Today, Planovalgus 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 lead to changes in other joints, as well as the spine.This significantly reduces the quality of life and can even lead to the development of arthrosis of the ankles, knees, hip joints, as well as diseases and curvature of the spine.Therefore, it is important not only to diagnose planovalgus foot deformity, but also to start treatment immediately.This will stop the development of pathology.But in the final stages of development, the condition can only be corrected through surgery.
What is PlanoValgus foot deformity?
Plano-valgus foot deficiency is a change in the structure of the foot, where a decrease in the size of the longitudinal arch occurs against the background of impaired function of the tendon of the posterior tibial muscle.As a result, the foot axis becomes distorted.This is accompanied by a lowering of the middle part and an outward turn of the heel with the inside side next to the support surface.In other words, the foot rolls inward, flattens, and in severe cases, an X-shaped curvature of the foot is observed.This can be seen by the presence of a relatively large distance between the heels when taking a standing position with the ankles touching each other.
According to various authors, the same problem occurs in 15-58% of people.
Plano-Valgus leg deficiency is fraught not only with the occurrence of obvious cosmetic defects, but also with the development of several complications.These are:
- Bursitis is inflammation of the synovial bursa of the foot joint.This is accompanied by redness of the skin in the projection of the affected joint, swelling, pain, which tends to intensify with mechanical action.
- Arthrosis-degenerative-dystrophic changes in the cartilage tissue, accompanied by its thinning and the gradual onset of pain.Next, the formation of osteophytes is observed on the articular surface of the bones until they unite with each other and paralyze the joint.With plano-valgus foot deformity, arthrosis can affect not only the foot joints, 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 protrusion on the side of the heel bone, which leads to sharp 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 discs, which leads to a decrease in their height and creates the prerequisites for the formation of intervertebral protrusions and hernias.
- Spinal curvature - can manifest as a deepening of the physiological curve (kyphosis, lordosis) or the development of scoliotic deformity.
Reason
The central link in the development of this disease is the rotation (rotation) of the talus in the horizontal and sagittal planes.This leads to a change in the point of support of the foot and flattens the arch.There are many factors that can contribute to this, but they are rarely considered separately.Often, the cause of plano-valgus foot deformity lies in the combined action of several causes.Therefore, this disease may be caused by:
- congenital connective tissue disorders;
- development of flat feet of any kind;
- lower leg injuries, especially leg bones and ligaments;
- osteoporosis, which is a disease accompanied by a decrease in calcium content in bones, which leads to increased fragility;
- Hormonal imbalance caused by endocrine diseases, especially diabetes mellitus, hypothyroidism, as well as physiological changes during pregnancy and menopause;
- the presence of excess body weight and especially obesity, which is caused by increased load on the legs and overstretching of muscles and ligaments;
- Neurological disorders, including polio, cerebral palsy;
- rickets;
- excessive pressure on the legs due to the need to stand, walk or engage in heavy physical labor for a long time;
- Wearing incorrectly chosen shoes, i.e. too narrow and/or high heels, which leads to the distribution of the load on the feet;
- foot abnormalities.
In the presence of congenital developmental anomalies, as well as heredity that causes hyperelasticity of the foot, plano-valgus foot 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, the disorder quickly worsens as a result of choosing the wrong shoes, insufficient physical activity, or, conversely, excessive and inappropriate physical activity.
In most cases, plano-valgus foot deformity develops in childhood.If during this period, the disorder is not observed and corrected, the disease remains with the person and in the future tends to progress when good conditions are created.In adults, plano-valgus foot deformity most often worsens during pregnancy or due to weight gain, which is usually associated with a sedentary lifestyle.
Symptoms of plano-valgus foot deformity
Plano-valgus foot deformity is characterized by a gradual increase in the intensity of symptoms.Therefore, if at first the pathology manifests itself only as a minor discomfort, then at a later stage its manifestation can become an obstacle to leading an active lifestyle or even complicate significant movements.This disease is characterized by:
- pain in the legs, especially in the back, worse after standing, walking or physical work;
- ankle swelling;
- increased fatigue while walking;
- compaction, formation of corns, calluses and skin pain in the area of the head of the small metatarsal bone, aggravated by wearing shoes with heels and prolonged physical activity;
- X-shaped curvature of the legs, which over time leads to pain in the knees;
- the displacement of the first toe, gradually leading to the change of the other toe (hallux valgus);
- gait disorder.
Sometimes patients have an accessory sesamoid bone in the area of the scaphoid bone.
Plano-valgus foot deformities increase the likelihood of ingrown toenails.And its deviation to the side with a strong curvature causes a change in the shape of the remaining fingers.As a result, they become curved, take the shape of claws, and the joints thicken.This is called a Hammertoe deformity.
At the same time, in the area of the metatarsophalangeal joint, the growth of the joint is also observed with the formation of a callus on the lateral surface, which is called a lump or bone.This leads to difficulty when choosing shoes and making wear that you are already uncomfortable.
Deformation level
During plano-valgus deformity of the foot, 4 stages are distinguished, each of which is accompanied by a specific set of symptoms.These are:
- Stage 1 - there is still no bone defect in the leg, but sometimes pain occurs in the area of the posterior tibial tendon, especially after standing or walking.This may be complicated by Tenosynovitis, which is inflammation of the posterior tibial tendon.And the heel angle relative to the shin axis is no more than 10-15 °.
- Level 2-There is a slight deformation of the foot with the heel bone dislocated by 15-20 °.At the same time, in a state of rest, that is, when a person is lying down, the legs acquire a normal shape.Since there is no permanent deformation anymore, 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 leg deformity has become permanent.In this case, the hindfoot joint can no longer accept passive movement.The heel angle relative to the shin axis is 20-30 °.
- Level 4 - The foot is very deformed, completely flat, the axis of change with the ankle.When performing an X-ray and evaluating the image, the lateral inclination of the talus can be seen.This is a direct sign of deltoid ligament failure.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 longitudinal arch angle and the intermetatarsal angle are measured using radiographic images, as well as the height of the arch in millimeters.
Pathology tends to progress, especially quickly under the influence of factors that have a negative effect on the condition of the feet (obesity, frequent lifting and carrying of heavy objects, prolonged positions, incorrect shoes, etc.).
Diagnostics
If signs of planovalgus foot deformity occur, it is important to consult an orthopedist as soon as possible.And although this disease can be diagnosed based on the results of the examination, doctors always pay attention to the history of the disease and the patient's life.The data obtained during the survey provides the doctor with important information, thanks to which he can not only determine the cause of the disability, but also to create an optimal treatment plan.
Deep attention is paid to the symptoms of the disease, the circumstances of their occurrence, and the characteristics of development.The orthopedist must explain the nature of the pain, its location 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 movement of the tarsal joint by asking the patient to stand on tiptoe, perform passive movements, and conduct other tests.Orthopedists also assess the condition:
- ships from the bottom leg;
- foot and leg skin, temperature, hair distribution properties;
- sensitivity of both legs and feet;
- Lower leg muscle tone.
All this helps determine the possible causes and consequences of the development of plano-valgus foot deformity.This allows you to choose the most effective treatment tactics, which will be aimed at eliminating all existing disorders.
Also, when diagnosing plano-valgus foot deformities, instrumental and laboratory research methods must be established to determine the extent of foot changes and clarify the nature of the necessary therapeutic measures.This:
- X-ray of the leg in 3 projections;
- Plantography;
- pedometry;
- UAC and OAM;
- Joint ultrasound.
In difficult diagnostic cases, CT or MRI may be prescribed.This is a modern method for studying bones and soft tissues, respectively, providing the most accurate and detailed data on their condition.
Conservative treatment of planovalgus foot deformity
Almost always, the treatment of planovalgus foot deformity begins with a conservative appointment, that is, non-surgical therapy.Only at stage 3-4 of this disease, the patient can be immediately recommended for surgical intervention.
Therefore, conservative treatment of flat-valgus feet is always complex.It consists of:
- the use of individual orthopedic insoles;
- wear comfortable or orthopedic shoes;
- drug treatment;
- exercise therapy;
- therapeutic massage;
- Kinesio Taping;
- Physiotherapy.
In addition, patients will be advised to take steps to lose weight if signs of obesity are present, and to avoid wearing tight shoes or high heels.From the moment the Plano-Valgus foot deformity is diagnosed, you should choose and wear only comfortable shoes with wide enough feet and comfortable wide heels up to 3 cm high.They must be made of natural materials and do not squeeze the feet.
Shoes with flat soles such as ballet flats, crocs or uggs are also contraindicated.
All these methods are aimed at eliminating symptoms, improving the patient's quality of life and stopping the development of disability.But it is possible to completely cure flat-valgus feet with their help only if the disorder is diagnosed at stage 1 in children.
If there is a hallux valgus deformity of one foot, special orthoses may be prescribed to move it to the correct position.
All patients should understand that the path of planovalgus foot deformity is negatively affected by:
- smoking;
- the presence of chronic diseases that reduce immunity;
- violation of doctor's recommendations regarding physical regimen, choice of shoes, etc.;
- hypothermia and overheating;
- the presence of other orthopedic disorders that negatively affect the biomechanics of the foot;
- osteoporosis;
- infectious disease.
Therefore, patients should avoid exposure to these factors to increase the effectiveness of therapy.Moreover, if 3 months after the start of conservative treatment and the implementation of the entire set of measures prescribed by the doctor, the patient continues to experience pain and there are no positive dynamics, this may be a reason to consider the problem of surgery.
Insoles and custom orthopedic shoes
When diagnosing a plano-valgus foot deformity of any degree, the patient is required to wear individually made orthopedic insoles.They should be placed in ordinary shoes instead of the ones that came with them, and at a later stage of pathological development - in special orthopedics.
Due to the fact that they are made according to the structural characteristics of the patient's left and right leg separately, they allow them to be assigned the most anatomical position.This is the key to restoring the biomechanics of normal movement, eliminating leg fatigue, swelling and pain.In addition, they restore the normal axis of the joint, which can reduce the risk of complications.
Conventionally produced orthopedic insoles are not used for plano-valgus foot deformities.
Therefore, individual orthopedic insoles help to properly distribute the load on the foot.This leads to over-relaxed muscle training and excessive relaxation, which directly affects the main cause of the development of flat feet.
In the first days, you need to walk with orthopedic insoles for 2-3 hours.This is due to the fact that at first they will cause discomfort, because the legs need to be adjusted to the correct position.Gradually, the period 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 should 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 planovalgus foot deformity is symptomatic.In other words, it aims to reduce the severity of pain.For this purpose, 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 the undesirable consequences of flat-valgus feet occur.It may consist of the following:
- corticosteroids - used to relieve severe inflammation, characteristic bursitis, etc.;
- means to improve blood circulation - prescribed for congestive processes in the legs 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 important component in the treatment of planovalgus foot deformity.It aims to strengthen the posterior and anterior tibial muscles, peroneal and gastrocnemius muscle groups.
For each patient, the required 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:
- roll any cylindrical or round object on the floor, such as a rolling pin or ball;
- Walk on the toes and then on the outside of the foot;
- climbing inclined boards;
- work on an exercise bike or a barefoot bike;
- grasping and lifting small objects from the floor with your toes;
- grasping and folding a newspaper or towel like an accordion with your toes;
- perform a sliding movement with one leg on top of the other shin;
- Sit in the "Turkey" position and get up from there.
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 needs to be done systematically.Therefore, classes should be conducted every day in a comfortable environment without rushing.It will not hurt to take off your shoes and roll the ball with your feet at any convenient time, for example, when working at the computer.This will help relieve pressure from your feet and improve your well-being.
Physiotherapy
To increase the effectiveness of conservative treatment of flat valgus feet, a course of physiotherapeutic procedures is prescribed.They are indicated for leg deformities of grade 2 or higher and help not only reduce the severity of the disease, but also produce a therapeutic effect.
In the case of plano-valgus deformity of the foot, procedures are indicated that have anti-inflammatory, analgesic, and anti-edematous effects.But they can only be started in the absence of an acute inflammatory process.As a rule, they are set:
- electrophoresis;
- magnetic therapy;
- diadynamic therapy;
- UVT;
- electrical stimulation of leg and lower leg muscles;
- Ozokerite and paraffin applications;
- Mud therapy.
Kinesio Taping
Kinesio Taping is a new method of treating orthopedic disorders and injuries in the medical field, which involves attaching special elastic tape to the skin.They help to unload the necessary muscles and support others, as well as properly distribute the load on the foot support points.But for the tape to work, the doctor using the tape must have a good understanding of technique and anatomy.
The tape is made from hypoallergenic material and is used for an average of 5 days.You can wear 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 tape breathes, which eliminates the risk of developing skin diseases.
Therapeutic massage
Massage for plano-valgus foot deformities aims to normalize the tone of the lower leg muscles, develop joints and increase trophism by activating blood circulation.Therefore, during a therapeutic massage session, the doctor will pay attention not only to the feet and plantar muscles, but also to the lower leg and thigh muscles.
As a rule, it is recommended to undergo therapeutic massage 4 times a year, consisting of 15-20 sessions.Thanks to them, there is a significant improvement in the patient's condition, the elimination of the most disturbing symptoms of planovalgus foot deformity, or at least a decrease 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 suitable for both adults and children.This carpet is distinguished by the presence of different shaped convection.Therefore, walking barefoot on them helps train the leg muscles and activate blood circulation.This has a positive effect on the condition of the foot and increases the effectiveness of conservative treatment of planovalgus deformity.
Therefore, planovalgus foot deformity is a common orthopedic disease.It can reduce a person's quality of life and lead to the development of severe complications.Therefore, it is important to diagnose deviations from the norm as early as possible and undergo comprehensive treatment.But if the plano-valgus foot is diagnosed in adulthood, conservative therapy will only help prevent the development of the deformity.However, in the early form 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, the correct foot anatomy can be restored surgically.