Plano-valgus foot deformity

Today the planovalgus foot deformity is one of the most common problems in traumatology and orthopaedics.This pathology 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 arthrosis of the ankle, knee, hip joints, as well as diseases and curvature of the spine.Therefore, it is important not only to timely diagnose planovalgus foot deformity, but also to start treatment immediately.This will stop the progression of the pathology.But in the final stages of development, the situation 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 functionality of the tendon of the tibialis posterior muscle.As a result, the axis of the foot becomes distorted.This is accompanied by a lowering of the midsection and a rotation of 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 curvature of the legs is observed.This can be seen by the presence of a fairly large distance between the heels when assuming a standing position with the ankles touching.

According to various authors, a similar problem is found in 15-58% of people.

Plano-valgus foot deformity is fraught not only with the appearance 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 of the joints of the foot.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 appearance of gradually increasing pain.Subsequently, the formation of osteophytes is observed on the articular surfaces of the bones until they fuse with each other and immobilize the joint.With planovalgus foot deformity, osteoarthritis can affect not only the foot joints, but also the ankle, knee and hip joints.
• A heel spur is a consequence of excessive stretching of the plantar fascia and the formation of a protrusion on the side of the heel bone, which leads to severe 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 conditions for the formation of intervertebral protrusions and hernias.
• Curvature of the spine - can 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 support points of the foot and a flattening of its arches.There are many factors that can contribute to this, but they are extremely rarely observed in isolation.Most often, the causes of plano-valgus foot deformity lie in the combined action of a number of reasons.Therefore, the disease can result from:

• congenital disorders of connective tissue;
• progression of flat feet of any type;
• injuries of the lower limbs, especially bones and ligaments of the feet;
• osteoporosis, which is a disease accompanied by a decrease in calcium content in the bones, which leads to greater fragility;
• hormonal imbalances caused by endocrine diseases, in particular diabetes mellitus, hypothyroidism, as well as physiological changes during pregnancy and menopause;
• the presence of excess weight and especially obesity, caused by the increased load on the foot 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 engage in heavy physical work for a long time;
• wearing incorrectly chosen shoes, i.e. excessively narrow and/or high heels, which lead to an altered distribution of the load on the foot;
• foot anomalies.

In the presence of congenital developmental anomalies, as well as hereditarily caused hyperelasticity of the foot, plano-valgus feet can attract attention almost immediately after the birth of the child.But more often the pathology is diagnosed when the child begins to walk.Often in such situations, ailments quickly worsen due to the choice of the wrong shoes, insufficient physical activity or, conversely, excessive and inappropriate physical activity.

In most cases, planovalgus foot deformity develops during childhood.If during this period the ailment 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 often worsens during pregnancy or due to weight gain, which is usually associated with a sedentary lifestyle.

Symptoms of planovalgus foot deformity

The plano-valgus foot deformity is characterized by a gradual increase in the intensity of symptoms.Therefore, if initially the pathology manifests itself only as mild discomfort, in the later stages its manifestations can become an obstacle to leading an active lifestyle or even significantly complicate simply movement.The disease is characterized by:

• foot pain, especially in the back, which worsens after prolonged standing, walking or doing physical work;
• swelling of the ankles;
• increased fatigue when walking;
• compaction, formation of corns, calluses and soreness of the skin in the area of the heads of the small metatarsal bones, aggravated by the use of high-heeled shoes and prolonged physical activity;
• X-shaped curvature of the legs, which over time leads to pain in the knees;
• displacement of the first toe, which gradually leads to changes in the other toes (hallux valgus);
• gait disturbances.

Sometimes patients have an accessory sesamoid bone in the scaphoid area.

Plano-valgus foot deformity increases the likelihood of an ingrown toenail.And its lateral deviation with a strong curvature causes a change in the shape of the remaining fingers.As a result, they curve, take the shape of claws, and the joints thicken.This is called hammertoe deformity.

At the same time, in the area of the metatarsophalangeal joint, a growth of the joint with the formation of a callus on its lateral surface, popularly called a nodule or bone, is also observed.This leads to difficulties in choosing shoes and makes it uncomfortable to wear the ones you already own.

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 no bone deformities in the foot yet, but pain sometimes occurs in the area of the posterior tibial tendon, especially after prolonged standing or walking.This can be complicated by tenosynovitis, that is, inflammation of the posterior tibial tendon.And the angle of the heel relative to the axis of the tibia is no more than 10-15°.
• Stage 2 – there is a slight deformation of the foot with dislocation of the heel of 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.Since there is no rigidly fixed deformation yet, therapeutic massage at this stage is a very effective treatment method.But this does not eliminate the need for other means of conservative therapy.
• Stage 3 – the foot deformity has already stabilized.In this case the hindfoot joints are no longer susceptible to passive movements.The angle of the heel with respect to the axis of the tibia 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 failure.The deviation of the heel from the axis of the tibia is 30° or more.

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

The pathology tends to progress, especially rapidly under the influence of factors that negatively affect the condition of the foot (obesity, frequent lifting and carrying heavy objects, prolonged standing, inappropriate shoes, etc.).

Diagnostics

If you experience any 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 the examination results, the doctor always pays close attention to the history of the disease and the patient's life.The data obtained during the survey provides the doctor with important information, thanks to which it will be possible not only to determine the causes of the deformity, but also to draw up an optimal treatment plan.

Particular attention is paid to the symptoms of the disease, the conditions of their onset and the characteristics of progression.The orthopedist must clarify the nature of the pain, its localization and duration, the presence of neurological disorders, the presence of restrictions on physical activity, etc.

Subsequently, an orthopedic examination is necessary.In this procedure, the doctor evaluates the mobility of the tarsal joints by asking the patient to stand on tiptoe, performing passive movements, and performing other tests.The orthopedist also evaluates the condition:

• vessels of the lower limbs;
• the skin of the feet and legs, its temperature, the nature of 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 select the most effective therapeutic tactics, which will aim to eliminate all existing ailments.

In addition, when diagnosing plano-valgus 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 required therapeutic measures.This:

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

In difficult diagnostic cases, CT or MRI may be prescribed.These are modern methods of studying bones and soft tissues, respectively, providing the most accurate and detailed data on their condition.

Conservative treatment of planovalgus foot deformity

Almost always, treatment of planovalgus foot deformity begins with the appointment of conservative, i.e. non-surgical, therapy.Only in stages 3-4 of the disease can patients be immediately recommended for surgery.

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

• use of individual orthopedic insoles;
• wear comfortable or orthopedic shoes;
• pharmacological treatment;
• physical therapy;
• therapeutic massage;
• Kinesiotaping;
• physiotherapy.

Additionally, patients will be advised to take steps to lose weight if signs of obesity are present and to avoid wearing tight shoes or high heels.From the moment planovalgus foot deformity is diagnosed, it is necessary to choose and wear only comfortable shoes with a fairly wide toe and a comfortable wide heel up to 3 cm high.They must be made of natural materials and not crush the foot.

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

All these methods aim to eliminate symptoms, improve patients' quality of life and stop the progression of the deformity.But it is possible to completely cure a flat foot valgus with their help only if the disorder is diagnosed at stage 1 in children.

If there is a hallux valgus deformity of a toe, special orthoses may 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 the doctor's recommendations regarding physical regimen, choice of shoes, etc.;
• hypothermia and overheating;
• the presence of other orthopedic disorders 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 have pain and no positive dynamics are observed, this may be a reason to consider the question of surgical intervention.

Custom insoles and orthopedic shoes

When diagnosing a plano-valgus foot deformity of any degree, patients are required to wear individually made orthopedic orthotics.They should be placed in ordinary shoes instead of those supplied with them, and in the later stages of the development of pathology - in special orthopedic shoes.

Since they are made separately based on the structural characteristics of the patient's left and right foot, they allow them to assume 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 axis of the joints, which can significantly reduce the risk of complications.

Conventional mass-produced orthopedic insoles are not used for plano-valgus foot deformities.

Therefore, 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 overloaded 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 because they will cause discomfort initially, as the leg needs to be readjusted to the correct position.Gradually, the duration of wearing the insoles increases, reaching the maximum possible.In most cases, patients get used to it and can wear them all day without problems after 2 weeks.

If the insoles become deformed or worn, 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 his comments.

Drug therapy

Pharmacological therapy in the absence of complications of planovalgus foot deformity is symptomatic.In other words, it is intended 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 well-being.

Drug therapy is also prescribed if unwanted consequences of flat-valgus foot occur.It may consist of the following:

• corticosteroids – used to relieve severe inflammation, features 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.

Physical therapy

Physical therapy is an integral component of the treatment of planovalgus foot deformity.It aims to strengthen the tibialis posterior and anterior 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;
• walk on the toes and then on the outer parts of the feet;
• climb onto a slanted board;
• work on an exercise bike or bicycle barefoot;
• grasp and lift small objects off the floor with your toes;
• grasp 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;
• sit in the “Turkish” position and stand up from it.

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

But physical therapy must be done systematically.Therefore, classes should take place daily in a comfortable environment without rushing.It wouldn't hurt to take off your shoes and roll the ball with your foot at any convenient time, for example when working on 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 foot valgus, courses of physiotherapeutic procedures are prescribed.They are indicated for grade 2 or higher foot deformities and help not only reduce the severity of the disease, but also produce a therapeutic effect.

In 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;
• magnetotherapy;
• diadynamic therapy;
• UVT;
• electrical stimulation of the muscles of the lower leg and foot;
• ozocerite and paraffin applications;
• mud therapy.

Kinesiotaping

Kinesio taping is a new method of treating orthopedic disorders 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 understanding of the technique and anatomy.

The tapes are made of 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 in any way and are practically not felt on the body.At the same time, the material of the tapes breathes, eliminating the risk of developing skin diseases.

Therapeutic massage

Massage for plano-valgus foot deformity aims to normalize the muscle tone of the lower limbs, develop the joints and improve trophism by 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 muscles of the lower leg and thigh.

As a rule, it is recommended to undergo a course of therapeutic massage 4 times a year, consisting of 15-20 sessions.Thanks to them, a noticeable improvement in the condition of patients is observed, the elimination of the most annoying 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 both adults and children.These carpets are distinguished by the presence of differently shaped convexities.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.

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 a deviation from the norm as early as possible and undergo comprehensive treatment.But if planovalgus 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 sufficient 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, it is possible to surgically restore the correct anatomy of the foot.