FLAT-FOOTEDNESS (pes planus) — the deformation of foot which is characterized by decrease in its arches. Decrease in the longitudinal arch leads to longitudinal P., cross — to cross longitudinal and cross P. are combined by P. Neredko. Sometimes P. is followed by a deviation of foot of a knaruzha — a valgirovaniye.
The lowered arch at children up to 4 — 5 years is a consequence of unfinished development of foot and does not demand special treatment, however dynamic observation, strengthening of the muscular and copular device since 3 — 4-year age is necessary. In the absence of positive dynamics appoint orthopedic svodoformiruyushchy insoles and even orthopedic footwear.
The item happens inborn and acquired.
Inborn P. meets seldom, it is combined with other deformations and is a consequence of primary pre-natal malformations of fabrics of an embryo (fig. 1). Inborn P.'s treatment is carried out from the first days of life (redressment, the fixing soft bandages, stage plaster bandages, then orthopedic footwear).
The acquired P. depending on a causative factor is divided on static, rachitic, traumatic and paralytic.
Static flat-footedness — the most often found deformation of feet. Longitudinal P. prevails, quite often it is combined with cross. The last in the isolated look arises seldom.
cost the Reasons of static deformations happen external and internal, quite often they are combined. The overloads connected with long stay standing, including caused by a profession (e.g., at hairdressers, cooks), wearing irrational footwear most often belong to the external reasons. The internal reasons consist in the hereditary and constitutional predisposition: primary weakness of the muscular and copular device, dysplasia of foot. Implementation of these reasons is connected with the beginning of walking and intensive growth at children, then puberty, the beginning of work, pregnancy, a climax, senile age, etc.
the Clinical picture
the Clinical picture of longitudinal flat-footedness is characterized by emergence of pain and changes of outlines of foot. At slight P. (the I degree) fatigue in legs, morbidity appears during the pressing on feet or the middle of a sole. Gait loses plasticity. By the evening there can be a puffiness on the back of feet simulating heart failure. More constant and severe pains in feet, in anklebones, in shins are characteristic of the expressed P. (the II degree). Gait considerably loses elasticity and smoothness. The longitudinal arch lowered without loading even more decreases at loading. Selection of footwear is at a loss. At sharply expressed P. (the III degree) constant pains in feet, shins are observed, it is frequent in a waist. Externally longitudinal arch at loading and without it is not defined. Foot adopts the valgus provision and does not give in to correction by hands, the heel is spread, rounded shape, contours of an Achilles tendon are maleficiated, foot and an ankle joint are edematous, joints of foot of a tugopodvizhna. Walking is complicated.
Working capacity is reduced. Wearing footwear of quantity production is impossible.
Cross P. is characterized by flattening or disappearance of the cross arch of foot, it is the reason of deformation of fingers (fig. 2). Main signs: a rasplastannost of front department of foot, pain and callosity of skin of a sole under heads of plusnevy bones, a tension of sinews of razgibatel of fingers. With increase in degree of cross P. appear hallux valgus (see) and molotkoobrazny fingers. Depending on manifestation a wedge, symptoms 3 extents of deformation allocate to similarly longitudinal P.
Treatment in it takes generally conservative, leading place to lay down. physical culture. It in various volumes is appointed at all forms and degrees of the Item. Exercises to lay down. gymnastics strengthen the muscles supporting the arch and promoting a tension of the copular device, korrigirut vicious installation of feet, bring up a stereotype of the correct position of all body and the lower extremities during the standing and walking, affect obshcheukreplyayushche an organism, improve a metabolism, activate the motive mode. The leading place is taken by the special exercises directed to correction of deformation of feet. At the beginning of a course of exercise carry out from the initial position sitting or lying that excludes influence of the weight (weight) of a body on the arch of foot when muscles got stronger (fig. 3, 1—8) not enough. Further appoint exercises from the initial position standing or in walking, giving chance, except a training of muscles, to korrigirovat the arches of feet and their valgus installation (fig. 3, 9—18). All these exercises in this or that combination recommend to include in a day regimen of children (morning exercises, physical education classes at school, at home several times a day). For strengthening of the muscles which are actively participating in maintenance of normal height of the arches in addition to lay down. gymnastics, it is possible to use exercises under natural conditions — walking barefoot on the friable soil, sand, a log, a lasagna on a rope, a pole, a podgrebaniye of sand feet, swimming, etc. Strengthening of the muscular and copular device of a shin and foot is promoted by massage and self-massage which is reasonable to carrying out on muscles of a front and inner surface of a shin, a bottom surface of foot. Massage at emergence of pains and feelings of exhaustion in legs by the end of day, after long standing or walking is especially shown. Massage is carried out by courses lasting 1,5 — 2 months, time of one procedure 10 — 12 min.
For improvement of a trophicity of fabrics carry out physiotherapeutic treatment. At the expressed P. appoint orthopedic insoles (instep supports) with the calculation of cross or at the same time cross and longitudinal arch. At cross P. apply cuffs from bandage rubber with a tab to maintenance of the arch (fig. 4). At sharply expressed P. it is shown orthopedic footwear (see).
The indication to operation at P. is unsuccessfulness of conservative treatment (the remaining pains, dysfunction of feet), progressing of deformation.
At longitudinal static P. an operative measure is applied seldom. Osteoplastic operation of Pertes (fig. 5) is most rational. Anesthesia the general or Intra bone. After operation apply a plaster bandage for up to 4 — 5 weeks in the provision of easy hyper correction. Further apply to lay down. gymnastics, massage, physical therapy, orthopedic footwear.
The complex of the operational receptions directed to cross P.'s elimination and deformations of the I finger is called reconstructive operation of front department of foot (fig. 6.). Operation is made under intra-bone or general anesthesia. After operation impose a plaster boot; for the 5th day begin the movements I of a finger. In 2 weeks the bandage is shortened and turned into removable. In 1 month allow walking in cuffs with support of the cross arches in footwear with a lacing, on a heel to 3 cm
Prevention consists in the organization the correct physical. education of children in all age periods, strengthening of the muscular and copular device of shins and feet, supply of children with rational footwear with a back and a sole, flexible at the level of metatarsophalangeal joints, a small heel and with a lacing.
It is necessary to monitor development of the correct gait at the child: children shall not go widely placing legs and parting socks not to overload an inner edge of foot and sheaves supporting him. The classes given in day nursery, kindergartens, schools shall include the special exercises directed to strengthening of muscles and the copular device of a shin and foot. With predisposition to P. occupations are recommended by swimming; such sports as weightlifting, run on the long distances, speed skating connected with an overload of the lower extremities are excluded.
Rachitic flat-footedness develops on the soil rickets (see), at Krom of a bone become soft, pliable and are easily deformed from loading. Treatment is fortifying, vitamin therapy, physical therapy. At unstable, i.e. giving in to manual correction, forms P. redressment, plaster bandages, orthopedic insoles, orthopedic footwear is shown; at the fixed forms — orthopedic footwear.
Traumatic flat-footedness is result of incorrectly accrete fractures of anklebones, bones of a tarsus and metatarsus (fig. 7), damage of the soft tissues strengthening the arches of foot. Treatment includes physiotherapeutic procedures, carrying orthopedic insoles, orthopedic footwear.
At P. which is combined with a valgus deviation of foot that is sometimes observed after a fracture of anklebones nadlodyzhechny is shown osteotomy (see) with fixing of foot in korrigirovanny situation.
Paralytic flat-footedness (fig. 8) is formed at paralysis of the muscles supporting the arches of foot, most often later poliomyelitis (see). In mild cases recommend orthopedic boots. At unstable deformation at children, since 5-year age, make change of a long fibular muscle on an inner edge of foot. For deduction of a heel from a valgus deviation the extraarticular artificial ankylosis of a collision and calcaneal joint on Graysa (fig. 9) is shown.
See also Foot .
Bibliography: Boychev B., Konforti B. and Chokanov To. Operational orthopedics and traumatology, the lane with bolg., Sofia, 1961; Kaptelin A. F. Recovery treatment (physiotherapy exercises, massage and work therapy) at injuries and deformations of a musculoskeletal system, M., 1969; Kolontay Yu. Yu. and Poddubnyak S. G. Operational treatment of a metatarsus latus by strengthening of the copular office of front department of foot, Ortop, and travmat., No. 1, page 60. 1977; Medical physical culture at diseases at children's age, under the editorship of G. M. Ivanova, M., 1975; The Multivolume guide to orthopedics and traumatology, under the editorship of N. P. Novachenko, t. 2, page 702, M., 1968; The Multivolume guide to surgery, under the editorship of B. V. Petrovsky, t. 12, page 531, M., 1960; Modern methods of treatment of contractures and deformations of joints, under the editorship of M. V. Volkov and M. D. Mikhelman, page 69, M., 1975; F r and d l and N d M. O. Static deformations of foot at adults and children, Ortop, and travmat., No. 8, page 3, 1960; H and to l and V. D. Ortopediya's N, book 2, page 713, M., 1957; Yaremenko D. A. and T l ok and V. A. Operational treatment poperech-norasplastaniy groans and valgus deviation of 1 finger. Ortop, and travmat., No. 9, page 16, 1973; The foot and its disorders, ed. by L. Klenerman, Oxford a. o., 1976; Jones B. S. Flat foot, J. Bone Jt Surg1., v. 57-B, p. 279, 1975; N i e d e r e with k e r K. Der Plattfuss, S. 90, Stuttgart, 1959.
Of H. Kramarenko; B. Illarionov (to lay down. physical.).