Today, planovalgus foot deformity is one of the most common problems in trauma and orthopedics.This disease 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 arthritis of the ankle, knee, hip joints, as well as diseases and curvatures of the spine.Therefore, it is important not only to promptly diagnose planovalgus foot deformity, but also to begin treatment immediately.This will stop the progression of the pathology.But at the final stage of development, this condition can only be corrected with 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 posterior tibial tendon.As a result, the shaft of the foot is deformed.This is accompanied by lowering its medial part and turning the heel outward with the inner part adjacent to the supporting surface.In other words, the foot rolls inward, flattens, and in severe cases, an X-shaped bend in the leg is observed. This can be seen by the presence of a fairly large gap between the heels when in a standing position with the ankles touching each other.
According to various authors, similar problems occur in 15-58% of people.
Plano-valgus foot deformity not only causes obvious aesthetic defects, but also leads to the development of a number of complications.This is:
- Bursitis is an inflammation of the bursa of the foot joint.This is accompanied by redness of the skin on the protruding part of the affected joint, swelling, pain, which tends to increase with mechanical impact.
- Arthritis – degenerative-dystrophic changes in cartilage tissue, accompanied by its thinning and the appearance of gradually increasing pain.Then, the formation of osteophytes is observed on the articular surfaces of the bones until they fuse together and immobilize the joint.With plano-valgus foot deformity, arthritis can affect not only the foot joints but also the ankle, knee and hip joints.
- Heel spurs are the result of the plantar fascia being stretched too much and forming a protrusion on one side of the heel bone, leading to sharp pain in the heel area when walking.This is often accompanied by Achilles tendonitis.
- Cartilage degeneration is degenerative-dystrophic changes in the intervertebral discs, leading to loss of height and setting the stage for the formation of protrusions and herniations between vertebrae.
- Curvature of the spine - can manifest as deeper physiological curves (kyphosis, scoliosis) or the development of scoliosis deformity.
Reason
The central link in the development of the disease is the rotation (rotation) of the talus in the horizontal and vertical planes.This leads to changes in the foot's support points and flattening of the arches.There are many factors that can contribute to this, but they are extremely rarely observed individually.Usually, the cause of plano-valgus foot deformity lies in a combination of several reasons.Therefore, the disease can come from:
- congenital connective tissue disorders;
- progression of flat feet of any kind;
- injuries to the lower extremities, especially the bones and ligaments of the foot;
- osteoporosis, i.e. a disease accompanied by a decrease in calcium content in bones, leading to increased fragility;
- Hormonal imbalance due to endocrine diseases, especially diabetes, 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 feet and excessive tension of the muscles and ligaments;
- neurological disorders, including polio and cerebral palsy;
- rickets;
- excessive stress on the feet due to standing, walking, or doing heavy labor for long periods of time;
- wearing improperly selected shoes, i.e. too narrow shoes and/or high heels, leading to impaired load distribution on the foot;
- foot abnormalities.
In the presence of congenital developmental defects, as well as hereditary increased elasticity of the feet, flat feet can attract attention almost immediately after the child is born.But often the pathology is diagnosed when the child begins to walk.Often in such situations, the disorder is quickly aggravated by 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 is not noticed and corrected, the disease will still exist in humans and will later tend to progress when favorable conditions are created.In adults, plano-valgus foot deformity often worsens during pregnancy or due to weight gain, often related to 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 in the form of minor discomfort, then at a later stage its manifestations can become an obstacle to an active lifestyle or even significantly complicate simple movement.The disease is characterized by:
- pain in the feet, especially the back, that worsens after standing, walking, or doing heavy work for long periods of time;
- ankle swelling;
- increased fatigue when walking;
- compaction, formation of corns, calluses and skin soreness in the head area of the small metatarsal bones, aggravated by wearing high heels and prolonged physical activity;
- The legs are bent in an X shape, leading to knee pain over time;
- displacement of the first toe, gradually leading to changes in the other toes (Hallux valgus);
- gait disorder.
Sometimes patients have additional sesamoid bones in the scaphoid region.
Plano-valgus foot deformity increases the likelihood of ingrown toenails.And deviation to the side with a strong curvature will cause a change in the shape of the remaining fingers.As a result, they become curved, claw-shaped, and the joints thicken.This is called a hammertoe deformity.
At the same time, in the area of the ankle joint, growth of the joint is also observed with the formation of callus on its lateral surface, commonly called a nodule or bone.This leads to difficulties when choosing shoes and makes wearing your original shoes uncomfortable.
Deformation
During the plano-valgus deformity of the foot, 4 stages are distinguished, each of which is accompanied by a certain set of symptoms.This is:
- Stage 1 – there is still no bone deformity in the foot, but sometimes there is pain in the posterior tibial tendon area, especially after standing or walking for long periods of time.This can be complicated by tenosynovitis, which is inflammation of the posterior tibial tendon.And the angle of the heel relative to the shin axis is no more than 10-15°.
- Stage 2 – the foot is slightly deformed with the heel bone being dislocated 15-20°.At the same time, in a state of rest, that is, when a person lies down, the foot has a normal shape.Because there is no rigid fixed deformity, therapeutic massage is a very effective treatment method at this stage.But this does not eliminate the need for other conservative treatments.
- Stage 3 – foot deformity has been corrected.In this case, the joints of the hind feet are no longer able to comply with passive movements.The angle of the heel relative to the shin axis is 20-30°.
- Stage 4 – the foot is severely deformed, completely flat, the ankle joint axis changes.When X-rays and imaging assessments are performed, lateral tilt of the talus may be seen.This is a direct sign of a torn deltoid ligament.Deviation of the heel from the shin axis is 30° or more.
There is also a degree of flat feet.To diagnose them, the angle of the longitudinal arch and the angle between the metatarsals are measured using X-ray images, as well as the height of the arch in millimeters.
The pathology tends to progress, especially rapidly under the influence of factors that negatively affect the condition of the feet (obesity, frequent lifting and carrying of heavy objects, standing for a long time, wearing shoes incorrectly, etc.).
Diagnose
If there are signs of planovalgus foot deformity, it is important to consult an orthopedist as soon as possible.And although the disease can be diagnosed based on examination results, doctors always pay close attention to the patient's medical history and life.The data obtained during the survey provide the doctor with important information, thanks to which it is possible not only to determine the cause of the deformation, but also to devise an optimal treatment plan.
Close attention should be paid to the symptoms of the disease, the conditions of its occurrence and the characteristics of its progression.The orthopedist must clarify the nature of the pain, its location and duration, the presence of neurological disorders, limitations in physical activity, etc.
After this, an orthopedic examination is required.During this procedure, the doctor evaluates the mobility of the ankle joint by asking the patient to stand on tiptoes, perform passive movements, and conduct other tests.Chiropractors also evaluate the condition:
- pulse of the lower extremities;
- foot skin, temperature, hair distribution;
- sensitivity of both feet and legs;
- 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 allows you to choose the most effective treatment tactics aimed at eliminating all existing disorders.
In addition, when diagnosing plano-valgus foot deformity, laboratory and instrumental research methods are necessarily prescribed to accurately determine the degree of changes in the foot and clarify the nature of the necessary treatment measures.This:
- 3-projection x-ray of the foot;
- botany;
- geometric measurements;
- UAC and OAM;
- Joint ultrasound.
In cases where the diagnosis is difficult, CT or MRI may be indicated.These are modern methods for studying bones and soft tissues, providing 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 therapy, that is, non-surgical therapy.Only at stages 3-4 of the disease are patients recommended for immediate surgical intervention.
Therefore, conservative treatment of hallux valgus is always complicated.It includes:
- use individual orthopedic insoles;
- wear comfortable or orthopedic shoes;
- drug treatment;
- exercise therapy;
- massage therapy;
- kinesio recording;
- physical therapy.
Additionally, patients will be advised to take weight loss measures if they show signs of obesity and to avoid wearing tight shoes or high heels.From the moment of diagnosis of plano-valgus foot deformity, you should choose and wear only comfortable shoes with a fairly wide toe and a comfortably wide heel up to 3 cm high.They must be made of natural materials and not squeeze the feet.
Shoes with completely flat soles such as ballet flats, Crocs or Uggs are also contraindicated.
All of these methods are aimed at eliminating symptoms, improving the patient's quality of life and stopping the progression of the deformity.But flat feet can be completely cured with their help only if the disorder is diagnosed at stage 1 in children.
If a toe has a hallux valgus deformity, special orthotics may be prescribed to move it into the correct position.
All patients should understand that the planovalgus foot deformity process is negatively affected by:
- smoke;
- the presence of chronic diseases that reduce immunity;
- violation of the doctor's recommendations regarding physical regimen, shoe choice, 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 exposure to these factors to increase treatment effectiveness.Moreover, if 3 months after starting conservative treatment and implementing all the measures prescribed by the doctor, the patient continues to have pain and lacks positive motivation, this may be a reason to consider the issue of surgery.
Custom orthopedic insoles and shoes
When diagnosing plano-valgus foot deformity of any degree, the patient must wear custom-made orthotic insoles.They should be placed in regular shoes instead of walking shoes, and in later stages of pathological development - in special orthopedic shoes.
Because they are tailored to the structural features of the patient's left and right feet separately, they allow them to achieve the most anatomically precise positioning.This is the key to restoring normal biomechanics of movement, eliminating leg fatigue, swelling and pain.In addition, they restore the normal axis of the joint, which can significantly reduce the risk of complications.
Conventional mass-produced orthotic insoles are not used for plano-valgus foot deformities.
Therefore, individual orthotic insoles help to correctly distribute the load on the foot.This leads to exercise of overstretched muscles and relaxation of overstretched muscles, i.e. it directly affects the underlying cause of the development of flat feet.
In the first days, you need to walk with the orthopedic insole for 2-3 hours.This is because they will initially cause discomfort as the legs need to be repositioned.Gradually, the time of wearing the insole is increased, reaching the maximum possible.In most cases, patients get used to it and can wear it all day without problems after 2 weeks.
If the sole is deformed or worn, it should be replaced with a new one.To do this, you will again need to contact an orthopedist who will take individual measurements and send them to production with his comments.
Treatment with medication
Medical treatment when uncomplicated 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 health.
Medical treatment is also indicated if unwanted consequences of flat feet occur.It may include the following:
- corticosteroids – used to reduce severe inflammation, characteristic of bursitis, etc.;
- means improves blood circulation - prescribed for congested processes in the feet and the appearance of signs of varicose veins;
- chondroprotector - prescribed when degenerative-dystrophic changes in the joints, etc. occur.
Exercise therapy
Physical therapy is an integral part 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 muscles.
For each patient, the necessary 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:
- rolling any cylindrical or circular object on the floor, such as a rolling pin or ball;
- walk on your toes then walk on the outside of your foot;
- climb up an inclined plank;
- working out on an exercise bike or bike barefoot;
- grasp and lift small objects on the floor with your toes;
- grasp and fold a newspaper or towel like an accordion with your toes;
- perform a sliding movement with the foot of one leg on the shin of the other leg;
- Sit in the “Turkish” position and stand up from it.
Swimming has a very good effect on the condition of the legs.Therefore, if the patient has the opportunity, he should go to the swimming pool at least 2-3 times a week.
But exercise therapy needs to be done systematically.Therefore, classes should be conducted daily in a comfortable, unhurried environment.It won't hurt to take off your shoes and roll the ball with your foot at any convenient moment, for example, when working in front of a computer.This will help reduce stress on your feet and improve your health.
Physical therapy
To increase the effectiveness of conservative treatment of flat valgus feet, physiotherapy courses are prescribed.They are indicated for grade 2 or higher foot deformities and not only help reduce the severity of the disease but also provide effective treatment.
In case of plano-valgus deformity of the foot, procedures are indicated that have an anti-inflammatory, analgesic and anti-edema effect.But they can be started only in the absence of an acute inflammatory process.As a rule, they are prescribed:
- electrophoresis;
- magnetic therapy;
- psychodynamic therapy;
- UVT;
- electrical stimulation of the muscles of the legs and feet;
- ozokerite and paraffin applications;
- mud therapy.
Kinesio recording
Kinesio tape is a new method for the medical treatment of orthopedic disorders and the consequences of trauma, which involves applying special elastic tapes to the skin.They help release the necessary muscles and support others, as well as correctly distribute the load on the support points of the foot.But for tape to be effective, the doctor applying the tape must understand the technique and anatomy.
The bandage is made from hypoallergenic material and stays on for an average of 5 days.You can wear any pair of shoes with you, play sports, take a bath, etc.They do not cause any problems and there is practically no sensation in the body.At the same time, the material of the bandage is breathable, helping to eliminate the risk of skin diseases.
Massage therapy
Massage for plano-valgus foot deformity is aimed at normalizing muscle tone of the lower limbs, developing joints and improving nutrition by activating blood circulation.Thus, during a therapeutic massage session, the doctor will pay attention not only to the feet and calf muscles, but also to the muscles of the lower legs and thighs.
As a rule, a course of therapeutic massage should be carried out 4 times a year, consisting of 15-20 sessions.Thanks to them, the patient's condition noticeably improves, eliminating the most disturbing symptoms of planovalgus foot deformity, or at least reducing 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 one suitable for both adults and children.These rugs are distinguished by the presence of protrusions of different shapes.Therefore, walking barefoot on them helps to train the foot 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 significantly reduce a person's quality of life and lead to the development of serious complications.Therefore, it is important to diagnose deviations from the norm as early as possible and undergo comprehensive treatment.But if plano-valgus foot is diagnosed in adulthood, conservative therapy will only help prevent progression of the deformity.However, in the initial 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.