Today, flatfoot-valgus deformity is one of the most common problems in traumatology and orthopedics.This pathology occurs in children and adults.However, it often progresses over time and causes changes in other joints as well as the spine.This significantly reduces quality of life and may even lead to arthrosis of the ankle, knee, and hip joints as well as spinal disease and curvature.Therefore, it is not only important to promptly diagnose flat-valgus foot deformity, but also to start treatment immediately.This will prevent the progression of the pathology.But in the final stages of development, the condition can only be corrected through surgery.
What is flat valgus deformity of the foot?
Planar valgus deformity of the foot is an alteration of the foot structure resulting in a reduction in the size of the longitudinal arch of the foot in the context of impaired function of the posterior tibial tendon.As a result, the axis of the foot becomes distorted.This is accompanied by a lowering of its midsection and an outward rotation of the heel, with its inner section abutting the supporting surface.In other words, the foot rolls inward and becomes flat, and in severe cases, an X-shaped bend in the leg may be observed.This can be seen by the considerable distance between the heels when assuming a standing position with the ankles touching each other.
According to various authors, 15-58% of people have similar problems.
Planar valgus deformity of the foot not only causes obvious cosmetic defects but also causes many complications.These are:
- Bursitis is inflammation of the synovial bursa in the foot joint.This is accompanied by redness, swelling, and pain of the skin in the projection of the affected joint, which is exacerbated by mechanical action.
- Arthropathy - Degenerative dystrophic changes in cartilage tissue, accompanied by thinning of the cartilage tissue and progressively increasing pain.Subsequently, the formation of osteophytes is observed on the articular surfaces of the bones until they fuse with each other and secure the joint.In the case of flat valgus deformity of the foot, arthrosis affects not only the joints in the foot, but also the ankle, knee, and hip joints.
- Heel spurs are the result of overstretching of the plantar fascia, forming a protrusion on the side of the heel bone, causing severe pain in the heel area when walking.This is often accompanied by inflammation of the Achilles tendon.
- Osteochondrosis is a degenerative dystrophic change in the intervertebral disc that results in a reduction in disc height, creating prerequisites for the formation of herniation and intervertebral hernia.
- Curvature of the spine - can manifest as a deepening of the physiological curve (kyphosis, lordosis) or as a scoliotic deformity.
reason
A central link in the development of the disease is the rotation (rotation) of the talus in the horizontal and sagittal planes.This results in changes in the foot's point of support and flattening of the arch.There are many factors that contribute to this, but they are rarely observed in isolation.In most cases, the cause of flat and valgus deformity of the foot is a combination of factors.Therefore, the disease may be caused by:
- congenital connective tissue disorders;
- Progression of any type of flatfoot;
- Lower extremity injuries, especially injuries to the bones and ligaments of the feet;
- Osteoporosis, a disease in which the amount of calcium in bones decreases, leading to increased fragility;
- Endocrine disorders, especially hormonal imbalances caused by diabetes, hypothyroidism, and physiological changes during pregnancy and menopause;
- Excess weight, especially obesity, caused by increased loads on the feet and overstretching of muscles and ligaments;
- neurological diseases, including polio and cerebral palsy;
- rickets;
- Excessive pressure on the feet due to the need to stand, walk or engage in heavy physical labor for long periods of time;
- Wearing incorrectly chosen shoes, i.e. with heels that are too narrow and/or too high, which leads to impaired load distribution on the foot;
- Abnormalities of the feet.
In the presence of congenital developmental anomalies as well as genetic hyperelasticity of the feet, clubfoot can become noticeable almost immediately after birth.But more often, the pathology is diagnosed when the baby starts walking.Often in this case, the disease quickly worsens due to the wrong choice of shoes, insufficient physical activity, or, on the contrary, excessive and inappropriate physical activity.
In most cases, flat valgus deformity of the foot occurs during childhood.If the disease is not noticed and corrected during this period, the disease will continue to exist in the person and will often develop further in the future when favorable conditions are created.In adults, flatfoot deformity most commonly worsens during pregnancy or due to weight gain, which is often associated with a sedentary lifestyle.
Symptoms of flat and valgus foot deformity
Foot planar valgus deformity is characterized by a progressive increase in symptom intensity.Therefore, if initially the pathology manifests itself only in the form of mild discomfort, then in its later stages its manifestations can become an obstacle to an active lifestyle and even make simple movements very complicated.The disease is characterized by:
- Foot pain, especially back pain, worsened by prolonged standing, walking, or physical exertion;
- swollen ankles;
- Increased fatigue when walking;
- Compaction, formation of corns, calluses, and soreness of the skin over the small metatarsal heads, aggravated by wearing high heels and prolonged physical activity;
- An X-shaped bend in the legs can cause knee pain over time;
- Displacement of the first toe, gradually causing changes in the other toes (hallux valgus);
- Gait disturbance.
Sometimes patients have accessory sesamoid bones in the scaphoid region.
Flat valgus deformity of the foot increases the likelihood of ingrown toenails.Its deviation toward the side with greater curvature causes changes in the shape of the rest of the finger.As a result, they become curved, claw-shaped, and their 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 callus on its sides, often called a bump or bone.This can lead to difficulty choosing shoes and make you feel uncomfortable wearing the shoes you already have.
Degree of deformation
Planar valgus deformity of the foot is divided into 4 stages, each stage is associated with a specific set of symptoms.These are:
- Stage 1 – There is still no skeletal deformity in the foot, but pain may sometimes occur in the tibialis posterior tendon area, especially after standing or walking for long periods of time.This can be complicated by tenosynovitis, an inflammation of the tibialis posterior tendon.And the angle of the heel relative to the tibial axis does not exceed 10-15°.
- Stage 2 – Mild foot deformity, calcaneal dislocation 15-20°.At the same time, in the resting state, that is, when a person is lying down, the foot returns to its normal shape.Since there are no hard-fixed deformations, therapeutic massage is a very effective treatment method at this stage.But this does not eliminate the need for other conservative treatments.
- Stage 3 – The foot deformity has been fixed.In this condition, the joints in the rear foot are no longer suitable for passive movement.The angle of the heel relative to the axis of the tibia is 20-30°.
- Stage 4 - The foot is severely deformed, completely flattened, and the axis of the ankle joint changes.When an X-ray is taken and the image is evaluated, a lateral tilt of the talus can be seen.This is a direct sign of deltoid ligament failure.The deviation of the heel from the tibial axis is 30° or greater.
Flat feet also come in varying degrees.To diagnose them, it is necessary to measure the angle of the longitudinal arch and the intermetatarsal angle as well as the height of the arch in millimeters using radiographic images.
The lesions tend to progress, especially faster under the influence of factors that negatively affect the condition of the foot (obesity, frequent lifting and carrying of heavy objects, prolonged standing, wearing of inappropriate shoes, etc.).
diagnosis
If signs of flat-valgus foot deformity occur, it is important to consult an orthopedic surgeon as soon as possible.And while a disease can be diagnosed based on test results, doctors always pay close attention to medical history and the patient's life.The data obtained during the investigation provides doctors with important information not only to determine the cause of the deformity but also to develop the best treatment plan.
Pay close attention to the symptoms, conditions and progression characteristics of the disease.The orthopedic surgeon must clarify the nature of the pain, its location and duration, the presence of neurological disease, the presence of physical activity limitations, etc.
Thereafter, an orthopedic examination is required.During this procedure, doctors evaluate the mobility of the hock joint by asking the patient to stand on their tiptoes, perform passive movements, and perform other tests.Orthopedic surgeons also evaluate the condition:
- lower extremity blood vessels;
- Nature of skin, temperature, hair distribution of feet and legs;
- Sensitivity in feet and legs;
- Muscle tone of the lower limbs.
All of these can help 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 strategy aimed at eliminating all existing disease.
Furthermore, when diagnosing flat-valgus deformity of the foot, instrumentation and laboratory investigation methods must be specified to accurately determine the extent of foot changes and elucidate the nature of the therapeutic measures required.this:
- 3 projections of foot radiograph;
- plant morphology;
- pedometer;
- UAC and OAM;
- Ultrasound examination of joints.
In cases where diagnosis is difficult, CT or MRI may be performed.These are modern methods of studying bone and soft tissue respectively, providing the most accurate and detailed data on their condition.
Conservative treatment of flat and valgus deformity of the foot
Treatment of flat-valgus foot deformity almost always begins with conservative (i.e., non-surgical) treatment.Only in stages 3-4 of the disease can patients be immediately recommended for surgical intervention.
Therefore, conservative treatment of flat-valgus feet is always complicated.It includes:
- Use personal orthopedic insoles;
- Wear comfortable or orthopedic shoes;
- drug treatment;
- exercise therapy;
- therapeutic massage;
- Kinesio Taping;
- physiotherapy.
Additionally, if signs of obesity are present, patients will be advised to take steps to lose weight and avoid wearing tight shoes or high heels.From the moment of diagnosis of flat valgus deformity of the foot, you should choose and wear only comfortable shoes with a fairly wide toe box and a heel height of no more than 3 cm.They must be made of natural materials and not pinch the feet.
Completely flat shoes (such as ballet flats, Crocs, or Uggs) are also a no-no.
All of these approaches aim to eliminate symptoms, improve the patient's quality of life, and halt the progression of the deformity.But it is only possible to completely cure flat clubfoot with their help if it is diagnosed in the first stages of the child's life.
If a toe develops a bunion deformity, special orthotics can be used to move it into the correct position.
All patients should understand that the course of flatfoot-valgus deformity is negatively affected by:
- smoking;
- Presence of chronic diseases that lower immunity;
- Violating a doctor’s advice regarding physical health care, shoe selection, etc.;
- hypothermia and hyperthermia;
- Presence of other orthopedic conditions that negatively affect foot biomechanics;
- Osteoporosis;
- infectious disease.
Therefore, patients should avoid exposure to these factors to increase the effectiveness of treatment.And if, 3 months after starting conservative treatment and implementing the entire set of measures prescribed by the doctor, the patient continues to experience pain and has no positive dynamics, this may be a reason to consider surgical issues.
Custom orthopedic insoles and shoes
When diagnosing any degree of planovalgus deformity, the patient will need to wear individually fabricated orthotics.They should wear ordinary shoes instead of their own shoes, and in the later stages of the development of the pathology - special orthopedic shoes.
Because they are made individually based on the structural characteristics of the patient's left and right feet, they provide the patient with the most anatomically correct position.This is key to restoring normal movement biomechanics and eliminating leg fatigue, swelling and pain.Additionally, they restore the normal axis of the joint, significantly reducing the risk of complications.
Traditional mass-produced orthotics are not suitable for flat and valgus foot deformities.
Therefore, individual orthotics help distribute the load on the foot correctly.This leads to excessive muscle relaxation during training and relaxation of overly tense muscles, which directly affects the root cause of the development of flat feet.
For the first few days, you will need to walk in the orthotics for 2-3 hours.This is because, initially, they cause discomfort due to the need to readjust the legs into the correct position.Gradually, the time of wearing the insoles is increased, reaching the maximum possible value.In most cases, patients get used to them and can wear them all day long after two weeks without any problems.
If the insole is deformed or worn, it should be replaced with a new one.For this, you will again need to contact an orthopedic surgeon, who will take individual measurements and send them to production together with his opinion.
drug treatment
In the absence of complications from flatfoot-valgus deformity, medical treatment is symptomatic.In other words, its purpose is to reduce the severity of pain.For this reason, patients are advised to occasionally use NSAIDs in the form of internal products or ointments, gels, and creams.They will help you relieve pain quickly and improve your health.
If adverse consequences of flatfoot and clubfoot occur, medical treatment is also required.It may include the following:
- Corticosteroids – used to relieve severe inflammation, features of bursitis, etc.;
- Meant to improve blood circulation - used to treat congestion processes in the feet and the appearance of signs of varicose veins;
- Chondroprotectants - prescribed when degenerative dystrophic changes occur in joints etc.
exercise therapy
Physical therapy is an important component of treating flatfoot and clubfoot deformity.It is designed to strengthen the tibialis posterior and anterior muscles, peroneal muscles, and gastrocnemius.
For each patient, the necessary set of exercises is selected individually, taking into account the degree of pathological changes, age and other factors.Typically, the following exercises are prescribed:
- Rolling any cylindrical or round object, such as a rolling pin or ball, on the floor;
- Walk on your toes, then on the outside of your foot;
- Climbing sloping planks;
- Ride an exercise bike or bike barefoot;
- Use toes to grasp and lift small objects from the floor;
- Grab and fold a newspaper or towel with your toes like an accordion;
- Place the foot of one leg on the calf of the other leg in a sliding motion;
- Sit in the "Turkish" position and then stand up.
Swimming has a very good effect on the condition of the feet.Therefore, if the patient has the opportunity, it is recommended that he go to the swimming pool at least 2-3 times a week.
But exercise therapy needs to be carried out systematically.Therefore, classes should be held every day in a comfortable environment and not in a hurry.There's no harm in taking off your shoes and rolling the ball with your feet whenever convenient, such as when working at the computer.This will help relieve pressure on your feet and improve your health.
physical therapy
In order to improve the effectiveness of conservative treatment of flat-valgus feet, a course of physical therapy is required.They are indicated for foot deformities grade 2 or above and not only help reduce the severity of the condition but also produce a therapeutic effect.
If a flat valgus deformity of the foot is present, surgery with anti-inflammatory, analgesic and anti-edematous properties is required.But they can only be initiated in the absence of an acute inflammatory process.Generally speaking, they are specified as follows:
- electrophoresis;
- magnet therapy;
- dynamic therapy;
- UV irradiation;
- Electrical stimulation of calf and foot muscles;
- ozokerite and paraffin applications;
- Mud therapy.
Kinesio tape
Kinesio Taping is a new way to treat orthopedic conditions and the consequences of medical injuries that involves attaching special elastic bands to the skin.They help to relieve the necessary muscle load and support other muscles and correctly distribute the load to the support points of the foot.But in order for tape to be effective, the doctor using it must have a good understanding of the technique and anatomy.
The tape is made from hypoallergenic materials and lasts an average of 5 days.You can wear any shoes, play sports, shower, etc.They do not interfere in any way and are barely noticeable on the body.At the same time, the material of the tape breathes, thus eliminating the risk of skin diseases.
therapeutic massage
Massage for flat valgus deformities of the feet is aimed at normalizing muscle tone in the lower limbs, promoting joint development and improving nutrition by activating blood circulation.Therefore, during a therapeutic massage, the doctor will focus not only on the muscles of the feet and soles, but also on the muscles of the calves and thighs.
Generally speaking, it is recommended to have 4 therapeutic massages per year for a total of 15-20 sessions.Thanks to them, the patient's condition significantly improved, eliminating the most disturbing symptoms of flat-valgus deformity, or at least reducing its intensity.
An added bonus is purchasing a special massage mat.Today there are many models from which you can choose the one suitable for both adults and children.These rugs are characterized by the presence of convex surfaces of different shapes.Therefore, walking barefoot helps exercise foot muscles and promote blood circulation.This has a positive impact on foot condition and improves the effectiveness of conservative treatment of planovalgus deformity.
Therefore, flatfoot and clubfoot 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 abnormalities as early as possible and provide comprehensive treatment.But if flatfoot is diagnosed in adulthood, conservative treatment can only help prevent the progression of the deformity.However, in the initial form of the disease, this is entirely sufficient to restore a normal quality of life and maintain the ability to live an active lifestyle.In other cases, and when conservative treatments fail, surgery may be performed to restore the correct anatomy of the foot.