Plano-valgus foot deformity

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 cause the development of arthrosis of the ankle, knee, hip joints, as well as diseases and curvature of the spine.Therefore, it is important not only to immediately diagnose planovalgus foot deformity, but also to start treatment immediately.This will stop the progression of the pathology.But in the last stages of development, the situation can be corrected only through 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 its longitudinal arch occurs against the background of impaired function of the tendon of the posterior tibial muscle.As a result, the axis of the foot becomes distorted.This is accompanied by a lowering of its middle part and a turning of the heel outward with its inner part adjacent to the supporting surface.In other words, the leg rotates 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 you take a standing position with the ankles touching 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 appearance of a pronounced cosmetic defect, but also with the development of a number of complications.These are:

• Bursitis is an inflammation of the synovial bursae of the leg joints.This is accompanied by redness of the skin on 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 appearance of gradually increasing pain.Subsequently, the formation of osteophytes is observed on the articular surfaces of the bones until they fuse with each other and immobilize the joint.With plano-valgus foot deformity, arthrosis can affect not only the joints of the foot, but also the ankle, knee and hip.
• Heel spurs are 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 while walking.This is often accompanied by inflammation of the Achilles tendon.
• Osteochondrosis are degenerative-dystrophic changes in the intervertebral discs, which lead to a decrease in their height and create the prerequisites for the formation of protrusions and intervertebral hernias.
• Curvature of the spine - can appear as deepening of physiological curves (kyphosis, lordosis) or development of scoliotic deformity.

reason

The central link in the development of the disease is the rotation (rotation) of the tail in the horizontal and sagittal planes.This leads to changes in the supporting points of the foot and the flattening of its arches.There are many factors that can contribute to this, but they are rarely seen in isolation.Most often, the causes of plano-valgus foot deformity lie in the combined action of a number of reasons.Therefore, the disease can be caused by:

• congenital connective tissue disorders;
• progression of flat feet of any kind;
• injuries of the lower extremities, especially the bones and ligaments of the legs;
• osteoporosis, i.e. a disease associated with a decrease in calcium content in bones, which leads to increased fragility;
• hormonal imbalances caused by endocrine diseases, especially diabetes mellitus, hypothyroidism, as well as physiological changes during pregnancy and menopause;
• the presence of excess weight and especially obesity, which is caused by increased load on the legs and excessive stretching of muscles and ligaments;
• neurological disorders, including poliomyelitis, cerebral palsy;
• brandy;
• excessive stress on the legs due to the need to stand, walk or engage in heavy physical work for a long time;
• wearing wrongly chosen shoes, i.e. with excessively narrow and/or high heels, which leads to impaired distribution of the load on the feet;
• foot abnormalities.

In the presence of congenital anomalies of development, as well as hereditarily caused hyperelasticity of the foot, plano-valgus feet can attract attention almost immediately after the birth of the child.But most often the pathology is diagnosed when the baby begins to walk.Often in such situations, disorders quickly worsen as a result of the wrong choice of 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 was not noticed and corrected, the disease remains in the person and tends to progress in the future when favorable conditions are created.In adults, plano-valgus foot deformity is more 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 symptoms.Therefore, if initially the pathology manifests itself only as a minor inconvenience, then in the later stages its manifestations can become an obstacle to leading an active lifestyle or even significantly complicate just movement.The disease is characterized by:

• pain in the legs, especially in the back, that worsens after prolonged standing, walking or physical work;
• ankle swelling;
• increased fatigue while walking;
• compression, corn formation, callus and skin pain in the area of the heads of the small metatarsal bones, aggravated by wearing high-heeled shoes and prolonged physical activity;
• X-shaped curvature of the legs, which over time leads to pain in the knees;
• displacement of the first toe, gradually leading to changes in the other toes (Hallux valgus);
• gait disorders.

Sometimes patients have an extra sesamoid bone in the area of the scaphoid bone.

Plano-valgus foot deformity increases the likelihood of an ingrown toenail.And its deviation to the side with a strong curvature provokes a change in the shape of the remaining fingers.As a result, they become curved, take the form 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 observed with the formation of a callus on its lateral surface, commonly called a lump or bone.This leads to difficulties in choosing shoes and makes it uncomfortable to wear the ones you already have.

Degrees of deformation

During the planovalgus deformity of the leg, 4 stages are distinguished, each of which is associated with a certain set of symptoms.These are:

• Stage 1 – there are still no bone deformities in the leg, but sometimes pain appears 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 posterior tibial tendon.And the angle of the heel in relation to the axis of the foot is not more than 10-15 °.
• Stage 2 - there is a slight deformity of the foot with the heel bone displaced by 15-20°.At the same time, in a state of rest, that is, when a person is lying down, the legs assume a normal shape.Since there is still no firmly fixed deformity, 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 is already fixed.In this case, the hind leg joints are no longer suitable for passive movements.The angle of the heel in relation to the axis of the foot is 20-30°.
• Stage 4 - the leg is severely deformed, completely flat, the axis of the ankle joint changes.When performing an x-ray and evaluating the images, a lateral tilt of the talus is visible.This is a direct sign of deltoid ligament failure.Deviation of the heel from the axis of the foot is 30° or more.

There are also flat foot stairs.For their diagnosis, 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 negatively affect the condition of the foot (obesity, frequent lifting and carrying of heavy objects, prolonged standing, ill-fitting shoes, etc.).

Diagnosing

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 attention to the history of the disease and the life of the patient.The data obtained during the survey provide the doctor with important information, thanks to which it will not only be possible to determine the causes of the deformity, but also to design an optimal treatment plan.

Great attention is paid to the symptoms of the disease, the conditions of their occurrence and the features of the progress.Orthopedics should clarify the nature of the pain, its location and duration, 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 assesses the mobility of the tarsal joints by asking the patient to stand on tiptoes, performing passive range of motion, and performing other tests.Orthopedics also assesses the condition:

• vessels of the lower extremities;
• the skin of the legs and feet, its temperature, the nature of hair distribution;
• sensitivity of both legs and feet;
• muscle tone of the lower extremities.

All this helps to 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, during the diagnosis of plano-valgus foot deformity, instrumental and laboratory research methods are necessarily prescribed to accurately determine the degree of changes in the foot and to clarify the nature of the required therapeutic measures.This:

• x-ray of the legs in 3 projections;
• plantography;
• podometry;
• UAC and OAM;
• Ultrasound of joints.

In difficult diagnostic cases, CT or MRI may be prescribed.These are modern methods for the study of 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 the appointment of conservative, i.e. non-surgical, therapy.Only in stages 3-4 of the disease can patients be immediately recommended for surgical intervention.

So, conservative treatment of flat foot valgus is always complex.It consists of:

• the use of individual orthopedic beds;
• wearing comfortable or orthopedic shoes;
• drug treatment;
• exercise therapy;
• therapeutic massage;
• kinesio taping;
• physiotherapy.

In addition, patients will be 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 the plano-valgus foot deformity is diagnosed, you should choose and wear only comfortable shoes with a fairly wide toe and a comfortable wide heel up to 3 cm high.They should be made of natural materials and 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 symptoms, improving the quality of life of patients and stopping the progression of the deformity.But it is possible to completely cure a valgus flat foot with their help only if the disorder is diagnosed in stage 1 in children.

If there is a hallux valgus deformity of a toe, special orthoses may be prescribed to move it into 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 regarding the physical regime, the choice of shoes, etc.;
• hypothermia and overheating;
• the presence of other orthopedic disorders that negatively affect the biomechanics of the legs;
• osteoporosis;
• infectious diseases.

Therefore, patients should avoid exposure to 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 set of measures prescribed by the doctor, patients continue to have pain and there are no positive dynamics, this may be a reason to consider the issue of surgery.

Custom orthopedic shoes and insoles

When plano-valgus foot deformity of any degree is diagnosed, patients are asked to wear individually made orthopedic insoles.They should be placed in regular shoes instead of those that came with them, and in the later stages of the development of the pathology - in special orthopedic ones.

Due to the fact that they are made in accordance with the structural features of the patient's left and right legs separately, they allow them to be given the most accurate anatomical 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.

Conventional mass-produced orthopedic insoles are not used for plano-valgus foot deformities.

Thus, individual orthopedic insoles help to correctly distribute the load on the feet.This leads to the exercise of over-relaxed muscles and the relaxation of over-strained ones, thus directly affecting the root cause of the development of flat feet.

In the first days, you should walk with an orthopedic mattress for 2-3 hours.This is due to the fact that initially they will cause discomfort, as the leg must be adjusted to the correct position.Gradually, the duration of wearing the 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 pads are deformed or worn, they must 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 unwanted consequences of valgus flat feet occur.It may consist of the following:

• corticosteroids – used to relieve severe inflammation, characteristic of bursitis, etc.;
• means that improve blood circulation - prescribed for congestive processes in the legs and the appearance of signs of varicose veins;
• chondroprotectors - are prescribed when degenerative-dystrophic changes occur in the joints, etc.

Exercise therapy

Physical therapy is an integral component of the treatment of planovalgus foot deformity.It is aimed at strengthening the posterior and anterior tibial muscles, the peroneal 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:

• rolling any cylindrical or round object on the floor, such asa roll or ball;
• walking on the toes and then on the outer parts of the feet;
• climbing an inclined board;
• working on an exercise bike or barefoot bike;
• grasping and lifting small objects from the floor with the toes;
• grasping and folding a newspaper or towel like an accordion with the toes;
• performing sliding movements with the foot of one foot on the foot of the other;
• sitting down in the "Turkish" position and rising from it.

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 should be done systematically.Therefore, classes should take place every day in a comfortable, unhurried environment.It would not hurt to take off your shoes and roll a ball with your foot at any convenient time, for example, when working on the computer.This will help relieve stress from your feet and improve your well-being.

Physiotherapy

To increase the effectiveness of the conservative treatment of valgus flat feet, courses of physiotherapeutic procedures are prescribed.They are indicated for foot deformities of degree 2 or higher and help not only to reduce the severity of the disease, but also produce a therapeutic effect.

In case of plano-valgus deformity of the leg, procedures are indicated that have an anti-inflammatory, analgesic and anti-edematous effect.But they can start only in the absence of an acute inflammatory process.As a rule, they are described:

• electrophoresis;
• magnetic 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, which involves attaching special elastic bands to the skin.They help to unload the necessary muscles and support others, as well as to correctly distribute the load on the supporting points of the foot.But for taping to work, the doctor applying the tapes must have a good understanding of technique and anatomy.

The strips 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.They do not interfere in any way and are practically not felt in the body.At the same time, the material of the strips breathes, which eliminates the risk of developing skin diseases.

Therapeutic massage

Massage for plano-valgus foot deformity aims to normalize the muscle tone of the lower extremities, develop joints and improve trophism by activating blood circulation.Thus, during a therapeutic massage session, the doctor will pay attention not only to the legs and sole muscles, but also to the muscles of the lower leg and thigh.

As a rule, it is recommended to undergo a course of therapeutic massage 4 times a year, consisting of 15-20 sessions.Thanks to them, a significant improvement in the condition of patients is observed, 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 the right one for both adults and children.These carpets are distinguished by the presence of convexities of different shapes.Therefore, walking barefoot on them helps exercise the leg muscles and activate 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 a deviation from the norm as soon as possible and undergo 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 completely sufficient to restore the 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 surgically restored.