Valgus deformation of the feet is most often congenital. However, in some cases - with paralysis, traumatic lesions - can appear already in the mature period of life. The main symptoms of pathology are soreness in the area of the feet and muscles of the lower leg, a visible violation of the shape of the feet, as well as a change in gait. Diagnosis of the disease is carried out using a clinical examination, x -ray, electromyography, etc. Treatment includes conservative and surgical methods. However, proper effectiveness is observed only in reconstructive operations.
What is this ailment?
Valgus deformation is the curvature of the foot, characterized by the flattening of its longitudinal arch. Typically, the inner edge of the foot is lowered ("drops"), and the heel turns out.
The foot of a person, by virtue of his location, takes on the pressure of the entire mass of the human body. For this reason, it has a special anatomical structure, which allows depreciation, balancing and stabilizing movements. However, an important component for the implementation of these tasks is the correct stop form.
Today, the most important problem of traumatology and orthopedics is the valgus deformation of the foot. The meeting is estimated at 30-58%, where 2/3 of cases make up congenital disorders.
The pathology is largely socially significant, becausecovers all age groups of the population, and also helps to curvated the spinal column, the early development of osteochondrosis and arthrosis of the joints of the lower extremities.
When you take the feet (if you look at them from behind), a X-like deformation is formed at the ankle level: the ankles are in contact, while the heels are at a distance of 5-6 centimeters from each other.
Most often, pathology is congenital in nature and is diagnosed in children back in the hospital (or immediately after the start of walking). A similar condition is adjusted up to 5 years, after which (in the absence of proper treatment), a child develops flat feet.
Why does it arise?
It is believed that the main reason for the appearance of valgus deformation of the foot is an inadequate function of the posterior tibial muscle or weakness of the ligamentous apparatus.
Today, other factors in the development of pathology are distinguished:
- Congenital abnormalities with the incorrect location of the bones of the feet or shortening of the tendons (vertical ram bone, short heap tendon);
- Posture disorders when deformation of the feet compensates for the curvature of the spinal column;
- Traumatic lesions (fractures of the bones of the feet, lower legs, hips or knee, ruptures of the ligamentous and tendon apparatus);
- Paralysis (immobilization) due to damage to the nervous system for encephalitis, poliomyelitis, stroke, infringement of cerebrospinal melts for hernias, etc. ;
- Spasm (constant contraction) of the muscles of the lower leg;
- Concomitant diseases: pathology of the bone system with vitamin D (rickets), diabetes mellitus, osteoporosis (reduction of bone density), impaired thyroid and parathyroid glands, etc. ;
- Increased body weight, including a quick weight gain in menopause or during pregnancy.
The development of pathology is also facilitated by incorrectly selected shoes or excessive correction of clubfoot in childhood.
Degree and stage of the disease
The severity of the pathology (power of manifestation) is divided by degrees:
- Light with a vault height of 1. 5-2 centimeters and an angle of inclination of the heel to 15 degrees;
- The average, when the arch is flattened to the 1st centimeter, and the angle decreases to 10 degrees;
- Heavy at the height of the vault up to 0. 5 cm and the angle of inclination of the heel is 5 degrees.
Depending on the involvement of certain structures, the following stages of curvature are distinguished:
- There are no bone deformations, pain is determined on the inner surface of the ankle (in the area of fastening of the posterior tibial muscle);
- The curvature is light, the heel is slightly rejected;
- The foot is allotted, and the deformation is fixed (not correctly corrected);
- Wending is observed not only in the foot, but also in the ankle joint.
Symptoms
At the first stage, patients are disturbed by periodic pain after prolonged walks or long vertical loads (standing or sitting on the foot). As a rule, the pain syndrome intensifies when walking in improperly selected shoes. The next stage of the disease is associated with the occurrence of the curvature of the foot: patients in the standing position do not rely on the outer edge of the foot, but with its entire area. A slight change in the gait is observed.
At the third stage, the protrusion of the thawed bone is determined (noticeably lower than the ankle on the inner surface of the ankle), as well as a strong divert of the heel outside (the patient stands based on the inner edge of the heel bone). The advanced valgus deformation of the feet is characterized by a pronounced curvature of both the foot itself and the ankle joint. Patients complain of severe pain in the lower leg muscles, as well as a significant gait violation: the knees rub against each other, while the right and left foot are located at some distance.
The severe curvature of the feet is often complicated by deformation of the spinal column (scoliosis with different positions of the shoulders and wings of the pelvis), osteochondrosis (damage to the intervertebral disk with the formation of a hernia) or arthrosis (premature wear of intraarticular cartilage in the lower leg, knee and hip rod).
How to diagnose?
Diagnosis of the curvature of the foot consists of:
- The clinical inspection, during which the orthopedist detects a decrease in the arches of the foot, the deviation of the heel and ram bones, the visible "disappearance" of the outer and the protrusion of the internal ankles.
- X -ray - an affordable and informative method with which you can determine the change in the angles of the bone inclination and linear parameters of their relationship. These indicators are necessary to make a final diagnosis and clarify the degree of deformation.
- The method of registering steps aimed at determining the exact functional state of the limb. The method consists in registering the time of the support of individual parts of the foot when performing a step. In the course of the study, the phases of the foot rolling are also studied, which reflect the balance of the muscles of the lower limb.
- Dynamic electromyography, which records the electrical activity of the studied muscles and its dependence on the step phase.
- PhotoPlesmography with digital processing that allows you to obtain all standard indicators and determine the type/degree of curvature with high accuracy.
An additional consultation of a neurologist (with deformations due to spasms or paralysis), endocrinologist (in the case of diabetes or disorders of thyroid/parathyroid gland) and gynecologist (when the menacing) may be required. If the curvature of the foot appeared against the background of osteoporosis, densitometry is necessary - the study of bone density.
Treatment
Among the main methods of treating valgus curvature of the feet, conservative and operational are distinguished. Do not destroy sore joints with ointments and injections!
Conservative approach
This type of help is aimed at getting rid of the symptoms of the disease, but does not eliminate the root cause of the pathology.
The technique includes:
- the use of orthopedic insoles to support the I plus bone, the arch of the foot, as well as the elimination of the valgus lesions of the middle and back of the foot;
- Taping - fixing the foot and ankle using special adhesive ribbons with proper elasticity. The tape tape is worn around the clock within 3-5 days, after which they are replaced;
- sewing orthopedic shoes by individual standards;
- The use of orthosis and other fixing devices on the foot and ankle.
Conservative methods also include physiotherapeutic procedures (ozokerite, paraffin applications, electrophoresis, magnetic effects), massage and a complex of physiotherapy exercises, developed for a specific clinical case. Be careful! Today, most experts prefer surgical methods of treatment, becauseConservative therapy is ineffective (according to statistics, it is useless in 60% of cases).
Surgical intervention
The volume of operation and its type depend on the direct stage of the disease. Thus, the first degree of valgus deformation is treated by synovectomy (removal of the tendon shell for the correction of the general tension) or the osteotomy (dissection) of the heel in order to return to the anatomically correct position. At the second stage of the development of the disease, transplantation of the tendon bends of the fingers is used. Such an intervention is usually carried out against the background of dissection of the heel or a ram-lobed arthrodesis (surgical immobilization of the joint between the ram and scaphoid bones).
The curvature of the III degree requires arthrodesis of several joints of the foot at once: the plus-free, five-cup-cubic and ram-desired. Such three -pounding immobilization is often complemented by dissection of the heel bone. At the IV stage of pathology, reconstructive operations are needed not only on the foot, but also on the ankle. In this case, the instability of the ligamentous apparatus is adjusted using transplants (from their own body or artificial materials). The volume of operations on the foot itself is the same as with the III degree of curvature.
Recovery period
Rehabilitation includes walking without support on the operated leg for 2 months. At the same time, the patient needs to wear removable gypsum longshit from 1. 5 to 3 months. Active movements in the operated foot are recommended to start after 1. 5 months after surgery. By the 3rd month, a complex of strengthening physical education is introduced. However, subsequently patients are prohibited from bumpy walking and active sports activities. It is worth noting that it is possible to judge the final result of surgery only six months later.
Preventive measures
Prevention of valgus deformation of the stop includes the following measures:
- Early correction of congenital anomalies with the improper arrangement of the bones of the feet or shortening of tendon grains (vertical thawed bone, short heel tendon);
- Correction of posture disorders (scoliosis, etc. );
- Timely treatment of traumatic lesions (fractures of the bones of the feet, lower leg, thigh or knee joint, ruptures of the ligamentous and tendon apparatus);
- The correct rehabilitation after paralysis (immobilization) due to damage to the nervous system for encephalitis, poliomyelitis, stroke, infringement of cerebrospinal roots for hernias, etc. ;
- Relief of spasm (constant reduction) of the muscles of the lower leg;
- Therapy for concomitant diseases: pathologies of the bone system with vitamin D (rickets) deficiency, diabetes mellitus, osteoporosis (reduction of bone density), impaired function of thyroid and parathyroid glands, etc. ;
- A decrease in body weight to normal (especially with a quick weight gain in postmenopause or due to pregnancy);
- Selection of orthopedic shoes or the use of Supinators;
- Moderate correction of clubfoot without "hyper-correction"-excess treatment leading to secondary valgus-excretion of the feet.
Prevention of progression of the disease is to use conservative methods and early reconstructive operations. In this case, physical activity is limited in order to prevent the destruction and curvature of the ankle joints. Remember, timely treatment of valgus deformation of the feet not only improves the quality of life of patients, but also prevents the development of osteochondrosis and arthrosis of the knee or hip joints!