And now it’s time for a new conversation with the doctor. This time we will talk about another medical and social problem of our time – flat feet. Read the article and walk the path of life boldly with the whole family!
Flat feet correction. Doctor says The best advice from our top experts
General information
From the name itself, it can be understood that flat feet 一 is a deformity of the foot, which manifests itself in a decrease in its longitudinal and transverse arches. With flat feet, under the influence of adverse factors, the foot twists along the axis with a sharp decrease in its arches. In this regard, during standing and walking, the main load falls on the flattened inner edge of the feet. If normally the foot acts as a spring, then with flat feet there is a significant loss of their spring properties.
Our foot performs a number of important functions:
- support;
- spring (depreciation);
- motor;
-
balancing.
In the body, the spring function of the musculoskeletal system is provided by: physiological bends, intervertebral discs, and longitudinal and transverse arches of the feet. The smoothness and ease of gait depend on the condition of the foot. For a better understanding of the problem, I will briefly describe the anatomical features of this important part of the body.
foot anatomy
The foot consists of three vaults or arches. The external arch extends from the outer surface of the calcaneal tubercle of the calcaneus to the head of the fifth metatarsal.
The internal arch is located from the calcaneus to the head of the first metatarsal bone, and the apex of the internal longitudinal arch is the tuberosity of the navicular bone. The transverse arch runs from the head of the first to the head of the fifth metatarsal. The inner longitudinal and transverse arches perform the spring function of the foot and the outer longitudinal arches support. With a decrease in the internal longitudinal arch, a longitudinal flat foot is formed, and with a decrease in the transverse arch, a transverse one.
In the formation of the arches of the feet, an important role is played not only by the optimal relative position of the bones of the tarsus, metatarsus, and phalanges of the fingers but also by the coordinated work of the muscles of the lower leg and foot. In children, in comparison with adults, subcutaneous fat is more developed on the foot, therefore, up to 3 years, flattening of the arches of the feet is physiological.
The main vessels and nerves of the foot are located in the region of the internal longitudinal arch, therefore, with prolonged dynamic or static loads on the lower limbs, pain occurs in the foot. From compression of the plantar arteries, blood circulation is disturbed, which is clinically expressed in the appearance of edema of the feet.
Flatfoot classification
According to the anatomical feature, flat feet are divided into longitudinal and transverse.
With longitudinal flat feet, functional insufficiency of the anterior and posterior tibial muscles, the short flexor of the fingers, the square muscle of the sole and the long flexor of the fingers is manifested.
Transverse flatfoot is characterized by functional insufficiency of the muscle that removes the thumb and interosseous muscles.
The latter is rare and usually occurs in women. Due to overload of the forefoot when wearing high-heeled shoes.
According to the etiological – to congenital and acquired, which includes rachitic, traumatic, static, and paralytic.
Congenital flat foot is relatively rare. It is caused by an intrauterine malformation.
Rachitic flat feet is observed in preschool children who have had rickets. The deformation of the foot in this case occurs under the influence of the gravity of the body on rickety bones and the articular-ligamentous apparatus of the foot. Prevention and treatment of rachitic flat feet are closely related to the prevention and treatment of the underlying disease.
Paralytic flatfoot occurs when one or both of the tibial muscles, as well as the short muscles of the foot, are paralyzed, most often due to polio.
The cause of static (most common) flat feet is considered to be a weakness of muscle tone, and extreme muscle fatigue due to prolonged stay on the legs in certain professions, with an increase in body weight for a short period of time. Often, flat feet are formed when wearing irrational shoes (narrow, high heels). The flattening of the arches of the feet affects the position of the pelvis and spine, so flat feet are usually accompanied by the development of various types of posture disorders.
Symptoms and Classification of flat feet in Children
Symptoms of flat feet are increased fatigue when walking, pain in the calf muscles during long walking, and by the end of the day, a decrease in physical performance.
One of the manifestations of flat feet can be headaches as a result of a reduced spring function of the feet. A sign of pronounced flat feet is a change in the shape of the foot. It flattens and expands, especially in the middle part. At the same time, the heel is pronated 一 goes to the outside.
Longitudinal flatfoot
In the initial stage of the disease, children complain only of fatigue in the legs, increased fatigue after a long walk or static load. Then the pain in the legs intensifies, deformity of the feet appears, it becomes more and more difficult to find comfortable shoes, the inner part of the heel, which bears a large load, is more strongly trampled, the feet swell. With a flat-valgus foot, the heel and forefoot deviate to the outside in the form of the letter X, pain points appear on the sole (in the center of the internal longitudinal arch), under the ankles, in the muscles of the lower leg, in the knee and hip joints, in the lumbar region (due to a violation of posture ).
Transverse flatfoot
Gradually, the transverse arch blurs and a fan-shaped divergence of the fingers is formed. In the future, the first toe deviates outward, other fingers are deformed, “corns” and swelling appear on the sole. Pain points are determined between the heads of the metatarsal bones, especially at the base of the second and third fingers, as well as in the muscles of the lower leg, thighs and lower back.
Diagnosis of flat feet in children
The diagnosis of flat feet is made on the basis of anamnesis data (the age of the child, his living conditions, past diseases), complaints, visual examination of the feet in standing load and unloading (kneeling on a chair with freely hanging feet) and objective examination data (podometry, plantography and radiography ).
The foot is lubricated with one of the listed substances, then a clear imprint is made on light paper. The trace must be immediately outlined with a pencil to avoid vague contours. The plantogram technique is so simple that it can be done at home. But the same orthopedic doctor will evaluate the plantogram after the necessary measurements. The most accurate and objective method of examining the feet is x-ray. Currently, computer podography is used for this, based on the identification of local overload areas between the foot and the support, the symmetry of the load distribution between the feet. With its help, the dynamics of the condition of the feet, as well as the result of the treatment, are evaluated.
So, the patient was examined, the necessary examination was carried out and a diagnosis was made. So what is next?
Treatment of flat feet: arch supports and insoles
Further treatment will follow, which should be complex: massage, gymnastics, physiotherapy, biofeedback method and, of course, orthopedic therapy. Correction is most effective during the period of growth, since at this time the musculoskeletal system is being formed. This period lasts for 10-12 years, but the optimal correction of deformities at the age of 4-6 years.
o correct flat feet, as a rule, ordinary comfortable rational shoes are not enough. With a mild degree, arch supports and orthopedic insoles are prescribed. Arch supports can be cork, plastic or metal. They make walking easier by taking on some of the load. Shown for long walks during excursions, walks and hiking. It is not recommended to use them constantly, as atrophy of the arches of the feet quickly develops.
Orthopedic insoles are used for insufficiency of the musculoskeletal apparatus of the foot. Their main function is to distribute the load between the foot and the supporting surface.
Depending on the type of deformity, children are prescribed two types of insoles:
- vault-forming. They are made with the lining of the inner and outer longitudinal arches of the foot and are used to prevent the progression of the disease;
- vault-supporting. The place for laying out the inner and outer longitudinal arches is combined with an additional arch support of the heel section, as well as a high internal hard visor.
Insoles are made of genuine leather or synthetic materials, selected in an orthopedic salon along the length of the foot and worn in shoes with a back during the day. As the foot grows, it is necessary to change the size of the insoles.
Choice of orthopedic shoes
With an average degree of flat feet, orthopedic shoes are used, which do not correct the deformity, but improve the motor and static function of the limbs and prevent incorrect fixation of the position of the foot. Made from genuine leather. Orthopedic shoes are not prescribed for children under three years of age. In 10% of children, due to irregular treatment or its absence, flat feet cannot be corrected. In the absence of the effect of wearing orthopedic shoes, to normalize the ratio of bones in the talonavicular joint, stage splints made of gypsum or polivik with or without lacing are used. Splints ensure the correct positioning of the bones of the foot during the growth of the child.
Treatment of flat feet: massage and physiotherapy
With flat-valgus foot, physiotherapy is also successfully used. To stimulate the relaxed muscles of the inner surface of the lower leg and the sole of the foot, electrical neurostimulating currents are shown. On the contrary, on the contracted muscles of the outer surface of the lower leg and the dorsum of the foot, thermal procedures are shown for relaxation – paraffin, ozocerite and mud applications. The course of treatment is 15-20 procedures, during the year 3-4 such courses.
Physiotherapy goes well with massage.
Massage tasks:
- strengthening the muscles that support the arches of the feet;
- removal of fatigue in individual muscles;
- pain reduction;
-
restoration of the spring function of the stop.
Grinding, kneading and shock vibration are performed on the muscles of the inner surface of the lower leg and sole of the foot. Relaxing techniques are performed on the muscles of the outer surface of the lower leg: stroking, light rubbing and continuous vibration. The duration of the session is 15-20 minutes. The course of treatment is 12-15 sessions.
During the year, two massage courses are held, while you need to know that thermal procedures always precede massage.
Exercises for flat feet
Remedial gymnastics is an obligatory means of rehabilitation.
It will help to increase the strength endurance of the muscles of the lower extremities, correct the deformity of the feet, increase physical performance, educate and consolidate the skill of correct posture and the correct installation of the feet.
Before classes, it is advisable to massage the feet. Special gymnastic exercises are used in the position of unloading the feet in the initial position lying or sitting. In the classes, various simulators and objects are actively used: a ball, a gymnastic stick.
Walking exercises:
- on socks;
- on the outer vault;
- “goose step”;
- on socks in a semi-squat;
- with the turn of the feet with the heels out and toes in;
- on socks with high hips;
- sliding step with fingers bent;
- on a ribbed board;
- along a gymnastic stick along and across;
- on an inclined plane on toes;
- on a log on socks;
- dance steps on socks;
-
walking on stuffed balls.
Exercises in the initial standing position:
- lifting on toes together and alternately;
- rolling from heel to toe and back;
- half squat and squat on toes;
- semi-squat and squat heels apart and toes together;
- lifting the heels without lifting the toes off the floor;
- squat on a gymnastic stick;
- semi-squat on a gymnastic rail with a grip at chest level;
-
ball balancing.
Exercises in the initial sitting position:
- legs parallel, lifting heels together and alternately;
- dorsiflexion of the feet together and alternately;
- lifting the heel of one foot and the toe of the other;
- capturing small objects with toes and shifting them;
- sed in Turkish;
- raking with the fingers of the feet of a cloth rug;
-
kicking balls.
Exercises in the starting position lying down:
- pulling socks;
- feet on the floor, breeding heels to the sides and back;
- alternately lifting the heels from the support;
- the legs are bent, the hips are apart, the feet touch the soles of each other;
- abduction and adduction of the feet in the heel area with emphasis on the forefoot;
- circular motion of the feet;
- sliding the foot along the clay of the other leg;
-
lying on the stomach push-ups from the floor, legs on toes;
In addition, the classes include climbing on a rope and a gymnastic wall, jumping rope, jumping with a ball sandwiched between the feet, jumping on toes on one leg and on two alternately. Classes should be held at home daily.