Today, flat valgus deformity of the foot is one of the most common problems in traumatology and orthopedics.This pathology occurs in both children and adults.However, it tends to progress over time and lead to changes in other joints as well as the spine.This significantly reduces the quality of life and can even cause the development of arthrosis of the ankle, knee, hip joints, as well as diseases and curvature of the spine.Therefore, it is important not only to promptly diagnose the flat valgus deformity of the foot, but also to start treatment immediately.This will stop the development of pathology.But in the final stages of development, the situation can be corrected only by surgery.
What is flat valgus deformity of the foot?
Flat-valgus deformity of the foot is a change in the structure of the foot, in which a decrease in the size of its longitudinal arch is observed against the background of impaired function of the tendon of the posterior tibial muscle.As a result, the axis of the foot is distorted.This is accompanied by a lowering of its middle part and an outward rotation of the heel, with its inner part abutting the bearing surface.In other words, the foot curls inward, flattens, and in severe cases, an X-shaped curvature of the legs is observed.This is shown by the presence of a fairly large distance between the heels when standing in a standing position with the ankles touching.
According to various authors, a similar problem occurs in 15-58% of people.
The flat-valgus deformity of the foot is fraught not only with the appearance of a pronounced cosmetic defect, but also with the development of a number of complications.These are:
- Bursitis is an inflammation of the synovial bursae of the joints of the foot.This is accompanied by reddening of the skin in the projection of the affected joint, swelling, pain, which tends to intensify with mechanical action.
- Arthrosis - degenerative-dystrophic changes in cartilage tissue, accompanied by its thinning and the appearance of gradually increasing pain.Subsequently, the formation of osteophytes on the articular surfaces of the bones until their fusion with each other and immobilization of the joint is observed.In flat-valgus deformity of the foot, arthrosis can affect not only the joints of the foot, but also the ankle, knee and hip joints.
- A heel spur is the result of excessive stretching of the plantar fascia and the formation of a bulge on the side of the heel bone, resulting in sharp pain in the heel area when walking.This is often accompanied by inflammation of the Achilles tendon.
- Osteochondrosis is degenerative-dystrophic changes in the intervertebral discs, which leads to a decrease in their height and creates conditions for the formation of protrusions and intervertebral hernias.
- Distortion of the spine - can manifest as a deepening of the physiological curves (kyphosis, lordosis) or the development of scoliotic deformity.
Reasons
The central link in the development of the disease is the rotation (rotation) of the talus in the horizontal and sagittal planes.This leads to changes in the support points of the foot and flattening of its arches.There are many factors that can contribute to this, but they are extremely rarely seen in isolation.Most often, the causes of flat-valgus deformity of the foot lie in the combined action of a number of causes.Therefore, the disease can be caused by:
- congenital connective tissue disorders;
- progression of flat feet of any kind;
- injuries to the lower limbs, especially to the bones and ligaments of the legs;
- osteoporosis iea disease accompanied by a decrease in the content of calcium in the bones, which leads to increased fragility;
- hormonal imbalance caused by endocrine diseases, in particular diabetes mellitus, hypothyroidism, as well as physiological changes during pregnancy and menopause;
- the presence of excess weight and especially obesity, which is due to increased load on the foot and overstretching of muscles and ligaments;
- neurological diseases, including poliomyelitis, cerebral palsy;
- rickets;
- excessive stress on the legs due to the need to stand, walk or engage in heavy physical labor for a long time;
- wearing the wrong shoes, i.e.excessively narrow and / or high heels, which leads to a disturbed distribution of the load on the foot;
- foot abnormalities.
In the presence of congenital anomalies of development, as well as hereditary hyperelasticity of the foot, flat valgus feet can attract attention almost immediately after the birth of the child.But more often the pathology is diagnosed when the baby begins to walk.Often, in such situations, disorders quickly worsen as a result of improper choice of shoes, insufficient physical activity or, conversely, excessive and inappropriate physical activity.
In most cases, flat-valgus deformity of the foot develops in childhood.If during this period the violation is not noticed and corrected, the disease remains with the person and tends to progress in the future when favorable conditions are created.In adults, flat-valgus deformity of the foot is most often worsened during pregnancy or due to weight gain, which is usually associated with a sedentary lifestyle.
Symptoms of flat-valgus deformity of the foot
Flat-valgus deformity of the foot is characterized by a gradual increase in the intensity of symptoms.Therefore, if initially the pathology manifests itself only as a mild discomfort, then in the later stages its manifestations can become an obstacle to leading an active lifestyle or even significantly complicate movement.The disease is characterized by:
- pain in the foot, especially in the back, worse after prolonged standing, walking or physical work;
- ankle swelling;
- increased fatigue when walking;
- thickening, formation of calluses, calluses and soreness of the skin in the area of the heads of the small metatarsal bones, aggravated by wearing high-heeled shoes and prolonged physical activity;
- X-shaped curvature of the legs, which over time leads to pain in the knees;
- displacement of the first toe, which gradually leads to changes in the other toes (hallux valgus);
- gait disturbances.
Sometimes patients have an extra sesamoid bone in the area of the scaphoid bone.
Flat-valgus deformity of the foot increases the likelihood of an ingrown toenail.And its deviation to the side with a strong curvature provokes a change in the shape of the remaining fingers.As a result, they distort, take on the shape of nails, and the joints thicken.This is called a hammer toe deformity.
At the same time, in the area of the metatarsophalangeal joint, there is also growth of the joint with the formation of a callus on its lateral surface, popularly called a lump or bone.This makes choosing shoes difficult and makes wearing the ones you already have uncomfortable.
Degrees of deformation
During flat-valgus deformity of the foot, 4 stages are distinguished, each of which is accompanied by a certain set of symptoms.These are:
- Stage 1 – there are still no bony deformities of the foot, but sometimes there is pain in the area of the posterior tibial tendon, especially after prolonged standing or walking.This can be complicated by tenosynovitis, i.e.inflammation of the posterior tibial tendon.And the angle of the heel relative to the axis of the tibia is no more than 10-15°.
- 2nd stage – there is a slight deformity of the foot with dislocation of the heel at 15-20°.At the same time, in a state of rest, that is, when a person is lying down, the legs take on a normal shape.Since there is still no firmly fixed deformity, therapeutic massage is a very effective method of treatment at this stage.But this does not eliminate the need for other means of conservative therapy.
- Stage 3 - the foot deformity is now fixed.In this case, the joints of the rear part of the foot are no longer susceptible to passive movements.The angle of the heel relative to the axis of the tibia is 20-30°.
- Stage 4 – the foot is severely deformed, completely flat, the axis of the ankle joint changes.When taking an X-ray and evaluating the images, a lateral tilt of the talus is seen.This is a direct sign of damage to the deltoid ligament.The deviation of the heel from the axis of the tibia is 30 ° or more.
There are also degrees of flat feet.For their diagnosis, the angle of the longitudinal arch and the intermetatarsal angle are measured with radiographic images, as well as the height of the arch in millimeters.
The pathology tends to progress, especially quickly under the influence of factors that negatively affect the condition of the feet (obesity, frequent lifting and carrying of heavy objects, prolonged standing, unsuitable shoes, etc.).
Diagnosis
If signs of flat valgus deformity of the foot appear, it is important to consult an orthopedist as soon as possible.And although the disease can be diagnosed based on the results of the examination, the doctor always pays close attention to the history of the disease and the life of the patient.The data obtained during the examination provide the doctor with important information, thanks to which it will be possible not only to determine the causes of the deformity, but also to draw up an optimal treatment plan.
Particular attention is paid to the symptoms of the disease, the conditions of their occurrence and the characteristics of the progression.The orthopedist must clarify the nature of the pain, its localization and duration, the presence of neurological disorders, the presence of restrictions on physical activity, etc.
After that, an orthopedic examination is necessary.In this procedure, the doctor evaluates the mobility of the tarsal joints by having the patient rise on toes, perform passive movements, and conduct other tests.The orthopedist also assesses the condition:
- vessels of the lower extremities;
- the skin of the legs and feet, its temperature, the nature of the hair distribution;
- tenderness of legs and feet;
- muscle tone of the lower limbs.
All this helps to determine the possible causes and consequences of the development of flat-valgus deformity of the foot.This allows you to choose the most effective treatment tactics that will be aimed at eliminating all existing disorders.
Also, when diagnosing a flat-valgus deformity of the foot, instrumental and laboratory research methods are necessarily prescribed to accurately determine the degree of changes in the foot and to clarify the nature of the necessary therapeutic measures.this:
- x-ray of the legs in 3 projections;
- plantography;
- podometry;
- UAC and OAM;
- Ultrasound of the joints.
In difficult diagnostic cases, CT or MRI may be prescribed.These are modern methods for examining bones and soft tissues respectively, giving the most accurate and detailed data on their condition.
Conservative treatment of flat valgus deformity of the foot
Almost always, the treatment of flat valgus deformity of the foot begins with the appointment of conservative, i.e.non-surgical therapy.Only at 3-4 stages of the disease, patients can be immediately recommended for surgical intervention.
So conservative treatment of flat valgus foot is always complicated.It consists of:
- use of individual orthopedic insoles;
- wearing comfortable or orthopedic shoes;
- drug treatment;
- exercise therapy;
- therapeutic massage;
- kinesio taping;
- physiotherapy.
In addition, patients will be advised to take measures to lose weight if signs of obesity are present and to avoid wearing tight shoes or high heels.From the moment the flat-valgus deformity of the foot is diagnosed, you should choose and wear only comfortable shoes with a fairly wide nose and a comfortable wide heel up to 3 cm high.They should be made of natural materials and not press the leg.
Shoes with completely flat soles such as ballet flats, Crocs or Uggs are also contraindicated.
All these methods are aimed at eliminating symptoms, improving the quality of life of patients and stopping the progression of the deformity.But it is possible to completely cure the flat-valgus foot with their help only if the disease is diagnosed at stage 1 in children.
If there is a hallux valgus deformity of one toe, special orthoses may be prescribed to move it into the correct position.
All patients should understand that the course of flat valgus deformity of the foot is negatively affected by:
- smoking;
- the presence of chronic diseases that reduce immunity;
- violation of the doctor's recommendations regarding the physical regime, the choice of shoes, etc.;
- hypothermia and overheating;
- the presence of other orthopedic disorders that negatively affect the biomechanics of the legs;
- osteoporosis;
- infectious diseases.
Therefore, patients should avoid exposure to these factors in order to increase the effectiveness of the therapy.In addition, if 3 months after the start of conservative treatment and the implementation of the entire set of measures prescribed by the doctor, patients continue to have pain and there is no positive dynamics, this may be a reason to consider the issue of surgery.
Custom-made orthopedic insoles and shoes
When diagnosing a flat-valgus deformity of the foot of any degree, patients are required to wear individually made orthopedic insoles.They should be put in ordinary shoes instead of those that came with them, and in the later stages of the development of the pathology - in special orthopedic ones.
Due to the fact that they are made in accordance with the structural features of the patient's left and right leg separately, they allow to give them the most anatomically correct position.This is the key to restoring normal biomechanics of movements, eliminating fatigue, swelling and pain in the legs.In addition, they restore the normal axis of the joints, which can significantly reduce the risk of complications.
Conventional mass-produced orthopedic insoles are not used for flat valgus deformities of the foot.
In this way, individual orthopedic insoles help to properly distribute the load on the foot.This leads to the training of over-relaxed muscles and the relaxation of over-strained ones, i.e.directly affects the root cause of the development of flat feet.
In the first days, you should walk with orthopedic insoles for 2-3 hours.This is due to the fact that initially they will cause discomfort, as the leg must be readjusted to the correct position.Gradually, the duration of wearing insoles increases, reaching the maximum possible.In most cases, patients get used to them and can wear them all day without problems after 2 weeks.
If the insoles become deformed or worn, they must be replaced with new ones.To do this, you will again need to contact an orthopedist who will take individual measurements and send them to production with his comments.
Drug therapy
Drug therapy in the absence of complications of flat valgus deformity of the foot is symptomatic.In other words, it is aimed at reducing the intensity of pain.For this purpose, patients are advised to occasionally use NSAIDs in the form of products for internal use or ointments, gels and creams.They will help you quickly relieve pain and improve your well-being.
Drug therapy is also prescribed if unwanted consequences of a flat-valgus foot occur.It may consist of the following:
- corticosteroids - used to relieve severe inflammation, characteristic of bursitis, etc.;
- means that improve blood circulation - are prescribed for stagnant processes in the legs and the appearance of signs of varicose veins;
- chondroprotectors - prescribed for degenerative-dystrophic changes in the joints, etc.
Exercise therapy
Physical therapy is an integral part of the treatment of flat valgus deformity of the foot.It is aimed at strengthening the posterior and anterior tibial muscles, the peroneal muscle group and the gastrocnemius muscle.
For each patient, the set of necessary exercises is selected individually, taking into account the degree of pathological changes, age and other factors.As a rule, the following exercises are prescribed:
- rolling any cylindrical or round object on the floor, such as a rolling pin or ball;
- walking on the toes and then on the outsides of the feet;
- climbing an inclined board;
- working on an exercise bike or bicycle barefoot;
- grasping and lifting small objects from the floor with toes;
- grasping and folding a newspaper or cloth like an accordion with the toes;
- making sliding movements with the foot of one leg on the shin of the other;
- sitting in "Turkish" pose and getting up from it.
Swimming has a very good effect on the condition of the legs.Therefore, if the patient has the opportunity, it is recommended to visit the pool at least 2-3 times a week.
But exercise therapy should be done systematically.Therefore, classes should be held daily in a comfortable, unhurried environment.It will not hurt to take off your shoes and roll a ball with your foot at any convenient moment, for example, when you are working on the computer.This will help relieve stress on your feet and improve your well-being.
Physiotherapy
In order to increase the effectiveness of conservative treatment of flat valgus foot, courses of physiotherapy procedures are prescribed.They are indicated for leg deformities of the 2nd degree or higher and help not only to reduce the severity of the disease, but also to achieve a therapeutic effect.
In the case of flat-valgus deformity of the foot, procedures that have an anti-inflammatory, analgesic and anti-edematous effect are indicated.But they can be started only in the absence of an acute inflammatory process.As a rule, they are prescribed:
- electrophoresis;
- magnetic therapy;
- diadynamic therapy;
- UVT;
- electrical stimulation of the lower leg and foot muscles;
- ozokerite and paraffin applications;
- mud treatment.
Kinesio taping
Kinesio taping is a new method of treating orthopedic diseases and the consequences of injuries in medicine, which involves sticking special elastic bands on the skin.They help to unload the necessary muscles and support others, as well as properly distribute the load on the support points of the foot.But for taping to work, the doctor placing the tapes must have a good understanding of technique and anatomy.
The strips are made of hypoallergenic materials and are placed for an average of 5 days.You can wear any shoes with them, play sports, take a shower, etc.They do not interfere in any way and are practically not felt on the body.At the same time, the material of the strips breathes, which eliminates the risk of developing skin diseases.
Therapeutic massage
The massage for flat-valgus deformity of the foot is aimed at normalizing the muscle tone of the lower limbs, developing the joints and improving trophics by activating blood circulation.Thus, during a therapeutic massage, the doctor will pay attention not only to the feet and plantar muscles, but also to the muscles of the lower leg and thigh.
As a rule, it is recommended to undergo a course of therapeutic massage 4 times a year, consisting of 15-20 sessions.Thanks to them, there is a noticeable improvement in the condition of patients, elimination of the most alarming symptoms of flat valgus deformity of the foot, or at least a reduction in their intensity.
An additional bonus will be the purchase of a special massage mat.Today there are many models, among which you can choose the one suitable for both adults and children.These carpets are distinguished by the presence of different shaped protrusions.That's why walking barefoot on them helps to train the muscles of the foot and activate blood circulation.This has a positive effect on the condition of the feet and increases the effectiveness of conservative treatment of flat valgus deformity.
Thus, flat valgus deformity of the foot is a common orthopedic disease.This can significantly reduce a person's quality of life and lead to the development of severe complications.Therefore, it is important to diagnose the deviation from the norm as early as possible and to undergo comprehensive treatment.But if the flat-valgus foot is diagnosed in adulthood, conservative therapy will only help to prevent the progression of the deformity.But in the initial forms of the disease, this is quite enough to restore the normal quality of life and maintain the ability to lead an active lifestyle.In other cases, as well as when conservative treatment is ineffective, the correct anatomy of the foot can be restored surgically.