Flat feet - a foot lesion, characterized by varying degrees of flattening its arches, up to their complete disappearance. Treatment of flatfoot is especially true in children.
GENERAL
The foot arch are two: longitudinal and transverse. For flat broken shock absorbing function of the foot, which often leads to the emergence of various pathologies of the musculoskeletal system.
Statistics flatfoot:
- Flatfoot meets every tenth child, and approximately 17% of adults.
- The most common form of flatfoot is cross in conjunction with the abduction of the thumb foot outwards. This type of flatfoot is diagnosed in approximately 65% of cases.
- The second highest frequency of detection (approximately 33%) occurs with concomitant longitudinal flat flatness forefoot.
- longitudinal flat in a "pure" form is less common - about 5% of cases.
- congenital flat is usually combined with valgus deformity. The frequency of this disease is approximately 11% of all diseases of feet.
The final formation of the arches occurs in about 8-10 years to the life of the child. Therefore, early diagnosis of flat feet in children causes some difficulties.
CAUSES
Congenital flat stop formed as a result of fetal development anomalies its germ presence of amniotic strands in the uterus during pregnancy and the like. d.
Acquired flatfoot is formed under the influence of various unfavorable factors in childhood and adults.
The causes of flat feet:
- Rickets. In this disease of bone is decreased resistance to mechanical stresses together with the weakening of the musculo-ligamentous apparatus. In the period of active growth of the child is formed ploskovalgusnoy deformation.
- Polio. Intensity of deformation of the foot depends on the severity of paralysis and muscle amount involved in this disease. Usually flat formed in the development of tibial paralysis and / or plantar muscles.
- bone injury feet. The most vulnerable to the formation of flat feet are fractures of the tarsal bones, heels or ankles.
- hereditary predisposition. Usually associated with the weakness of the ligamentous apparatus, or connective tissue disease.
- Reduced muscle tone resulting from a sedentary lifestyle.
- physical exhaustion due to prolonged stay in a standing position.
- overweight, Pregnancy, regular heavy lifting and carrying.
- incorrectly selected footwear.
Improper footwear is a very common cause of flat feet. It was found that when walking without shoes the main burden falls on the rearfoot.
At a height of 2-4 cm heel load is distributed evenly across its surface. A long wearing heel height of 4 cm above redistributes load on distal foot separated. It causes muscle weakness and ligaments and It leads to spreading its forward department.
CLASSIFICATION
There are several criteria for the classification of this pathology.
According genesis:
- Congenital.
- Purchased.
Types of flatfoot:
- Longitudinal.
- Cross.
- Combined.
According to the etiological agent:
- Static.
- Rachitic.
- Traumatic.
- Paralytic.
There are three degrees of the clinical course of the transverse and longitudinal flat feet, depending on the changes on radiographs.
SYMPTOMS
The formation of flat feet for a long time can proceed symptomless.
The main manifestation of flatfoot:
- The first signs of the disease may be the appearance of fatigue in the lower extremities and pain in the plantar part of the foot.
- As the disease progresses the pain spread to the lower leg muscles, hips and even the lower back. A person is sometimes difficult to walk or even stand.
- Quite often, these patients unsuccessfully treated for lumbar degenerative disc disease and sciatica.
- The pains usually occur towards the end of the day, and are often accompanied by a decrease in muscle tone in the lower extremities.
- At the beginning of the disease can occur spastic voltage jerking these muscles.
- Patients often notice that the shoes wear out faster, and the heel or sole wears mostly on the inside.
- In transverse flatfoot often formed "corns" in the distal part of the foot, especially in the projection of the heads of the third and fourth metatarsals.
- There is an expansion of the foot and its deformation, which is accompanied by a problem in the selection of shoes.
- Changes gait, getting the type of "stilted".
DIAGNOSTICS
For the diagnosis of flat foot necessarily made medical history and the patient's complaints, conducted clinical examination and additional methods of research are used.
Additional methods of research flatfoot:
- Podometrics. A special technique index is calculated longitudinal and transverse arch.
- Plantography. We study the foot print on a flat surface. Used to study the biomechanics of the foot.
- Electromyography. We investigate the condition of the musculoskeletal system of the foot and lower leg.
- Radiography. The study should be carried out exclusively in a standing position. Calculated parameters of the state of the foot - the angles of the longitudinal arch, calcaneal deviation of fingers towards the instep and arch height. Also identify the possible secondary changes in the joints of the foot - osteoarthritis, Subluxations and dislocations.
Criteria for diagnosis of longitudinal flat:
- On examination revealed lengthening foot. She flattened and almost all of its surface is in contact with the support.
- Flattened longitudinal arch, heel rejected outwards. When running forms of pathology valgus deformity detected in all parts of the foot.
- Awkward gait dilution socks feet apart.
- In conducting reduction podometrics detected index to the longitudinal arch 27 and below.
- On plantogram determined reduction podsvodnogo space until its complete disappearance.
- The X-ray diagnosed increase in the angle of the longitudinal arch. First degree angle corresponds flatfoot 131-140 degrees, the second - 141-155, and the third - more than 155.
- Also indicative measure of disease is to reduce the height of the arch defined during radiography. If it is the first degree of 28-35 mm, the second - 17-27, in the third - less than 17.
Diagnostic criteria transverse flatfoot:
- When conducting inspection revealed reduction in the length of the foot with its expansion and flattening in the anterior.
- Metatarsals fan-like divergent. The first finger is deformed valgus - Hallux valgus. It deflected outwards and forms a sometimes quite pronounced angle with the head of the first metatarsal bone.
- toes are "Hammer" form.
- On radiographs revealed wide gaps between the metatarsals - diastase and dislocations and subluxations in the metatarsophalangeal joints.
- A first finger angle deviations from the corresponding metatarsal bones at the first degree of flatfoot is less than 15 degrees, the second - 20-30 in the third - 30.
- On plantogram detected flatness of the distal part of foot, increasing reliance on the head of the second to fourth metatarsal.
It should be noted that in children the disease is usually diagnosed between the ages of 5-6 years not previously. This is due to physiological immaturity arches of the foot in young children, and the identification of their symptoms flatfoot is a normal age.
TREATMENT
conservative and surgical treatments are used for correction of flat feet. The choice of a particular type of treatment depends primarily on the extent and shape deformation.
First of all, the patient is recommended to eliminate etiologic factors - to reduce the weight, stop wearing high heels, change the working conditions and so on..
The principles of conservative treatment of flatfoot:
- Physiotherapy. A set of exercises is chosen individually, performing them should be daily. LFK course can sometimes be several years.
- Massage legs and feet.
- Physiotherapy. Widely used electromyostimulation, hydrotherapy.
- The use of special modeling supinator with arches of the foot, as well as proper wearing shoes.
- Children have special bandages and tires are used.
Surgical intervention is usually applied in case of large deformation of the foot or with the progression of the disease, despite ongoing conservative therapy. Apply operations on soft tissues (e.g., tendons), bones or combined effects.
Postoperatively, the patient should long wearing corrective devices.
COMPLICATIONS
The negative effects of flat feet lead to disruption of the normal functioning of virtually the entire organism.
Flatfoot Complications:
- Chronic pain of varying intensity in the foot, lower limbs, back.
- Various strains of foot as a whole and its separate units: a first finger ( "Bone"), heel spurs, corns formation, the ingrown nail, etc...
- Clubfoot.
- The disproportion of the lower limb muscles.
- Diseases of the pelvic and knee joints.
- Pathological condition of the spine: scoliosis curvature, osteochondrosis, intervertebral hernia, etc...
- Phlebeurysm.
PREVENTION
Preventive measures should be carried out with flat feet of the child an early age. You should also eliminate all possible factors that trigger the disease development.
Prevention of flat feet:
- Frequent walking barefoot on uneven surface topography (sand, pebbles and so on. N.) Or a special massage mats.
- Choosing the right shoes. Children's shoes should be comfortable, with flexible soles, rigid back of the heel and 1-1.5 cm. Shoes should fit tightly, but do not squeeze the foot. It is desirable that it was made from natural materials. Adult optimum heel height shoe for everyday wear - up to 4 cm.
- Regular physical training and sports. However, the need to avoid physical stress and fatigue.
- Children are encouraged to do special exercises for the musculo-ligamentous apparatus of the foot: walking on his toes, heels, outer side of the feet, etc...
- At long loads need to take a break and give the legs a rest. Also in these cases, we recommend wearing special insoles, arch supports.
- After the end of the working day is useful to do a warm foot bath with subsequent massage.
- It is necessary to lead a healthy lifestyle, eat right.
FORECAST FOR RECOVERY
With timely diagnosis of flat foot well be corrected even with conservative methods. In children, the disease in such cases can be completely cured. Adults may significantly improve health.
If you experience severe foot deformities prognosis for recovery less favorable disability may occur.
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