Nowadays, the planavalgus foot deformity 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 cause changes in other joints, as well as the spine.This significantly reduces the quality of life and can even lead to the development of osteoarthritis of the ankle, knee and hip joints, as well as diseases and curvatures of the spine.Therefore, it is important to not only quickly diagnose flatfoot deformity but also begin treatment immediately.This will stop the progression of the pathology.But in the final stages of development, the situation can only be corrected through surgery.
What is planavalgus foot deformity?
Plano-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 occurs against the background of impaired function of the tendon of the tibialis posterior muscle.As a result, the axis of the foot is distorted.This is accompanied by a descent of its midsection and a turn of the heel outward with its inner part glued to the support surface.In other words, the foot rolls inward, flattens, and in severe cases, an X-shaped curvature of the legs is observed. This can be seen by the presence of a fairly large distance between the heels when standing with the ankles touching.
According to various authors, a similar problem occurs in 15 to 58% of people.
Flatfoot-valgus deformity entails not only the appearance of a pronounced cosmetic defect, but also the development of a number of complications.These are:
- Bursitis is an inflammation of the synovial bursae in the joints of the foot.This is accompanied by redness of the skin in the projection of the affected joint, swelling, pain, which tends to intensify with mechanical action.
- Osteoarthritis - degenerative-dystrophic changes in cartilage tissue, accompanied by its thinning and the appearance of gradually increasing pain.Subsequently, the formation of osteophytes is observed on the articular surfaces of the bones until they fuse together and immobilize the joint.With flatfoot-valgus deformity, osteoarthritis can affect not only the joints of the foot, but also those of the ankle, knee, and hip.
- A heel spur results from excessive stretching of the plantar fascia and the formation of a bulge on the side of the heel bone, causing sharp pain in the heel area when walking.This is usually accompanied by inflammation of the Achilles tendon.
- Osteochondrosis is degenerative-dystrophic changes in the intervertebral discs, which lead to a decrease in their height and create preconditions for the formation of intervertebral bulges and hernias.
- Curvature of the spine: it can manifest itself as a deepening of physiological curves (kyphosis, lordosis) or the development of a scoliotic deformity.
Reasons
The central link in the development of the disease is the rotation (rotation) of the talus in the horizontal and sagittal plane.This causes changes in the foot's support points and flattening of its arches.There are many factors that can contribute to this, but they are rarely observed in isolation.Most often, the causes of flatfoot-valgus deformity lie in the combined action of several reasons.Therefore, the disease can result from:
- congenital connective tissue disorders;
- progression of flat feet of any type;
- injuries to the lower extremities, especially bones and ligaments of the feet;
- osteoporosis, that is, a disease accompanied by a decrease in the calcium content in the bones, which leads to increased fragility;
- hormonal imbalances 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, caused by increased load on the foot and excessive stretching of muscles and ligaments;
- neurological disorders, including polio, cerebral palsy;
- rickets;
- excessive stress on the feet due to the need to stand, walk or do heavy physical work for a long time;
- wearing incorrectly selected shoes, that is, excessively narrow and/or high heels, which causes poor distribution of the load on the foot;
- foot anomalies.
In the presence of congenital developmental anomalies, as well as hereditarily caused 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 choosing the wrong footwear, insufficient physical activity or, conversely, excessive and inappropriate physical activity.
In most cases, flatfoot-valgus deformity develops in childhood.If during this period the disorder was not detected and corrected, the disease remains in the person and in the future tends to progress when favorable conditions are created.In adults, flatfoot-valgus deformity often worsens during pregnancy or due to weight gain, which is often associated with a sedentary lifestyle.
Symptoms of flatfoot-valgus deformity
Flatfoot-valgus deformity is characterized by a gradual increase in the intensity of symptoms.Therefore, if initially the pathology manifests itself only as a minor discomfort, in the later stages its manifestations can become an obstacle to leading an active lifestyle or even significantly complicate simple movement.The disease is characterized by:
- pain in the foot, especially in the back, that worsens after standing, walking, or doing physical work for a long time;
- swelling of the ankles;
- increased fatigue when walking;
- compaction, formation of corns, calluses and pain of the skin in the area of the heads of the small metatarsal bones, aggravated by the use of shoes with heels and prolonged physical activity;
- X-shaped curvature of the legs, which over time causes 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 accessory sesamoid bone in the area of the scaphoid bone.
The flatfoot-valgus deformity increases the likelihood of an ingrown toenail.And its deviation to the side with a strong curvature causes a change in the shape of the remaining fingers.As a result, they curve, take the shape of claws, and the joints thicken.This is called hammertoe deformity.
At the same time, in the area of the metatarsophalangeal joint, growth of the joint is also observed with the formation of a callus on its lateral surface, popularly called a bump or bone.This creates difficulties when choosing shoes and makes it uncomfortable to wear the ones you already have.
Degrees of deformation
During plano-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 no bone deformities in the foot yet, but pain in the posterior tibial tendon area sometimes appears, especially after standing or walking for a long time.This can be complicated by tenosynovitis, that is, inflammation of the posterior tibial tendon.And the angle of the heel with respect to the axis of the shin does not exceed 10-15°.
- Stage 2: There is a slight deformity of the foot with the heel bone dislocated between 15 and 20°.At the same time, in a state of rest, that is, when a person is lying down, the feet acquire a normal shape.Since there is no rigidly fixed deformation yet, therapeutic massage is a very effective treatment method at this stage.But this does not eliminate the need to use other means of conservative therapy.
- Stage 3: The foot deformity has now resolved.In this case, the rearfoot joints are no longer susceptible to passive movements.The angle of the heel with respect to the axis of the shin is 20 to 30°.
- Stage 4: The foot is severely deformed, completely flat, the axis of the ankle joint changes.When performing an x-ray and evaluating the images, a lateral inclination of the talus is seen.This is a direct sign of deltoid ligament insufficiency.The deviation of the heel from the axis of the shin is 30° or more.
There are also degrees of flat feet.To diagnose them, the angle of the longitudinal arch and the intermetatarsal angle, as well as the height of the arch in millimeters, are measured using radiographic images.
Pathology tends to progress, especially quickly under the influence of factors that negatively affect the condition of the foot (obesity, frequent lifting and carrying heavy objects, prolonged standing, inappropriate footwear, etc.).
Diagnosis
If signs of planavalgus foot deformity occur, 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 patient's life.The data obtained during the examination provide the doctor with important information, thanks to which it will not only be possible to determine the causes of the deformity, but also to draw up an optimal treatment plan.
Much attention is paid to the symptoms of the disease, the conditions of its onset and the characteristics of 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 this, an orthopedic examination is required.In this procedure, the doctor evaluates the mobility of the tarsal joints by asking the patient to stand on tiptoe, performing passive movements, and performing other tests.The orthopedist also evaluates the condition:
- vessels of the lower extremities;
- the skin of the feet and legs, its temperature, the nature of the hair distribution;
- sensitivity of both feet and legs;
- Muscle tone of the lower extremities.
All this helps to determine the possible causes and consequences of the development of flatfoot-valgus deformity.This allows you to select the most effective treatment tactics, which will be aimed at eliminating all existing disorders.
In addition, when diagnosing flatfoot-valgus deformity, instrumental and laboratory research methods are necessarily prescribed to accurately determine the extent of changes in the foot and clarify the nature of the required therapeutic measures.This:
- x-ray of feet in 3 projections;
- plantography;
- pedometry;
- UAC and OAM;
- Joint ultrasound.
In cases of difficult diagnosis, computed tomography or magnetic resonance imaging may be prescribed.These are modern methods for studying bones and soft tissues, respectively, providing the most accurate and detailed data on their condition.
Conservative treatment of planavalgus foot deformity.
Almost always, the treatment of planavalgus foot deformity begins with the appointment of conservative, that is, non-surgical, therapy.Only at stages 3-4 of the disease can patients be immediately recommended for surgical intervention.
Therefore, conservative treatment of flatfoot-valgus is always complex.It consists of:
- use of individual orthopedic insoles;
- wear comfortable or orthopedic shoes;
- pharmacological treatment;
- exercise therapy;
- therapeutic massage;
- kinesio tape;
- physiotherapy.
Additionally, patients will be advised to take steps to lose weight if they have signs of obesity and to avoid wearing tight shoes or high heels.From the moment the flatfoot-valgus deformity is diagnosed, it is advisable to choose and wear only comfortable shoes with a fairly wide toe and a wide, comfortable heel up to 3 cm high.They should be made of natural materials and not squeeze the foot.
Shoes with completely flat soles such as ballet flats, Crocs or Uggs are also contraindicated.
All of these methods aim to eliminate symptoms, improve patients' quality of life, and stop the progression of the deformity.But completely curing flatfoot valgus with its help is possible only if the disorder is diagnosed at stage 1 in children.
If there is a hallux valgus deformity in a toe, special orthotics may be prescribed to move it to the correct position.
All patients should understand that the course of the planavalgus foot deformity is negatively affected by:
- smoke;
- the presence of chronic diseases that reduce immunity;
- violation of the doctor's recommendations regarding physical regimen, choice of footwear, etc.;
- hypothermia and overheating;
- the presence of other orthopedic disorders that negatively affect the biomechanics of the feet;
- osteoporosis;
- infectious diseases.
Therefore, patients should avoid exposure to these factors to increase the effectiveness of the treatment.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 feel pain and there is no positive dynamic, this may be a reason to consider the issue of surgery.
Custom orthopedic shoes and insoles.
When diagnosing a flatfoot-valgus deformity of any degree, patients should wear individually made orthotic insoles.They should be put in regular shoes instead of those that come with them, and at later stages of the development of pathology - in special orthopedic shoes.
Because they are manufactured according to the structural characteristics of the patient's left and right foot separately, they allow them to be given the most anatomically correct position.This is the key to restoring normal biomechanics of movements, eliminating fatigue, swelling and pain in the legs.Additionally, they restore the normal axis of the joints, which can significantly reduce the risk of complications.
Conventional mass-produced orthotic insoles are not used for flatfoot-valgus deformities.
Thus, individual orthopedic insoles help to correctly distribute the load on the foot.This leads to training of muscles that are too relaxed and a relaxation of overloaded ones, that is, it directly affects the fundamental cause of the development of flat feet.
In the first days it is necessary to walk with orthopedic insoles for 2-3 hours.This is because they will initially cause discomfort as the leg needs to be readjusted to the correct position.Little by little, the time of use of the insoles is increased, until reaching the maximum possible.In most cases, patients get used to it 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 need to contact an orthopedist again, who will take individual measurements and send them to production with your comments.
Drug therapy
Drug therapy in the absence of complications of planavalgus foot deformity is symptomatic.In other words, its goal is to reduce the intensity of pain.To this end, patients are recommended 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 undesirable consequences of flat valgus feet occur.It may consist of the following:
- corticosteroids – used to relieve severe inflammation, characteristic of bursitis, etc.;
- means that improve blood circulation: prescribed for congestive processes in the foot and the appearance of signs of varicose veins;
- chondroprotectors - prescribed when degenerative-dystrophic changes occur in the joints, etc.
exercise therapy
Physical therapy is an integral component of the treatment of planavalgus foot deformity.Its goal is to strengthen the posterior and anterior tibial muscles, the peroneal muscle group and the gastrocnemius.
For each patient, the necessary set of 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 roller or ball;
- walking on the toes and then on the outside of the feet;
- climb a leaning board;
- work barefoot on a stationary bike or bicycle;
- grasping and lifting small objects off the floor with toes;
- grasping and folding a newspaper or towel like an accordion with your toes;
- perform sliding movements with the foot of one leg on the shin of the other;
- sit in the "Turkish" position and rise from it.
Swimming has a very good effect on the condition of the feet.Therefore, if the patient has the opportunity, it is recommended that he visit the pool at least 2-3 times a week.
But exercise therapy must be done systematically.Therefore, classes should be held daily in a comfortable and unhurried environment.It wouldn't hurt to take off your shoes and roll a ball with your foot at any convenient time, for example, while working at the computer.This will help relieve stress on your feet and improve your well-being.
Physiotherapy
To increase the effectiveness of conservative treatment of valgus flatfoot, courses of physiotherapeutic procedures are prescribed.They are indicated for foot deformities of grade 2 or higher and help not only reduce the severity of the disease, but also produce a therapeutic effect.
In case of plano-valgus deformity of the foot, procedures that have anti-inflammatory, analgesic and anti-edematous effects are indicated.But it is possible to start them 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 muscles of the leg and foot;
- ozokerite and paraffin applications;
- mud therapy.
kinesio tape
Kinesiotaping is a new method of treating orthopedic disorders and the consequences of injuries in medicine, which consists of gluing special elastic tapes to the skin.They help to unload the necessary muscles and support others, as well as to correctly distribute the load on the support points of the foot.But for the tape to work, the doctor who applies the tapes must have a good knowledge of the technique and anatomy.
The tapes are made of hypoallergenic materials and are applied for an average of 5 days.You can wear any shoes with them, play sports, 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 tapes breathes, which eliminates the risk of developing skin diseases.
therapeutic massage
Massage for flatfoot-valgus deformity is aimed at normalizing the muscle tone of the lower extremities, developing joints and improving trophism by activating blood circulation.Thus, during a therapeutic massage session, 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 therapeutic massage course 4 times a year, consisting of 15-20 sessions.Thanks to them, there is a noticeable improvement in the condition of patients, the elimination of the most annoying symptoms of the planavalgus foot deformity or at least a decrease in their intensity.
An additional advantage 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 rugs are distinguished by the presence of convexities of different shapes.Therefore, walking barefoot on them helps 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 planavalgus deformity.
Therefore, planavalgus foot deformity is a common orthopedic disease.It can significantly reduce a person's quality of life and lead to the development of serious complications.Therefore, it is important to diagnose a deviation from the norm as early as possible and undergo comprehensive treatment.But if flatfoot-valgus is diagnosed in adulthood, conservative therapy will only help prevent the progression of the deformity.However, in the initial forms of the disease, this is completely sufficient to restore normal quality of life and maintain the ability to lead an active lifestyle.In other cases, as well as when conservative treatment is ineffective, correct foot anatomy can be restored surgically.