Plano-valgus foot deformity

Today, flat valgus foot deformity is one of the most common problems in traumatology and orthopedics.This pathology occurs in 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 to not only promptly diagnose the planovalgus foot deformity, but also to begin treatment immediately.This will stop the progression of the pathology.But in the final stages of development, the situation can only be corrected through surgery.

What is plano valgus foot deformity?

Plano-valgus deformity of the foot is a change in the structure of the foot, in which there is a decrease in the size of its longitudinal arch in a context of compromised function of the posterior tibial muscle tendon.As a result, the axis of the foot becomes distorted.This is accompanied by a lowering of its midsection and a turning of the heel outward with its inner portion adjacent 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, with the ankles touching.

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 a number of complications.These are:

• Bursitis is an inflammation of the synovial bursae in the joints of the feet.This is accompanied by redness of the skin in the projection of the affected joint, swelling, pain, which tends to intensify with mechanical action.
• Arthrosis – degenerative-dystrophic changes in the cartilaginous tissue, accompanied by its thinning and the occurrence of gradually increasing pain.Subsequently, the formation of osteophytes is observed on the articular surfaces of the bones until they fuse and immobilize the joint.With planovalgus foot deformity, osteoarthritis can affect not only the foot joints, but also the ankle, knee and hip joints.
• Heel spurs are a consequence of excessive stretching of the plantar fascia and the formation of a protrusion on the side of the heel bone, which causes sharp pain in the heel area when walking.This is often accompanied by inflammation of the Achilles tendon.
• Osteochondrosis is a degenerative-dystrophic change in the intervertebral discs, which leads to a decrease in their height and creates the prerequisites for the formation of intervertebral protrusions and hernias.
• Spinal curvature - may manifest as deepening of physiological curves (kyphosis, lordosis) or 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 plane.This leads to changes in the foot's support points and the flattening of its arches.Many factors can contribute to this, but they are rarely observed in isolation.Most often, the causes of planovalgus foot deformity lie in the combined action of a number of reasons.Therefore, the disease can result from:

• congenital connective tissue diseases;
• progression of flat feet of any type;
• injuries to the lower extremities, especially bones and ligaments of the feet;
• osteoporosis, that is, a disease accompanied by a decrease in the calcium content in bones, which leads to increased fragility;
• hormonal imbalances caused by endocrine diseases, namely 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 feet and excessive stretching of muscles and ligaments;
• neurological disorders, including polio, cerebral palsy;
• rickets;
• excessive stress on the feet due to the need to stand, walk or perform heavy physical work for a long time;
• wearing incorrectly selected shoes, that is, excessively narrow and/or high heels, which leads to impaired distribution of the load on the foot;
• foot anomalies.

In the presence of congenital developmental anomalies, as well as hereditary hyperelasticity of the foot, planovalgus feet can attract attention almost immediately after the birth of the child.However, more often, the pathology is diagnosed when the baby begins to walk.Often in such situations, disorders quickly worsen as a result of choosing the wrong footwear, insufficient physical activity or, conversely, excessive and inappropriate physical activity.

In most cases, planovalgus foot deformity develops in childhood.If during this period the disorder was not noticed and corrected, the disease remains with the person and in the future tends to progress when favorable conditions are created.In adults, planovalgus foot deformity worsens more often during pregnancy or due to weight gain, which is often associated with a sedentary lifestyle.

Plano-Valgus Foot Deformity Symptoms

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 discomfort, in the later stages its manifestations can become an obstacle to an active lifestyle or even significantly complicate simple movement.The disease is characterized by:

• foot pain, especially in the back, worsening after standing, walking or doing physical work for a long time;
• swelling of the ankles;
• increased fatigue when walking;
• compaction, formation of corns, calluses and pain in the skin in the region of the heads of the small metatarsal bones, aggravated by wearing shoes with heels and prolonged physical activity;
• X-shaped curvature of the legs, which over time leads to knee pain;
• displacement of the first toe, gradually leading to changes in the other toes (Hallux valgus);
• gait disturbances.

Sometimes patients have an accessory 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 strong curvature causes a change in the shape of the other fingers.As a result, they become curved, take on the shape of claws, and the joints become thicker.This is called hammertoe deformity.

At the same time, in the region of the metatarsophalangeal joint, growth of the joint is also observed with the formation of a callus on its lateral surface, popularly called a lump or bone.This makes it difficult to choose shoes and makes it uncomfortable to wear the ones you already have.

Degrees of deformation

During plano-valgus deformity of the foot, 4 stages are distinguished, each of which is accompanied by a certain set of symptoms.These are:

• Stage 1 – there are still no bone deformities in the foot, but sometimes pain occurs in the region of the posterior tibial tendon, especially after standing or walking for a long time.This can be complicated by tenosynovitis, i.e. inflammation of the posterior tibial tendon.And the angle of the heel in relation to the shin axis is no more than 10-15°.
• Stage 2 – there is a slight deformation 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 feet acquire a normal shape.As there is no rigidly fixed deformation yet, therapeutic massage is a very effective treatment method at this stage.But this does not eliminate the need for other means of conservative therapy.
• Stage 3 – the foot deformity has already been corrected.In this case, the rearfoot joints are no longer amenable to passive movement.The angle of the heel in relation to the shin axis is 20-30°.
• Stage 4 – the foot is severely deformed, completely flat, the axis of the ankle joint changes.When taking an x-ray and evaluating the images, a lateral tilt of the talus is visible.This is a direct sign of deltoid ligament insufficiency.The deviation of the heel in relation to the shin axis is 30° or more.

There are also degrees of flat feet.To diagnose them, the longitudinal arch angle and the intermetatarsal angle are measured using radiographic images, as well as the height of the arch in millimeters.

The 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, inappropriate footwear, etc.).

Diagnosis

If signs of a planovalgus foot deformity occur, it is important to consult an orthopedist as soon as possible.And although the disease can be diagnosed based on the test results, the doctor always pays close attention to the history of the disease and the patient's life.The data obtained during the examination provides the doctor with important information, thanks to which it will not only be possible to determine the causes of the deformity, but also to draw up an optimal treatment plan.

Much attention is paid to the symptoms of the disease, the conditions of its occurrence and the features of progression.The orthopedist must clarify the nature of the pain, its location and duration, the presence of neurological disorders, the presence of restrictions on 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 tiptoe, performing passive movements and carrying out other tests.The orthopedist also evaluates the condition:

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

All this helps to determine the possible causes and consequences of the development of planovalgus foot deformity.This allows you to select the most effective treatment tactics, which will be aimed at eliminating all existing disorders.

In addition, when diagnosing planovalgus foot deformity, instrumental and laboratory research methods are necessarily prescribed to accurately determine the extent of changes in the foot and clarify the nature of the necessary therapeutic measures.That:

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

In cases that are difficult to diagnose, computed tomography or magnetic resonance imaging may be prescribed.These are modern methods of studying bones and soft tissues, respectively, which provide more 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 can patients be immediately recommended for surgical intervention.

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

• use of individual orthopedic insoles;
• wear comfortable or orthopedic shoes;
• drug treatment;
• exercise therapy;
• therapeutic massage;
• kinesio tape;
• physiotherapy.

Additionally, patients will be advised to take steps to lose weight if there are signs of obesity and to avoid wearing tight shoes or high heels.From the moment the planovalgus foot deformity is diagnosed, you should choose and wear only comfortable shoes, with a very wide toe box and wide, comfortable heels of up to 3 cm in height.They should be made from natural materials and not squeeze the foot.

Shoes with completely flat soles, such as flats, Crocs or Uggs, are also contraindicated.

All of these methods aim to eliminate symptoms, improve patients' quality of life and prevent 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 at stage 1 in children.

If there is hallux valgus deformity of a toe, special orthotics may be prescribed to move it into the correct position.

All patients should understand that the course of the planovalgus foot deformity is negatively affected by:

• smoking;
• the presence of chronic diseases that reduce immunity;
• violation of the doctor's recommendations regarding physical regime, choice of footwear, etc.;
• hypothermia and overheating;
• the presence of other orthopedic diseases that negatively affect the biomechanics of the feet;
• 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 experience 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 planovalgus foot deformity of any degree, patients are required to wear individually made orthopedic insoles.They should be put on regular shoes instead of accompanying shoes, and at later stages of the development of pathology - in special orthopedic shoes.

As they are made according to the structural characteristics of the patient's left and right feet separately, they allow them to be given the most anatomically correct position.This is the key to restoring normal movement biomechanics, 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 planovalgus foot deformities.

Thus, individual orthopedic insoles help to correctly distribute the load on the foot.This leads to the training of overly relaxed muscles and the relaxation of overworked muscles, that is, it directly affects the root cause of the development of flat feet.

In the first few days, you need to walk with orthopedic insoles for 2 to 3 hours.This is due to the fact that they will initially cause discomfort as the leg needs to be readjusted to the correct position.Little by little, the time of use of the insoles 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 insoles become deformed or worn out, they must be replaced with new ones.To do this, you will need to contact an orthopedist again, who will take individual measurements and send them to production with your comments.

Drug therapy

Drug therapy in the absence of complications of planovalgus foot deformity is symptomatic.In other words, it aims to reduce the intensity of pain.To this end, it is recommended that patients 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 undesirable consequences of flat valgus foot 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 foot and the appearance of signs of varicose veins;
• chondroprotectors - 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 aims to strengthen the posterior and anterior tibial muscles, the peroneal muscle group and the gastrocnemius.

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 round object on the floor, such as a rolling pin or ball;
• walking on toes and then on the outer parts of the feet;
• climb an inclined board;
• work on an exercise bike or bicycle barefoot;
• grasp and lift small objects from the floor with the toes;
• grab and fold a newspaper or towel like an accordion with your toes;
• perform sliding movements with the foot of one leg on the shin of the other;
• sitting in the “Turkish” position and getting up from it.

Swimming has a very good effect on the condition of the feet.Therefore, if the patient has the opportunity, it is recommended that he visit the pool at least 2-3 times a week.

But exercise therapy needs to be done systematically.Therefore, classes should be held daily in a comfortable and 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 at the computer.This will help relieve stress from your feet and improve your well-being.

Physiotherapy

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

In the case of plano-valgus deformity of the foot, procedures that have anti-inflammatory, analgesic and anti-edematous effects are indicated.But they can only be started in the absence of an acute inflammatory process.As a rule, the following are prescribed:

• electrophoresis;
• magnetic therapy;
• diadynamic therapy;
• UVT;
• electrical stimulation of leg and foot muscles;
• ozokerite and paraffin applications;
• mud therapy.

Kinesio recording

Kinesio taping is a new method of treating orthopedic diseases and the consequences of injuries in medicine, which involves gluing special elastic tapes to the skin.They help to unload the necessary muscles and support others, as well as correctly distribute the load on the support points of the foot.But for the tape to work, the doctor applying the tapes must have a good knowledge of the technique and anatomy.

The tapes are made from hypoallergenic materials and are applied for an average of 5 days.You can wear any shoes with them, play sports, take a shower, etc.They do not interfere with anything and are practically not felt in the body.At the same time, the material of the tapes breathes, which eliminates the risk of developing skin diseases.

Therapeutic massage

Massage for planovalgus foot deformity aims to normalize muscle tone in the lower extremities, develop joints and improve trophism, activating blood circulation.Therefore, during a therapeutic massage session, the doctor will pay attention not only to the feet and plantar muscles, but also to the leg and thigh muscles.

As a rule, it is recommended to undergo a course of therapeutic massage 4 times a year, consisting of 15 to 20 sessions.Thanks to them, there is a noticeable improvement in the condition of patients, 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 adults and children.These rugs are distinguished by the presence of convexities of different shapes.Therefore, walking barefoot on them helps train the foot muscles and activate blood circulation.This has a positive effect on the condition of the feet and increases the effectiveness of conservative treatment of plano valgus 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 deviation from the norm as early as possible and undergo comprehensive treatment.But if pes planovalgus is diagnosed in adulthood, conservative therapy will only help prevent 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, such as when conservative treatment is ineffective, the correct anatomy of the foot can be restored surgically.