases, congenital clubfoot cannot be treated and can cause permanent disability in the child.

How to get rid of clubfoot

Clubfoot can be cured. For this, various conservative and surgical techniques are used. This problem is dealt with by an orthopedic surgeon. The earlier the problem is recognized and therapy is started, the better the prognosis.

Treatment of clubfoot using the Ponseti method (plastering)

This method of conservative treatment of clubfoot was developed by Ignazio Ponseti in the USA back in the 50s of the twentieth century. The specialist was against surgical correction of the defect, since he believed that such an intervention leads to gross secondary disorders, which often prevents the restoration of normal function of the child’s foot and ankle.

The Ponseti method is an effective conservative treatment method for clubfoot, characterized by high results.

After a detailed analysis of the physiology and biomechanics of the foot, the doctor proposed a new casting technique, which can be started at any age, but preferably from two weeks.

Usually after 5-6 plasterings it is possible to completely correct the deformity. As a rule, the entire course of treatment takes 4-8 weeks.

After the casting is completed, the child must wear a special orthopedic brace (braces). The main task of the brace is to stretch the muscles, which will help prevent relapses. It is very important to adhere to the prescribed regimen of wearing the orthopedic brace. According to statistics, only 6% of children whose parents adhere to the use of braces experience a recurrence of clubfoot.

Braces for fixing feet with congenital clubfoot

Other methods of conservative treatment

Soft dressings

This method is close to the previous one, but fixation is carried out with bandages. The method can be used for mild deformities in combination with a set of therapeutic exercises and massage.

Elastic orthopedic structures

Such splints and splints are made from special metal alloys. Although they are soft, they securely fix the feet in the correct position.

Orthoses

The technique consists of fixing the feet and ankles in the desired position using special orthopedic orthoses. This group of therapeutic effects includes orthopedic shoes, insoles, rigid splints, and elastic orthoses.

Massage

This is an indispensable component of conservative treatment. Only a specialist should perform massage of the feet and legs. As a rule, 4 to 10 courses of special manual intervention are required.

Therapeutic foot massage for a child should only be performed by a specialist

Physiotherapy

Exercise therapy also plays an important role in the correction and prevention of relapses of clubfoot. You need to work with your child every day. The exercises must first be learned together with a doctor, and then you can perform them yourself at home.

Physiotherapeutic procedures

Physiotherapy is an auxiliary method of therapy and can be used in children over 2 years of age. Most often, magnetic therapy, electrophoresis, phonophoresis, and warm paraffin applications are prescribed.

Medicines

They play a minor role in treatment. Vitamins can be used, especially group B. Also, depending on the cause of clubfoot, the doctor may prescribe one or another course of medication.

Surgical correction

Surgery is used only in cases where clubfoot was diagnosed late and conservative therapy did not produce a positive result. Surgical correction is also prescribed in difficult cases, when the defects are very severe and cannot be eliminated using conventional methods.

Clubfoot is a serious defect of the musculoskeletal system, especially its congenital forms. But in the case when the problem was noticed on time and the correct treatment was prescribed, clubfoot is quickly and easily eliminated, and the child will begin to walk correctly and without any difficulties.

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Congenital clubfoot– a developmental defect of the foot, characterized by its adduction, supination and plantar flexion.

Clinical picture of clubfoot. Plantar flexion of the foot at the ankle joint (equinus), inward rotation of the plantar surface with lowering of the outer edge (supination of the foot), adduction of the foot in the forefoot with an increase in its arch (adduction) are detected. The foot deformity is combined with inward rotation of the lower leg at the level of the lower third and limited mobility in the ankle joint. When a child begins to walk, in the presence of clubfoot, roughening of the skin of the outer edge of the foot is observed, atrophy of the lower leg muscles, especially the gastrocnemius, and recurvation of the knee joints develops, as well as a peculiar gait in which one foot is carried over the other.

Treatment of congenital clubfoot should begin in newborns after the umbilical wound has healed. The essence of non-operative treatment consists of repressive gymnastics that corrects the deformity of the foot (3-5 minutes with breaks for massaging the muscles of the foot and lower leg 3-4 times a day), and holding the foot in the corrected position with a soft bandage (according to Fink-Ettingen).

Each time the achieved position of the foot must be fixed using the Fink-Ettingen bandage method with a flannel bandage 5–6 cm wide, 2 m long, with the knee joint bent at an angle of 90°. They start bandaging from the foot. The frequency of repetitions of manipulations followed by bandaging depends on the severity of the deformity (possibly up to 10 times a day).

After achieving hypercorrection of the foot, and in the case of a soft tissue form, its possible correction by the age of 2–3 months, to prevent relapses until walking is allowed, polyethylene splints are applied to hold the foot and lower leg in the hypercorrection position.

For moderate and severe types of clubfoot, from 3 weeks of age the child is treated with staged plaster casts.

In severe forms of congenital clubfoot, from the age of 3 years, surgical intervention on the tendon-ligamentous apparatus according to T.S. Zatsepin is indicated using a distraction-compression device to move the foot to a position of hypercorrection, reduce the talus into the ankle joint and decompress the talus.

In 1951, V. Sturm proposed ligamentocapsulotomy - a surgical intervention on the bursal-ligamentous and tendon apparatus of the foot with mandatory dissection of the capsule of the tarsometatarsal joints and the ligament between the navicular and first sphenoid bones. These operations are recommended for children under 10 years of age.

In severe cases of clubfoot with pronounced adduction and supination of the foot, in advanced cases, surgery is performed on the bones of the foot at the age of 12 years and older. This is a wedge-shaped resection of the bones of the foot with the base along the outer edge in the area of ​​the calcaneocuboid joint and the apex in the area of ​​the talonavicular joint. Sometimes a crescent-shaped resection of the foot bones is performed according to M.I. Kuslik and fixation with a distraction device. This surgery removes a crescent-shaped bone fragment from the midfoot.

Flat valgus foot. If the patient is not treated regularly, flat feet may progress and planovalgus deformity of the foot will occur. In this case, the longitudinal arch is sharply flattened to the third degree, pain appears when walking quite quickly and is noted in the area of ​​the inner ankle, when the deltoid ligament is sharply stretched. The talus tilts and descends with the head and neck downwards. The plantar nerve passes under the head of the talus, a continuation of the posterior tibial nerve. Trauma to it leads to neuropathy of the plantar and posterior tibial nerves. This causes a reflex spasm of the muscles of the lower leg and foot. The outwardly deviated calcaneus puts pressure on the lower pole of the lateral malleolus, also causing pain. The calcaneus is placed in a sharply valgus position. When the arch is flattened, the forefoot is retracted outward.

Non-operative treatment of planovalgus foot deformity using insoles and arch supports and orthopedic shoes with an external rigid shank is not always effective. The patient is indicated for surgical intervention to correct foot deformity. The treatment method according to F.R. Bogdanov consists of economical resection of the calcaneocuboid and talonavicular joints for their arthrodesis in the corrected position of the longitudinal and transverse arches of the foot with simultaneous lengthening of the peroneus brevis tendon, transplantation of the peroneus longus tendon to the inner surface of the foot under the heel - navicular ligament, as well as lengthening the calcaneal tendon with the elimination of pronation of the heel and abduction of the forefoot.

The treatment method according to M.I. Kuslik consists of a crescent transverse resection of the foot with lengthening of the calcaneal tendon and transplantation of the peroneus longus tendon to the inner edge of the foot. After the operation, the patient must wear orthopedic shoes.