Plano-valgus foot deformity

Planovalgus foot deformity is one of the most common problems in traumatology and orthopedics today.This pathology occurs in both children and adults.However, over time it tends to progress 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 joint, knee, hip, as well as diseases and curvature of the spine.Therefore, it is important not only to diagnose planovalgus deformity of the foot in a timely manner, but also to start treatment immediately.This will stop the progression of the pathology.But in the final stage of development, the situation can be corrected only by surgery.

What is planovalgus foot deformity?

Plano-valgus deformation 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 on the background of disturbed function of the tendon of the posterior tibial muscle.As a result, the axis of the foot becomes distorted.This is followed by lowering the midfoot and turning the heel outward with the inside against the support 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 you take a standing position with the ankles touching.

According to different authors, a similar problem occurs in 15-58% of people.

Plano-valgus deformation of the foot is fraught not only with the appearance of a pronounced cosmetic defect, but also with the development of a series of complications.these are:

• Bursitis is an inflammation of the synovial bursae of the foot joints.This is accompanied by redness of the skin in the projection of the affected joint, swelling, and pain that is intensified by mechanical action.
• Arthrosis – degenerative-dystrophic changes in the cartilage tissue, accompanied by its thinning and the appearance of gradually increasing pain.After that, the formation of osteophytes is observed on the articular surfaces of the bones until they fuse with each other and immobilize the joint.In plano-valgus deformity of the foot, arthrosis can affect not only the joints of the feet, but also the joints of 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 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 prerequisites for the formation of protrusions and intervertebral hernias.
• Curvature of the spine - can be manifested as a deepening of physiological curves (kyphosis, lordosis) or the 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 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 considered in isolation.The causes of plano-valgus deformity of the foot most often lie in the combined action of several reasons.So, the disease can be a consequence of:

• congenital connective tissue disorders;
• progression of flat feet of any kind;
• injuries of the lower extremities, especially the bones and ligaments of the feet;
• osteoporosis, i.e. a disease accompanied by a decrease in calcium content in bones, which leads to increased fragility;
• hormonal imbalances caused by endocrine diseases, especially diabetes, hypothyroidism, as well as physiological changes during pregnancy and menopause;
• presence of excess weight, especially obesity, which is caused by increased load on the foot and overstrain of muscles and ligaments;
• neurological disorders, including polio, cerebral palsy;
• rickets;
• excessive stress on the feet due to the need for prolonged standing, walking or heavy physical work;
• wearing improperly chosen shoes, i.e. excessively narrow and/or high heels, which leads to a disturbed distribution of the load on the foot;
• foot abnormalities.

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

In most cases, plano-valgus foot deformity develops in childhood.If the disorder is not detected and corrected during that period, the disease remains with the person and tends to progress in the future when favorable conditions are created.In adults, plano-valgus deformity of the foot most often worsens during pregnancy or due to weight gain, which is usually associated with a sedentary lifestyle.

Symptoms of plano-valgus foot deformity

Plano-valgus deformity of the foot is characterized by a gradual increase in the intensity of symptoms.Therefore, if at first the pathology manifests itself only as minor discomfort, then in the later stages its manifestations can become an obstacle to leading an active lifestyle or even make simple movement significantly more difficult.The disease is characterized by:

• pain in the foot, especially in the back, which worsens after prolonged standing, walking or physical work;
• ankle swelling;
• increased fatigue when walking;
• tightness, formation of corns, calluses 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 eventually leads to pain in the knees;
• movement of the first toe, which gradually leads to changes in the other toes (Hallux valgus);
• gait disturbances.

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

Plano-valgus deformity of the foot increases the likelihood of an ingrown toenail.And its deviation to the side with a strong curvature causes a change in the shape of the remaining fingers.As a result, they become curved, claw-like, and the joints thicken.This is called a hammer toe deformity.

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

Degrees of deformation

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

• Stage 1 – there is still no deformity of the bones of the foot, but there is sometimes pain in the area of the posterior tibial tendon, especially after standing or walking for a long time.This can be complicated by tenosynovitis, ie.inflammation of the posterior tibial tendon.And the angle of the heel in relation to the axis of the lower leg is not greater than 10-15°.
• Phase 2 – a slight deformation of the foot occurs with dislocation of the heel bone by 15-20°.At the same time, in a state of rest, i.e. when a person is lying down, the feet assume a normal shape.Since there is no rigidly fixed deformation yet, 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 foot deformity is already fixed.In this case, the hindfoot joints are no longer subject to passive movements.The angle of the heel in relation to the axis of the lower leg is 20-30°.
• Stage 4 – the foot is severely deformed, completely flat, the axis of the ankle joint changes.When an X-ray is taken and the images are evaluated, the lateral tilt of the talus is visible.This is a direct sign of failure of the deltoid ligament.The deviation of the heel from the axis of the lower leg is 30° or more.

There are also degrees of flat feet.For their diagnosis, the longitudinal arch angle and the intermetatarsal angle are measured using radiographs, as well as the height of the arch in millimeters.

Pathology has a tendency to progress, especially quickly under the influence of factors that negatively affect the condition of the feet (obesity, frequent lifting and carrying of heavy objects, prolonged standing, improper footwear, etc.).

Diagnostics

If signs of planovalgus deformity of the foot 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 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 will be possible not only to determine the causes of the deformity, but also to create an optimal treatment plan.

Great attention is paid to the symptoms of the disease, the conditions of their occurrence and the characteristics of the progression.The orthopedist must 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 evaluates the mobility of the tarsal joints by asking the patient to stand on the toes, performing passive movements and other tests.The orthopedist also assesses the condition:

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

All this helps in determining the possible causes and consequences of the development of plano-valgus deformity of the foot.This allows you to choose the most effective treatment tactics, which will be aimed at eliminating all existing disorders.

Also, when diagnosing plano-valgus deformity of the foot, instrumental and laboratory research methods are necessarily prescribed in order to precisely determine the extent of changes in the foot and to clarify the nature of the necessary therapeutic measures.this:

• x-ray of the foot 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 studying bones, i.e. soft tissues, which provide the most accurate and detailed data on their condition.

Conservative treatment of planovalgus foot deformity

Almost always, the treatment of planovalgus deformity of the foot begins with the appointment of conservative, i.e. non-surgical, therapy.Only in stage 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;
• 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 deformity of the foot is diagnosed, you should choose and wear only comfortable shoes with a fairly wide top and a comfortable wide heel up to 3 cm high.They must be made of natural materials and not squeeze the foot.

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 deformities.But with their help, it is possible to completely cure flat-valgus foot only if the disorder is diagnosed in the 1st stage in children.

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

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

• smoking;
• the presence of chronic diseases that reduce immunity;
• violation of doctor's recommendations regarding physical regimen, choice of footwear, etc.;
• hypothermia and overheating;
• presence of other orthopedic disorders that negatively affect foot biomechanics;
• osteoporosis;
• infectious diseases.

Therefore, patients should avoid exposure to these factors in order to increase the effectiveness of therapy.Moreover, if 3 months after the start of conservative treatment and the implementation of the entire set of measures prescribed by the doctor, patients still have pain and there is no positive dynamics, this may be a reason to consider the issue of surgery.

Custom-made orthopedic insoles and shoes

When diagnosing plano-valgus foot deformity of any degree, patients are required to wear individually made orthopedic insoles.They should be put in ordinary 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 characteristics of the patient's left and right foot separately, they allow them to be given the most anatomically correct position.This is the key to restoring normal biomechanics of movement, eliminating leg fatigue, swelling and pain.In addition, they restore the normal joint axis, 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 in proper distribution of the load on the foot.This leads to training too many relaxed muscles and relaxing overstressed ones, that is, it directly affects the root cause of the development of flat feet.

In the first days, it is necessary to walk with orthopedic insoles for 2-3 hours.This is due to the fact that it will initially cause discomfort, as the leg needs to be re-adjusted to the correct position.The duration of wearing insoles gradually increases, reaching the maximum.In most cases, patients get used to them and after 2 weeks they can wear them all day without problems.

If the pads are deformed or worn, they should be replaced with new ones.To do this, you will again need to contact the 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 is aimed at reducing the intensity 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 a flat valgus foot appear.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 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.

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 as a rolling pin or a ball;
• walking on the toes and then on the outer parts of the feet;
• climbing on an inclined board;
• working on a stationary bike or a bike barefoot;
• grasping and picking up 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 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 to visit the pool at least 2-3 times a week.

But exercise therapy should be carried out systematically.Therefore, classes should be conducted daily in a pleasant environment without hurry.It would not hurt to take off your shoes and roll the ball with your foot at any time, for example, when you are working on the computer.This will help relieve stress from your feet and improve your well-being.

Physiotherapy

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

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

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

Kinesio taping

Kinesis taping is a new method of treating orthopedic disorders and the consequences of injuries in medicine, which involves gluing special elastic bands to the skin.They help relieve the necessary muscles and support others, as well as properly distribute the load on the support points of the feet.But for the taping to work, the doctor placing the strips must have a good understanding of the technique and anatomy.

The strips are made of hypoallergenic materials and are applied for an average of 5 days.With them you can wear any shoes, do sports, take a shower, etc.They do not bother in any way and are practically not felt on 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.So, during a therapeutic massage session, the doctor will pay attention not only to the feet and plantar muscles, but also to the lower leg and thigh muscles.

As a rule, it is recommended to undergo a course of therapeutic massage 4 times a year, which consists of 15-20 sessions.Thanks to them, there is a noticeable improvement in the condition of the patients, the elimination of the most disturbing symptoms of planovalgus foot deformity or at least a reduction 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 characterized by convexities 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 feet and increases the effectiveness of conservative treatment of planovalgus deformity.

So, planovalgus foot deformity is a common orthopedic disease.It can significantly reduce a person's quality of life and lead to the development of severe complications.Therefore, it is important to diagnose the 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 quite enough 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 restored surgically.