Nowadays, planovalgus foot deformity is one of the most common problems in traumatology and orthopedics.This pathology occurs in both children and adults.However, the disease progresses over time and leads to changes in other joints and the spine.This significantly reduces the quality of life and can even lead to the development of arthrosis of the ankle, knee and hip joints as well as diseases and curvatures of the spine.Therefore, it is important not only to diagnose planovalgus foot deformity in a timely manner, but also to begin treatment immediately.This stops the progression of the pathology.However, at the final stage of development, the situation can only be corrected by surgery.
What is Planovalgus Foot Deformity?
Plano-valgus deformity of the foot is a change in the structure of the foot, in which, against the background of impaired function of the tendon of the posterior tibial muscle, there is a reduction in its longitudinal arch.This leads to a deformation of the foot axis.This is accompanied by a lowering of the middle part and an outward rotation of the heel, with its inner part resting on 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 fact that there is a relatively large distance between the heels when standing and touching the ankles.
According to various authors, a similar problem occurs in 15-58% of people.
Plano-valgus foot deformity is associated not only with the appearance of a pronounced cosmetic defect, but also with the development of a number of complications.These are:
- Bursitis is an inflammation of the bursa of the ankle joints.This is accompanied by redness of the skin in the projection of the affected joint, swelling and pain, which tend to increase with mechanical impact.
- Osteoarthritis – degenerative-dystrophic changes in cartilage tissue, accompanied by its thinning and the appearance of gradually increasing pain.The formation of osteophytes is then observed on the articular surfaces of the bones until they fuse together and render the joint immobile.With plano-valgus foot deformity, osteoarthritis can affect not only the joints of the foot, but also the ankle, knee and hip joints.
- A heel spur is a result of excessive stretching of the plantar fascia and the formation of a protrusion on the side of the heel bone, causing stabbing pain in the heel area when walking.This is often 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 the conditions for the formation of protrusions and disc hernias.
- Curvature of the spine – can manifest itself in a deepening of physiological curvatures (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 planes.This leads to changes in the support points of the foot and a flattening of the arch of the foot.There are many contributing factors, but they are extremely rarely observed in isolation.The most common causes of plano-valgus foot deformity are a combination of several reasons.Therefore, the disease can have the following causes:
- congenital connective tissue disorders;
- Progression of flat feet of any kind;
- Injuries to the lower extremities, particularly the bones and ligaments of the feet;
- Osteoporosis, i.e.h.a disease associated with a decrease in calcium content in bones, resulting in increased brittleness;
- hormonal imbalances caused by endocrine diseases, particularly diabetes mellitus, hypothyroidism, as well as physiological changes during pregnancy and menopause;
- the presence of overweight and especially obesity, caused by increased load on the foot and overstretching of muscles and ligaments;
- neurological disorders, including polio, cerebral palsy;
- Rickets;
- excessive stress on the feet due to prolonged standing, walking or heavy physical work;
- Wearing incorrectly selected shoes, i.e.h.heels that are too narrow and/or high, resulting in impaired load distribution on the foot;
- Anomalies of the foot.
If there are congenital developmental anomalies as well as hereditary hyperelasticity of the foot, plano-valgus feet can become noticeable 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, a rapid aggravation of the symptoms occurs due to the choice of incorrect shoes, insufficient physical activity or, conversely, excessive and inappropriate physical activity.
In most cases, plano-valgus foot deformity develops in childhood.If the disorder was not noticed and corrected during this period, the disease remains with the person and tends to progress in the future when favorable conditions are created.In adults, plano-valgus foot deformity most often worsens during pregnancy or due to weight gain that usually accompanies a sedentary lifestyle.
Symptoms of plano-valgus foot deformity
Plano-valgus foot deformity is characterized by a gradual increase in the intensity of symptoms.If at first the pathology manifests itself only as minor discomfort, then in 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, which worsens after prolonged standing, walking or physical work;
- swelling of the ankles;
- increased fatigue when walking;
- Densification, formation of corns, calluses and pain of the skin in the area of the heads of the small metatarsals, 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;
- Displacement of the first toe, which gradually leads to changes in other toes (hallux valgus);
- Gait disorders.
Sometimes patients have an additional sesamoid bone in the scaphoid area.
A plano-valgus foot deformity increases the likelihood of an ingrown toenail.And its lateral deviation with strong curvature leads to a change in the shape of the rest of the fingers.As a result, they bend, 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 of the big toe, growth of the joint is also observed with the formation of a callus on its lateral surface, which is popularly called a bump or bone.This leads to difficulty choosing shoes and makes wearing existing shoes uncomfortable.
Degrees of deformation
There are 4 stages of plano-valgus deformity of the foot, each of which is accompanied by certain symptoms.These are:
- Stage 1 – there are no bone deformities in the foot yet, but pain sometimes occurs in the area of the posterior tibialis tendon, especially after standing or walking for a long time.This can be complicated by tenosynovitis, an inflammation of the posterior tibial tendon.And the angle of the heel relative to the axis of the shin is no more than 10-15°.
- Stage 2 – there is a slight deformation of the foot with a dislocation of the heel bone by 15-20°.At the same time, the feet take on a normal shape when at rest, i.e. when lying down.Since there is no rigidly fixed deformation yet, therapeutic massage is a very effective treatment method at this stage.However, this does not make other conservative therapeutic measures superfluous.
- Stage 3 – the foot deformity is already resolved.In this case, the joints of the hindfoot are no longer accessible for passive movements.The angle of the heel to the shin axis is 20-30°.
- Stage 4 – the foot is severely deformed, completely flat, the axis of the ankle joint changes.When taking x-rays and evaluating the images, a sideways tilt of the talus is noticeable.This is a direct sign of delta ligament failure.The deviation of the heel from the shin axis is 30° or more.
There are also degrees of flat feet.For diagnosis, the angle of the longitudinal arch and the intermetatarsal angle are measured using x-ray images as well as the height of the arch in millimeters.
The 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, incorrect footwear, etc.).
diagnosis
If signs of planovalgus foot deformity occur, it is important to see an orthopedist as soon as possible.And although the disease can be diagnosed based on the examination results, the doctor always pays close attention to the patient's medical history and life.The data obtained during the survey provides the doctor with important information, thanks to which not only can the causes of the deformity be determined, but also an optimal treatment plan can be drawn up.
Particular attention is paid to the symptoms of the disease, the conditions of its occurrence and the features of its progression.The orthopedist must clarify the nature of the pain, its location and duration, the presence of neurological disorders, the presence of limitations in physical activity, etc.
An orthopedic examination is then required.During this procedure, the doctor assesses the mobility of the tarsal joints by asking the patient to stand on tiptoes, perform passive movements, and perform other tests.The orthopedist also assesses the condition:
- vessels of the lower extremities;
- the skin of the feet and legs, its temperature, the nature of hair distribution;
- tenderness of both feet and legs;
- Muscle tone of the lower extremities.
All of the above helps determine the possible causes and consequences of developing plano-valgus foot deformity.This allows you to choose the most effective treatment tactics aimed at eliminating all existing disorders.
Even when diagnosing plano-valgus foot deformity, instrumental and laboratory research methods are necessarily prescribed in order to accurately determine the extent of the changes in the foot and clarify the type of therapeutic measures required.The:
- X-ray of the feet in 3 projections;
- plantography;
- podometry;
- UAC and OAM;
- Ultrasound of joints.
In difficult diagnostic cases, a CT or MRI may be prescribed.These are modern methods for examining bones or soft tissues that provide the most accurate and detailed data about their condition.
Conservative treatment of planovalgus foot deformity
Almost always, the treatment of planovalgus foot deformity begins with the appointment of conservative, that is, non-surgical therapy.Only in stage 3-4 of the disease can patients be recommended immediate surgical intervention.
Therefore, the conservative treatment of a flat valgus foot is always complex.It consists of:
- Use of individual orthopedic insoles;
- wearing comfortable or orthopedic shoes;
- drug treatment;
- exercise therapy;
- therapeutic massage;
- Kinesio taping;
- Physiotherapy.
In addition, patients are advised to take weight loss measures if signs of obesity are present and to avoid wearing tight shoes or high heels.From the moment plano-valgus foot deformity is diagnosed, you should choose and wear only comfortable shoes with a relatively wide toe and a comfortable wide heel up to 3 cm high.They must be made of natural materials and must not crush the foot.
Shoes with completely flat soles such as ballerinas, Crocs or Uggs are also contraindicated.
All of these methods are aimed at eliminating symptoms, improving the quality of life of patients and stopping the progression of the deformity.However, complete healing of flat valgus foot with their help is possible only if the disease is diagnosed in stage 1 in children.
If a toe is hallux valgus deformed, special orthoses can be prescribed to put it in the correct position.
All patients should understand that the course of planovalgus foot deformity is negatively affected by:
- Smoke;
- the presence of chronic diseases that reduce immunity;
- Violation of doctor's recommendations regarding physical activity, choice of shoes, etc.;
- hypothermia and overheating;
- the presence of other orthopedic diseases that negatively affect the biomechanics of the feet;
- Osteoporosis;
- Infectious diseases.
Therefore, patients should avoid contact with these factors to increase the effectiveness of therapy.In addition, if 3 months after the start of conservative treatment and the implementation of the entire package of measures prescribed by the doctor, pain continues to occur and positive dynamics do not appear, this may be a reason to think about surgery.
Custom orthopedic insoles and shoes
When a plano-valgus foot deformity of any extent is diagnosed, the wearing of custom-made orthopedic insoles is required.They should be put in regular shoes instead of the included shoes, and in later stages of the development of the pathology - in special orthopedic shoes.
Since they are manufactured separately according to the structural characteristics of the patient's left and right foot, they enable the most anatomically correct position possible.This is key to restoring normal movement biomechanics and eliminating leg fatigue, swelling and pain.In addition, they restore the normal joint axis, which can significantly reduce the risk of complications.
Conventional mass-produced orthotics are not used for plano-valgus foot deformities.
Individual orthopedic insoles help to correctly distribute the load on the foot.This results in overly relaxed muscles being trained and overused muscles being relaxed, i.e.h.it directly affects the cause of the development of flat feet.
In the first few days you will have to walk for 2-3 hours with orthopedic insoles.This is because they initially cause discomfort as the leg needs to be returned to the correct position.Gradually, the wearing time of the insoles is extended and reaches the maximum possible.In most cases, patients get used to them and can wear them all day without any problems after 2 weeks.
If the insoles become deformed or worn out, they should be replaced with new ones.To do this, you will again have to contact an orthopedist who will take individual measurements and send them to production with his comments.
Drug therapy
In the absence of complications of planovalgus foot deformity, drug therapy is symptomatic.In other words, the goal is to reduce the severity of the pain.For this purpose, patients are recommended to occasionally use NSAIDs in the form of internal products or ointments, gels and creams.They help you quickly relieve pain and improve your well-being.
Even if undesirable consequences of flat valgus occur, drug therapy is prescribed.It can consist of the following:
- Corticosteroids – to relieve severe inflammation characteristic of bursitis, etc.;
- Means that improve blood circulation - prescribed for congestion processes in the foot and the appearance of signs of varicose veins;
- Chondroprotectors – prescribed when degenerative-dystrophic changes occur in joints, etc.
Movement therapy
Physiotherapy is an integral part of the treatment of planovalgus foot deformity.The aim is to strengthen the posterior and anterior shin muscles, the peroneus muscle group and the gastrocnemius.
For each patient, the set of necessary 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 cylindrical or round objects on the floor, such as:B. a rolling pin or a ball.
- Walking on the toes and then on the outer parts of the feet;
- climbing on an inclined board;
- working barefoot on an exercise bike or bicycle;
- Use your toes to grab and lift small objects from the floor;
- grasp and fold a newspaper or towel with your toes like an accordion;
- Perform sliding movements with the foot of one leg on the shin of the other;
- Sitting in the “Turkish” position and getting up from it.
Swimming has a very good effect on the condition of the feet.Therefore, if the patient has the opportunity, it is recommended to visit the swimming pool at least 2-3 times a week.
But exercise therapy must be carried out systematically.Therefore, classes should take place daily in a comfortable, unhurried environment.It wouldn't hurt to take off your shoes and roll a ball with your foot at any time, for example when working at the computer.This relieves your feet and improves your well-being.
Physiotherapy
To increase the effectiveness of conservative treatment of flat valgus foot, physiotherapeutic procedures are prescribed.They are indicated for foot deformities of the 2nd degree or higher and not only help alleviate the severity of the disease, but also have a therapeutic effect.
In the case of plano-valgus deformity of the foot, interventions that have anti-inflammatory, analgesic and anti-edematous effects are indicated.However, they can only be started if there is no acute inflammatory process.As a rule, they are prescribed:
- electrophoresis;
- magnetic field therapy;
- diadynamic therapy;
- UVT;
- electrical stimulation of the lower leg and foot muscles;
- ozokerite and paraffin applications;
- Mud therapy.
Kinesio taping
Kinesio taping is a new method for treating orthopedic diseases and the consequences of injuries in medicine, in which special elastic tapes are glued to the skin.They help to relieve the necessary muscles and support others, as well as to correctly distribute the load on the support points of the foot.In order for taping to work, the doctor applying the tape must have a good understanding of the technique and anatomy.
Tapes are made of hypoallergenic materials and are applied for an average of 5 days.You can wear any shoes, play sports, take a shower, etc. They don't bother you in any way and are practically not noticeable on your body.At the same time, the material of the tapes is breathable, which eliminates the risk of skin diseases.
Therapeutic massage
Massage for plano-valgus foot deformity is aimed at normalizing muscle tone of the lower extremities, developing joints and improving trophism by activating blood circulation.Therefore, during a therapeutic massage, the doctor pays attention not only to the foot and sole muscles, but also to the lower leg and thigh muscles.
As a rule, it is recommended to undergo therapeutic massage four times a year with 15 to 20 sessions.Thanks to them, there is a noticeable improvement in the condition of patients, elimination of the most disturbing symptoms of planovalgus foot deformity or at least a reduction in their intensity.
An additional bonus is purchasing a special massage mat.Today there are many models among which you can choose the right one for both adults and children.These carpets are characterized by the presence of differently shaped bulges.Therefore, walking barefoot helps to train the foot muscles and activate blood circulation.This has a positive effect on the condition of the feet and increases the effectiveness of conservative treatment of planovalgus deformity.
Thus, planovalgus 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.However, if plano-valgus foot is diagnosed in adulthood, conservative treatment can only help prevent the deformity from progressing.However, in the first forms of the disease, this is quite enough 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 anatomy of the foot can be restored surgically.