A child's first steps for parents are a real celebration. Sometimes, during this joyful event, it turns out that the child treads on the wrong foot, bending the soles of the feet inside. In medicine, this phenomenon is called hallux valgus. Pathology can occur not only in children but also in adults. Learn about the causes of the problem and what treatment is best for your baby.
What is planovalgus deformity of the foot
Common orthopedic pathology of Hallux valgus is described in the medical literature as a decrease in the height of the fornix and a curvature of its axis. With this disease, the toes turn outward, and the middle part of the toe sits firmly on the floor. If you look at the feet of a sick person from the side or from above, you can see that the feet look like the letter X. Every third child suffers from valgus pathology of the ligamentous apparatus and about 30% of women over 30 years old
What does a child's ankle look like?
Every newborn has flat feet, but it is not worth dramatizing - this is just a temporary occurrence characteristic of all babies. The defect disappears as soon as the baby begins to stay in order, maintaining the vertical balance of the body and distributing the load evenly throughout the skeletal system. With valgus, the feet become X-shaped. While walking, the child does not step on the whole toe, but uses only its inner side, which leads to a number of negative consequences.
The International Classification of Diseases (ICD-10) was developed for the convenience of obtaining information from physicians, storing statistical data on the health status of the entire population of the planet in the health sector. According to this document, flat feet are assigned the international code M 21. 4, while:
- for congenital pathologies, code Q 66. 5 is used;
- the classical planovalg deformation is defined as M 21. 0.
Causes of the disease
Plovalgus deformity often affects women who prefer to wear shoes with high heels or a narrow toe. The disease is often diagnosed in athletes, hairdressers and people in other professions associated with prolonged stay. Risk factors for developing pathology in adults include:
- multiple sclerosis;
- psoriatic arthropathy;
- rheumatoid arthritis;
- Charot Syndrome;
- limb injuries;
- sedentary lifestyle;
- metabolic diseases;
- hereditary predisposition;
- conditions characterized by an increased load on the legs - overweight, pregnancy, postpartum period up to one year.
If in adults flat valve legs appear during life, then in children, the pathology may appear even before birth. Related to this, doctors can not determine for sure, but they believe that the deformity can be caused by: improper nutrition of a pregnant woman, gestosis, lack of vitamins. In children 3-5 years old, the flat valve foot appears due to:
- Localization of weak muscle ligaments in the lower leg, against the background of which the hypermobility of the joints develops.
- Poor inverter muscle activity and lateral dominance (this is a flexor muscle).
- Wearing the wrong shoes, too soft or too tight, for children.
- Infections, viral or bacterial diseases.
- Rickets, cerebral palsy (infantile cerebral palsy) - diseases that act destructively on the bones, making them vulnerable to injury, fracture, puncture.
- Soft tissue blood supply disorders.
- Connective tissue dysplasia against the background of intense growth.
- Complications of polio, polyneuropathy.
- Disorders of phosphorus-calcium metabolism, lack of vitamins.
- Endocrine system disorders - overweight or underweight, diabetes mellitus.
Plosovalgus feet in children according to the type of deformity
After determining the cause, the doctor prescribes a diagnostic test to determine the degree of deformity in order to choose the right treatment in the future. There are several types of pathology:
- Static form - diagnosed if one of the reasons for the development of the disease is inappropriate behavior, long stay (detected in almost 40% of the adult population).
- Structural is a sign of congenital pathology. Occurs due to an inaccurate location of the talus with a lateral deviation.
- Compensator - a deformity in which the child has a very short Achilles tendon, the legs are sloping.
- Corrective - a type of curvature that develops with a wrongly chosen method of treating club feet or a complete lack of medical care.
- Spastic nerve deformity - occurs with disorders in the cerebral cortex, accompanied by spasms in the limbs.
- The paralytic type is a consequence of polio or encephalitis.
- Rickets - flat foot is a consequence of rickets.
- Traumatic (consequences of injury). The cause of this pathology are ligament tears or sprains, ankle joint fractures, injuries of the hip part of the body.
Degree of pathology
Plosovalgus feet have several degrees of deformation, which are classified according to the degree of deviation of the arch from the norm. Doctors give a favorable prognosis for treatment when diagnosing first and second, third and fourth degree require longer therapy. Strain level classification:
- The first degree is an angle of deviation of up to 15 degrees. Violations are easily eliminated with conservative treatment.
- The second degree is a slope of no more than 20 degrees. The condition is successfully treated using the methods of exercise therapy (physiotherapy exercises), massages, physiotherapy procedures.
- The third degree is a deviation angle of up to 30 degrees. To eliminate the pathology, medicines, physiotherapy, massage are used. The treatment is long-term.
- Fourth degree - the angle of deviation is more than 30 degrees. Deformation is eliminated by surgery.
Symptoms of hallux valgus
This type of deformity is characterized by the manifestation of general and local symptoms. The first signs of the disease are fatigue while walking, leg pain, back pain. As the disease progresses, noticeable deformity of the joints and legs appears. Signs of flat foot valgus include:
- bone extension on the side near the thumb;
- aching pain in the legs;
- swelling of the limbs, large joints - knee, ankle, hip;
- redness of the skin at the site of bone extension;
- appearance of corns, corns;
- violation of the innervation of the muscles of the lower extremities;
- the intersection of the index and the thumb;
- calf muscle spasm;
- asymmetric adjustment of fingers.
Plosovalgus deformity of children's feet in the initial stage can be manifested by bending, crossing the legs while walking. Children can move their legs to facilitate movement. Outwardly, the planovalg deformity appears in the form of an X-shaped bend in the lower part of the foot, while the knees cannot be gathered together. It is difficult for a child to move, he gets tired quickly, is less active compared to his peers.
Plovalgus foot deformity in adults is manifested by pain in the extremities, a gradual increase in the length and width of the foot. Other signs:
- Familiar shoes become uncomfortable, press, bring discomfort.
- Gradually, the main symptom of the disease begins to appear - the curvature of the thumb from the outside, with the formation of a bone at the base.
- The index finger can be found on the thumb, while the rest takes the form of hammers.
- Adults often complain of a burning sensation in the lower extremities, a crisis in the knees and a pain in the lower back.
Diagnosis of the disease
When the first unpleasant symptoms or suspicions of a planovalgus disorder appear, you should immediately consult an orthopedic doctor. He will perform a visual examination of the patient, to determine if there are external signs of a violation. To confirm or disprove the diagnosis, he will prescribe examinations:
- X-rays are a study performed to assess the condition of the distal line of the tarsal part of the foot and joints. In the picture, you can see degenerative changes, identify the development of the disease, determine if the cause is a limb injury. The method does not require additional patient preparation. You need to remove shoes, clothes and jewelry. X-rays are not performed if a similar procedure was performed less than three months ago. It is undesirable to take a picture during pregnancy.
- Computer plantography is a modern screening method created to collect quantitative parameters and qualitatively assess the condition of the safe. Diagnosis helps to determine the presence and extent of flat feet, to assess the height of the arches. For this, the barefoot patient is placed on a glass platform and a photograph of the sole is made using a webcam at an angle of 120 degrees. During the procedure, the computer analyzes and calculates the patient parameters, the angle of inclination of the vertical arch.
- Computer podometry is a method of diagnosing the load exerted by the body on the lower part of the foot and the sole of the foot. Diagnosis is performed in real time using a special platform. The patient stands barefoot on the scanner, images of a multi-colored dot appear on the computer screen, indicating an increased or insufficient load. Podometry is used only to confirm the diagnosis.
Treatment of hallux valgus in children
Timely therapy aimed at eliminating the flat valve foot in children helps to achieve good results and completely eliminate the problem. The doctor may recommend enrolling in a pool or taking a course of mud baths. The patient is prescribed complexes of vitamins and minerals, biologically active supplements with vitamin D and calcium. For treatment, an integrated approach is used, included in the scheme:
- drug treatment;
- manual therapy methods.
Deformation treatment takes a long time. The average course of massage is 15 days, it will have to be repeated within two weeks. Wearing special orthopedic shoes helps fight the flat-valgus type of flat feet. Special exercises can be done at home using small balls, special massage clothes or sticks. The improvement in the situation with an integrated approach is observed in six months. If there is no effect, surgery will be required.
Special foot massage
In the initial stages of development, it is permissible to treat the pathology with the help of a gentle massage. Helps to strengthen muscles, relieves fatigue in the legs, reduces pain, restores blood circulation to tissues. It is best to entrust the procedure to a professional massage therapist, especially if the massage is done to a child. This ensures that the treatment is effective.
With the congenital flat valve foot, treatment begins when the baby is a month and a half old. The optimal time to start the procedure is one hour after the meal. This is necessary so that the manipulation of the massage therapist does not cause vomiting, dizziness or nausea. With a mild degree of hallux valgus, you will need to visit the clinic for at least 12 sessions, with a severe form of the disease - from 20 or more. The duration of the massage is 10-20 minutes. The minimum number of courses per year is 3-4.
Characteristics of manual therapy
In case of planovalg disorders, it is advisable to massage not only the legs, but also the back of the thighs, lower legs, lumbosacral spine. They use the same techniques as in a regular session - stroking, shaking, rubbing, squeezing, squeezing. To increase the effect, you can use special rollers, carpets, rolls. The only contraindication to manipulation is varicose veins, which occur mainly in adults.
With the flat-valgus type of flat feet, the massage should be done very carefully so as not to give uncomfortable sensations to the patient:
- For ease of the procedure, the patient is placed on his abdomen so that his legs hang over the edge of the surface. An elastic roller or a small cushion is placed under the shins. The skin is lubricated with oily or oily cream.
- The session begins with a back warm-up. To relax the back, the specialist hits the spine, sides and armpits. Finally, rub the back with your fingers.
- Special attention is paid to the lumbosacral region. There are nerve endings that send impulses to the muscles of the lower extremities. Performing the spine in different directions is performed, starting to pull the skin up and down.
- Behind the sacral part of the back, the buttocks and thighs are deceived. They are kneaded, squeezed, massaged with the fingers, ending the stage with caresses.
- After that, the back of the thighs, hips and lower legs are processed. Manipulations start with light strokes.
- Finally, a complete foot massage is performed, paying special attention to the heels and thumbs.
Physical therapy complex
Specific physical exercises are prescribed by an orthopedic doctor or rheumatologist, choosing the type of physical education for each patient individually. Active exercises with flat feet in children help strengthen the ankle and foot joints and form the arch. For adults, prolonged exercise helps:
- increases blood circulation;
- relieving inflammation;
- reduce painful sensations.
The complex of physiotherapy will be particularly effective in the second and third degree of pathology. It is necessary to engage in sports continuously throughout the course of treatment, and sometimes gymnastics continues after the end of therapy. You can do the exercises at home, with improvised tools, or by buying special orthopedic equipment for gymnastics in the store: massage mat, knife balls, plastic sticks. Examples of exercises:
- walking on a narrow path (inverted bench), "herringbone", on a triangular board, rope;
- the rotation of a thorn ball;
- transfer of rubber "hedgehog" to each other.
Exercises for hallux valgus in children
Fitness exercises can be performed with or without music, in a relaxing and cozy environment. With deformity of the foot planovalgus, classes are performed daily, each exercise repeated 3-4 times. What will help the child:
- Walking in a narrow lane. You can draw it yourself or make it from thick fabric. You can not go beyond the boundaries of the line.
- Walking on a rug with an ordinary surface.
- Pull the sock towards you with an inward turn. Exercise should be done while you are sitting in a firm chair.
- Walking across the room to the inside of the sole.
- Catch small objects from the floor with your fingers - special sticks, pencils, balls. To make the exercise more difficult, you can hold objects with your fingers for a few seconds.
- Squatting in place without removing your feet from the floor. If your toddler is doing this exercise, support him with your back to prevent falling.
- Full-length lift from a sitting position in Turkish. You should sit so that your feet are bent at the knees, and your heels are crossed.
- Alternate or simultaneous raising of the toes, followed by rolling on a full foot.
Non-surgical treatment of valgus flexion aims at forming the correct fornix, strengthening the muscles of the ligament apparatus. Physiotherapy procedures cope with these tasks. In addition, they help relieve pain, swelling and improve blood circulation. For varus pathology, orthopedists recommend:
- magnetic therapy;
- paraffin therapy;
- make mud applications;
- sign up for therapeutic swimming.
Children orthopedic shoes for flat valgus feet
To consolidate the result, you need to buy special orthopedic shoes. Its layers must be of the correct anatomical shape, the back and sides are solid, had the front of the foot. It is advisable to buy shoes with a comfortable backrest, women should give preference to shoes with low heels - up to 6 cm. It is undesirable to buy shoes with a straight heel, with an open heel.
To make the shoes suitable in all aspects, it is better to buy them in specialized shoe stores or make them to order. When choosing the latter option, check with the manufacturer if it is necessary to give an impression. If necessary, check out a podiatrist and make a half-loaded 3D trail using the formation foam. The casts are made separately for the right and left feet.
When buying ready-made orthopedic shoes for children, it is advisable to follow these tips:
- Shoes should be taken in size. They should not be too small or too large for the child to feel comfortable in the shoes.
- It makes no sense to buy such a wardrobe item with plans for the future, as the geometry of the legs changes as the legs grow.
- Good orthopedic shoes are sewn from natural materials so that the skin "breathes".
- Open, sharp or tight socks and heels are unacceptable in children’s shoes.
The benefits of clothing
Orthopedic shoes and beds not only help treat planovalg's feet, but also prevent the onset of pathology. The benefits of wearing such shoes are undeniable:
- the load on the musculoskeletal system is significantly reduced;
- the correct safe is formed;
- further damage to muscles and joints is eliminated;
- correct gait and posture is formed;
- muscles develop correctly.
Doctors resort to surgery only in extreme cases, when conservative treatment measures have not brought significant results. Without fail, surgery is prescribed for all patients diagnosed with fourth-degree planovalgus foot. They use different methods of surgical intervention:
- Grice surgery is a surgical procedure, during which the planovalgus legs are fixed with the help of extra-articular arthrodesis, not allowing them to bend inward.
- The Dobbs technique is an operation based on percutaneous fixation of the foot with a Kirschner wire followed by plastering. In fact, it is a method of manual impact. The doctor conducts 5-6 sessions (one per week), performing the application of plaster from the layer.
- Use of various soft tissue structures and arthrodesis implanted in plantar or joint tissues.
Prevention of hallux valgus in a child
They begin to form the correct safe from the baby’s first birthday, doing a gentle massage. The correct behavior of a pregnant woman helps protect against congenital pathology. The expectant mother should eat well, reduce the load on the legs, especially at 7-8 months of pregnancy, and refuse to take unverified medication.
Summer is very difficult to treat flatovalgus feet in adults, so it is important to pay special attention to disease prevention from an early age. Observe the following rules:
- Do a daily examination of the baby's feet for injuries, redness and calluses. Pay attention to the baby's walking and posture.
- See your podiatrist at least twice a year, starting in the first year of your newborn's life.
- Try to buy only high quality shoes, with narrow heels, closed toes, but not tight. For prevention, you can buy special orthopedic mattresses.
- Provide your baby with enough vitamin D. in the first year of life. It can be obtained from disposable foods or from sunlight.
- They perfectly strengthen the musculoskeletal system, maintain muscle tone - physical activity. Take 15 minutes in the morning to exercise or sign up for swimming, fitness, aerobics.
- In summer, try to walk barefoot more, preferring sandy soil, fine gravel, pebbles.
- Visit a masseur twice a year, if possible, undergo physiotherapy procedures.
- Flat feet of valgus will not be scary for a child if there is a raised carpet, orthopedic balls or rolls at home.
- With a diagnosis already made, you should regularly undergo an examination by an orthopedist, do gymnastics and do 3-4 massage sessions.
Characteristics of treatment of planovalgus feet in adulthood
Bending of children’s feet gives itself good therapeutic effects, but it is not always possible to completely cure planovalgus feet in adults. The fact is that over time, bone tissue and joints become stiffer, stronger, characterized by a lack of elasticity, which significantly complicates the process. Conservative treatment for adults aims to:
- elimination of unpleasant symptoms;
- increase in muscle tone;
- ligament strengthening.
If the planovalg feet have passed into the fourth stage of development, they use surgical intervention. Damaged joints are replaced with artificial implants, which helps to normalize the height of the fornix. Sometimes they use the osteotomy method - surgical bone reconstruction. After surgery, full restoration of functionality occurs in 3-4 months.
When the diagnosis of flat valve feet is accompanied by a protruding bone at the base of the big toe, the doctor may recommend holding special clamps on the toe. Splint hinge valgus is widely used. Gel pads are used to restrict the movement of the feet inside the shoe. Manipulations will be effective in the first and second stage of pathology development. For bow correction, adults are advised to buy orthopedic shoes or insoles.