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 progresses over time and leads to changes in other joints as well as the spine.This significantly worsens the quality of life, and can even cause the development of ankle, knee and hip arthrosis, as well as spine diseases and curvatures.Therefore, it is not only important to immediately diagnose planovalgus foot deformity, but also to start treatment immediately.This stops the progression of the pathology.But in the final stages of development, the situation can only be improved by surgery.
What is planovalgus foot deformity?
Plano-valgus deformity of the foot is a change in the structure of the foot, in which a decrease in the size of the longitudinal arch occurs due to damage to the function of the tendons of the posterior tibial muscle.As a result, the axis of the foot is distorted.This is accompanied by a lowering of its central part and a turning of the heel outwards so that its inner part is connected to the supporting 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 presence of a fairly large distance between the heels when standing and the ankles touch each other.
According to various authors, a similar problem occurs in 15-58% of people.
Plano-valgus foot deformity is fraught not only with the occurrence of a pronounced cosmetic defect, but also with the development of many complications.These are:
- Bursitis is an inflammation of the synovial bursa of the leg joints.This is accompanied by reddening of the skin in the projection of the affected joint, swelling, pain, which intensifies as a result of mechanical action.
- Arthrosis - degenerative-dystrophic changes in cartilage tissue, accompanied by thinning and gradually increasing pain.After that, the formation of osteophytes is observed on the articular surfaces of the bones until they fuse with each other and immobilize the joint.In the case of plano-valgus foot deformity, arthrosis can affect not only the joints of the foot, but also the ankle, knee and hip joints.
- Heel spurs are the result of excessive stretching of the plantar fascia and 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 the degenerative-dystrophic changes of the intervertebral discs, which lead to a decrease in their height and create the prerequisites for the development of protrusions and intervertebral hernias.
- The curvature of the spine - can manifest itself in the deepening of physiological curvatures (kyphosis, lordosis) or the development of 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 fulcrum of the foot and flattening of the arches.Many factors can contribute to this, but they are extremely rarely observed individually.Most often, the causes of plano-valgus foot deformity lie in the combined effect of several causes.Therefore, the cause of the disease can be:
- congenital connective tissue disorders;
- progression of any type of flat feet;
- injuries of the lower limbs, especially the bones and ligaments of the legs;
- osteoporosis, i.e. a disease associated with a decrease in the calcium content of the bones, which leads to increased fragility;
- hormonal imbalances caused by endocrine diseases, especially diabetes, hypothyroidism, and physiological changes during pregnancy and menopause;
- the presence of excess weight and, in particular, obesity, which is caused by increased load on the legs and overstretching of muscles and ligaments;
- neurological disorders, including polio, cerebral palsy;
- rickets;
- excessive strain on the legs due to long periods of standing, walking or heavy physical work;
- wearing improperly chosen shoes, i.e. wearing too narrow and/or high-heeled shoes, which leads to the distribution of the foot load;
- foot disorders.
In the case of congenital malformations and hereditary hyperelasticity of the foot, the 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.In such situations, disorders often worsen quickly due to poor choice of shoes, insufficient physical activity, or, on the contrary, excessive and inappropriate physical activity.
In most cases, plano-valgus foot deformity develops in childhood.If the disorder is not detected and corrected during this period, the disease will remain with the person and will progress in the future if favorable conditions arise.In adults, plano-valgus foot deformity is most often aggravated 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 the symptoms.Therefore, if the pathology appears initially only as a minor inconvenience, then its manifestations in the later stages can hinder an active lifestyle or even significantly complicate simple movement.The disease is characterized by:
- pain in the legs, especially in the back, worsening after prolonged standing, walking or physical work;
- ankle swelling;
- increased fatigue while walking;
- compaction, corns, calluses and skin pain in the area of the head of the small metatarsal bones, aggravated by wearing high heels and prolonged physical activity;
- X-shaped curvature of the legs, which over time leads to knee pain;
- displacement of the first toe, which gradually leads to changes in the other toes (Hallux valgus);
- gait disturbances.
Sometimes patients have an additional sesamoid bone in the area of the scaphoid bone.
Plano-valgus foot deformity increases the likelihood of ingrown toenails.And the lateral deviation of the strong curvature changes the shape of the remaining fingers.As a result, they bend, take the shape of claws, and the joints thicken.This is called hammer toe deformity.
At the same time, the growth of the joint can be observed in the area of the metatarsophalangeal joint, and a callus is formed on its lateral surface, which is popularly called a knot or a bone.This leads to difficulties when choosing shoes and makes it uncomfortable to wear existing shoes.
Degrees of deformation
During the plano-valgus deformation of the foot, 4 stages are distinguished, each of which is accompanied by certain symptoms.These are:
- Stage 1 - there are still no bony deformities in the foot, but sometimes there is pain in the area of the posterior tibial tendon, especially after prolonged standing or walking.This can be complicated by tenosynovitis, i.e. inflammation of the back tendon of the tibia.And the angle of the heel relative to the axis of the leg is no more than 10-15 °.
- Stage 2 – slight deformation of the foot, the heel bone moves by 15-20°.At the same time, in a state of rest, i.e. when a person is lying down, the legs take on a normal shape.Since there is no rigidly fixed deformation yet, therapeutic massage is a very effective treatment method at this stage.However, this does not eliminate the need for other means of conservative therapy.
- Stage 3 – the deformity of the foot is already fixed.In this case, the hind leg joints are no longer suitable for passive movements.The angle of the heel compared to the axis of the leg is 20-30°.
- Stage 4 – the foot is severely deformed, completely flat, the axis of the ankle joint changes.When taking the X-ray and evaluating the images, the lateral tilt of the talus can be seen.This is a direct sign of deltoid ligament failure.The deviation of the heel from the axis of the leg is 30° or more.
There are also graduated flat feet.For their diagnosis, the angle of the longitudinal arch and the intermetatarsal angle, as well as the height of the arch in millimeters, are measured using X-rays.
The pathology tends to progress, especially quickly under the influence of factors that negatively affect the condition of the feet (obesity, frequent lifting and carrying of heavy objects, prolonged standing, inappropriate shoes, etc.).
Diagnostics
If signs of planovalgus foot deformity appear, it is important to consult an orthopedist as soon as possible.And although the disease can be diagnosed based on the results of the examination, the doctor always pays a lot of attention to the history of the disease and the patient's life.The data obtained during the survey provide the doctor with important information, thanks to which it is possible not only to determine the causes of the deformity, but also to prepare an optimal treatment plan.
Increased attention is paid to the symptoms of the disease, the circumstances of their occurrence, and the characteristics of the progression.The orthopedist must clarify the nature, location and duration of the pain, the presence of neurological disorders, the presence of limitations in physical activity, etc.
After that, an orthopedic examination is required.In this procedure, the doctor evaluates the mobility of the tarsal joints by asking the patient to rise on the tip of the toes, perform passive movements, and perform other tests.The orthopedist also evaluates the condition:
- vessels of the lower limbs;
- the skin of the feet and legs, its temperature, the nature of the distribution of the fur;
- tenderness of both legs and feet;
- muscle tone of the lower limbs.
All this helps to determine the possible causes and consequences of the development of plano-valgus foot deformity.This makes it possible to choose the most effective treatment tactics aimed at eliminating all existing disorders.
In addition, during the diagnosis of plano-valgus foot deformity, instrumental and laboratory research methods are necessarily prescribed to accurately determine the extent of changes in the foot and to clarify the nature of the necessary therapeutic measures.This:
- leg X-ray in 3 views;
- botany;
- pedometry;
- UAC and OAM;
- Ultrasound of joints.
In difficult diagnostic cases, CT or MRI may be prescribed.These are modern methods of studying bones and soft tissues, which provide the most accurate and detailed data on their condition.
Conservative treatment of planovalgus foot deformity
The treatment of planovalgus foot deformity almost always begins with the appointment of conservative, i.e. non-surgical, therapy.Only in stage 3-4 of the disease can immediate surgical intervention be recommended to patients.
Therefore, the conservative treatment of flat-valgus feet is always complex.It consists of:
- use of unique orthopedic insoles;
- wearing comfortable or orthopedic shoes;
- medication;
- exercise therapy;
- therapeutic massage;
- kinesio taping;
- physiotherapy.
In addition, patients are advised to take measures to lose weight if signs of obesity are present and to avoid wearing tight shoes or high heels.From the moment that plano-valgus foot deformity is diagnosed, choose and wear only comfortable shoes with a fairly wide toe and a comfortable wide heel, up to 3 cm high.They must be made of natural materials and must not squeeze the leg.
Shoes with completely flat soles, such as ballet flats, Crocs or Uggs, are also contraindicated.
All these methods are aimed at eliminating the symptoms, improving the quality of life of the patients and stopping the progression of the deformity.However, a complete cure of flat-valgus foot is possible only if the disorder is diagnosed in children at the 1st stage.
If one toe has a hallux valgus deformity, a special orthosis may be prescribed to put it in the correct position.
All patients should understand that the course of planovalgus foot deformity is negatively affected by:
- smoking;
- the presence of chronic diseases that reduce immunity;
- violation of the doctor's recommendations on physical routine, choice of shoes, etc.;
- hypothermia and overheating;
- the presence of other orthopedic disorders that negatively affect the biomechanics of the foot;
- osteoporosis;
- infectious diseases.
Therefore, patients should avoid these factors in order 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, patients are still in pain and there is no positive dynamics, this may be a reason to consider the issue of surgery.
Custom orthopedic insoles and shoes
When diagnosing any degree of plano-valgus foot deformity, patients must wear custom-made orthopedic insoles.Instead of the shoes delivered with them, they should be placed in normal shoes, and in the later stages of the development of the pathology, in special orthopedic shoes.
Given that they are made separately according to the structural characteristics of the patient's left and right foot, they allow them to have the most anatomically appropriate position.This is the key to restoring normal biomechanics of movements, eliminating leg fatigue, swelling and pain.In addition, they restore the normal axis of the joints, which can significantly reduce the risk of complications.
Traditional mass-produced orthopedic insoles are not used in the case of plano-valgus foot deformities.
Thus, individual orthopedic insoles help to distribute the load on the foot correctly.This leads to the training of excessively relaxed muscles, the relaxation of overstretched muscles, i.e. it directly affects the root cause of flat feet.
In the first days, you must walk with orthopedic insoles for 2-3 hours.This is due to the fact that they initially cause discomfort, as the leg needs to be adjusted to the correct position.The duration of wearing the insole gradually increases, reaching 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 insole is deformed or worn, replace it with new ones.To do this, you will again need to contact an orthopedic doctor, 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, it aims to reduce the severity of pain.For this purpose, patients are advised to occasionally use NSAIDs in the form of products intended for internal use or in the form of ointments, gels and creams.They help to quickly relieve pain and improve well-being.
Drug therapy is also prescribed if undesirable consequences of flat-valgus feet occur.It may consist of:
- corticosteroids - used to relieve severe inflammation, typical of bursitis, etc.;
- means that it improves blood circulation - it is prescribed for stagnant 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
Physiotherapy is an integral part of the treatment of planovalgus foot deformity.Its purpose is to strengthen the back and front muscles of the tibia, the peroneal muscle group and the gastrocnemius.
For each patient, the necessary exercises are selected individually, taking into account the degree of pathological changes, age and other factors.The following exercises are usually prescribed:
- rolling any cylindrical or round object, such as a rolling pin or ball, on the floor;
- walking on the toes and then on the outer parts of the feet;
- climbing on an inclined board;
- working on an exercise bike or barefoot bike;
- grasping and lifting small objects from the floor with the toes;
- grasping a newspaper or towel and folding it like an accordion with your toes;
- performing sliding movements with the foot of one leg on the leg of the other;
- sitting in the "Turkish" position and getting up from there.
Swimming has a very good effect on the condition of the legs.Therefore, if the patient has the opportunity, it is recommended to visit the pool at least 2-3 times a week.
But exercise therapy must be done systematically.Therefore, classes should be held daily in a comfortable environment, without rushing.It would not hurt to take off your shoes and roll a ball with your feet at any time, for example when you are working on the computer.This will help relieve stress on your feet and improve your well-being.
Physiotherapy
Physiotherapy procedures are prescribed to increase the effectiveness of conservative treatment of flat valgus feet.They are indicated for foot deformities of degree 2 or higher, and not only reduce the severity of the disease, but also have a therapeutic effect.
In the case of plano-valgus deformity of the foot, procedures are recommended that have an anti-inflammatory, pain-relieving and anti-edema effect.But they can only be started in the absence of an acute inflammatory process.These are usually prescribed:
- electrophoresis;
- magnet therapy;
- diadynamic therapy;
- UVT;
- electrical stimulation of the muscles of the lower leg and foot;
- ozokerite and paraffin applications;
- mud therapy.
Kinesio taping
Kinesio taping is a new method of treating orthopedic disorders and the consequences of injuries in medicine, during which special elastic tapes are glued to the skin.They help relieve the necessary muscles and support others, as well as the correct distribution of the load on the support points of the foot.But for the taping to work, the doctor applying the tape needs to know the technique and anatomy well.
The tapes are made of hypoallergenic materials and are applied for an average of 5 days.You can wear any shoes with them, play sports, shower, etc.It does not bother you in any way and is practically not felt on the body.At the same time, the material of the bands breathes, which eliminates the risk of developing skin diseases.
Therapeutic massage
The purpose of the massage performed in the case of plano-valgus foot deformity is to normalize the muscle tone of the lower limbs, develop the joints and improve trophism by activating blood circulation.Thus, during a therapeutic massage, the doctor pays attention not only to the foot and plantar muscles, but also to the leg and thigh muscles.
In general, it is recommended to perform a therapeutic massage 4 times a year, which consists of 15-20 sessions.Thanks to them, the patients' condition improves noticeably, the most disturbing symptoms of planovalgus foot deformity disappear, or at least their intensity decreases.
An additional bonus is the purchase of a special massage mat.Today there are many models from which you can choose the right one for both adults and children.These carpets are characterized by different shaped embossments.Therefore, walking barefoot on them helps train the leg muscles and activates blood circulation.This has a positive effect on the condition of the legs 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 the deviation from the norm as early as possible and carry out comprehensive treatment.But if the plano-valgus foot is diagnosed in adulthood, conservative therapy will only help prevent the progression of the deformity.However, in the initial forms of the disease, this is quite sufficient to restore normal quality of life and maintain the ability to lead an active lifestyle.In other cases, and when conservative treatment is ineffective, the proper anatomy of the foot can be restored surgically.