Flat feet

Flat - foot deformity, characterized by flattening her arches. There are longitudinal and transverse platypodia, the combination of both these forms with each other and with other deformities of the foot.

Fig. 1. The relationship of the foot bones normal (left) and transverse flat foot (right).

Fig. 2. The relationship of the foot bones in norm (top) and under longitudinal flat feet (bottom).

When the transverse flat foot flattens cross the arch of the foot, so that its front Department relies on the heads of all five metatarsal bones, and not only I and V, as is normal (Fig. 1). Longitudinal flatfoot most often characterized by the flattening of the longitudinal arch of the foot (Fig. 2).
Flat feet may be congenital or acquired. The latter can be static, traumatic, paralytic. Static flatfoot is one of the most common orthopedic diseases; often bilateral; occurs due to excessive load on muscles, ligaments of the foot. Often an occupational disease in individuals whose work is connected with long legs (postmen, hairdressers, conductors, employees of counter and other). Predisposing factors: irrational shoes, weakness of ligaments of the foot and leg muscles, various diseases with blood circulation in the limbs - thrombophlebitis, endarteritis. Transverse platypodia may develop as an independent warp, or in combination with longitudinal flat feet and hallux valgus (see).
At the advanced stage of flatfoot gait changes significantly, it becomes awkward, shackled. Man walks widely positioned legs and feet, slightly bending his knee and hip joints, intensely swinging his arms. In the evening you may receive swelling of the foot, disappearing over night. Early sign of flatfoot - aching pain in the foot, the leg muscles, hips, lower back. Later stop deformed - extended, expanded in the middle part, longitudinal arch completely disappears, the heel deviates outward.

Fig. 3. The appearance of flat feet. Fig. 4. The prints of a foot normal (left) and poor (right).

Diagnosis of flatfoot in apparent cases is not complicated and can be delivered in the normal examination (Fig. 3). More accurate and objective data on the extent of flatfoot received during a special research methods. Produce prints or Ocherki the plantar surface of the foot planetography). Normal stop network on paper imprint heel, narrow strips on the outer edge of the foot and its anterior. With heavy flat sole imprinted completely (Fig. 4). The characteristic of the degree of flatfoot in the figures gives odometry (see).

Fig. 5. Gymnastic exercises for flat foot.

Fig. 6. Putting insoles-instep.

Prevention flatfoot is to provide high functional endurance muscular-ligamentous apparatus of the foot, which is achieved by the complex of special and General health-improving physical exercises, rational selection of shoes. At long distance recommended foot to put in parallel, periodically become on the outer edge of the foot. Shoes must strictly correspond to the size of the foot. Close and too loose shoes equally harmful effect on elastic properties of the foot. Rational heel height 3-4 see
Treatment of flatfoot depends on the stage of the disease and clinical manifestations. Assign daily warm baths knee, massage of muscles of the foot and lower leg exercises. Gymnastic exercises should be regular, 5-6 minutes, preferably several times during the day.
Begin exercises to walk barefoot, with a focus on the whole foot, then walking on tiptoe Crouch and walk on the outer edge of the foot. Complete the exercise by the jumps and leaps on the fingers (Fig. 5). Conduct exercises with pulling socks feet with emphasis fingers in immovable object, bending the fingers foot pressed to the floor, grabbing and raising his fingers small items from the floor. It is recommended to walk barefoot on uneven ground, sand, climbing across the smooth pole, running, jumping, playing football. In footwear put special insole - instep (Fig. 6), which raises omitted longitudinal arch. Transverse arch able to lift, podliv to insole, respectively heads of II-III metatarsal bones, a strip of soft rubber length 2.5 cm long, 2 cm and a thickness (in the middle part) 0.8 see When expressed flat feet recommended special orthopedic shoes (see). In severe cases, flat feet with persistent deformation of the foot, especially in patients with flat feet, make transactions on the ligaments and bones of the foot.

Flat feet (pes planus) - deformation, accompanied by a flattening of the arches of the foot. When the flattening of the longitudinal arch say longitudinal flat feet (Fig. 1)when flattening cross - about cross (Fig. 2). Often longitudinal flatfoot combined with the diversion of the forefoot, lifting the outer edge, the pronation of the heel, that is, valgus feet (pes plano-valgus). Dramatically expressed lead forefoot talking about pes plano-valgo-abductus.
There are five types of flat foot: congenital, beading, paralytic, traumatic, static.
Congenital flat foot is relatively rare. The reason of it are the defects of the embryo, amniotic banners, underdevelopment or absence of malomernogo bones, and other malformations.
Rachitic flatfoot observed in rickets in the soft bones and their low resistance and a General weakening of the muscular-ligamentous apparatus. Stop becomes pliable and under the influence of body load goes out supination position pronation, the forefoot is given, and the vaults are omitted.
Paralytic flat (Fig. 3) occurs in the majority of cases as a result of polio. The degree P. depends on the degree of paralysis and quantity of the involved muscle. Postovalova stop formed after polio, as a rule, paralysis of one or both tibial muscle satisfactory functions of all the other leg muscles.
Traumatic flat feet may result in fractures variety of separate bones, but is often a consequence of wrong accrete fractures ankles type Dupuytren.
Static flat (Fig. 4) is the most common type P. the Main reasons of its occurrence are weak muscle tone, excessive fatigue due to long stay on his feet.
Clinical presentation and course. The early symptoms P. include fatigue of legs and sore calf muscles when walking to the end of the day. Later, growing pains when standing and walking. In some cases the pain can be so sharp that patients struggle to move on crutches or forced to lie. Pain is usually localized in certain places: on the sole in the field of the code, in the field of ankle-boat-articulation and leg muscles. When sharper valgasova foot pain in the ankles. The signs of pronounced P.: lengthening stop, expanding them in the middle part, the flattening of the longitudinal arch, bronirovanie stop with discharge heels outwards. During the inspection special attention should be paid to the inner edge of the feet and the degree of flattening their code. Patients suffering from P., wear out the inside of your sole and heel shoes. For the diagnosis of flatfoot also used planetography (see) and podolatria (see) by the method of the Maltese order Fridlyand.

Fig. 3. Foot paralytic flat feet.
Fig. 4. Foot static flat feet.

X-ray examination. Convincing objective evidence P. obtained on x-rays, made sure the load of the foot. Lateral projection for longitudinal P. heel bone is parallel sole; the angle of the foot arch increases. Pathological statics of the foot bones with P. already early, even at an early age leads to osteoarthritis in the joints of Tarsus. In congenital flat foot, due to a sharp vertical talus, on the side of the x-ray of the foot articular gap between the heel and cube-shaped bones widely gaping, and the talus articulates with the scaphoid not his head and neck. Cross-P. on the plantar radiographs is more pronounced than in the norm, fan-shaped divergence peripheral parts of the metatarsal with increased distance between their heads. Cross the arch of the foot is reduced in height, head of the metatarsal bones lie in the plane almost parallel plantar surface of the foot. To differentiate P. should Martanovski metatarsalgia neuralgia, and osteochondropathy and areas of perestroika metatarsal bones, partial prerequisite of which P. may be. Treatment of congenital flat feet is the massage, the bondage of the foot. With a sharp form of the strain shows the treatment of plaster casts from fixing stops in varus position.
When starting the flat foot treatment is to strengthen the muscles warm baths, massages and gymnastics. Only with the failure of this treatment can be used in preschool children insoles-arch supports. Good effect gives rhythmic paradisaea tibial muscle. Patients should ban the wearing soft and felt boots. Children of school age and adults primarily spend conservative treatment aimed at restoring the normal installation of foot arch and leaf functions. The patient is first necessary to provide appropriate orthopedic shoes with the tab of the code and by raising the edge of the heel.
In case of flatfoot, exacerbated by the pain, treatment begins with a blend of plaster bandages in the position supination stop. On the disappearance of pain are appointed orthopedic shoes (see orthopedic Shoes)lifting the inside edge of the heel and moderately running arch, massage, gymnastics. In cases of failure showing surgery, which is in the hand of Redressal, and then anatomii Achilles tendon and transplantation long peroneal the muscles on the inside edge of the foot.
When pronounced pes plano-valgo-abductus treatment should begin with manufacturing of patients correctly fitted orthopaedic shoes with simultaneous carrying out of physical methods of treatment. If orthopedic shoes does not help resort to surgical treatment. The operation begins with the bloodless Redressal (see) under intraosseous anesthesia or General anesthesia, sometimes preliminary made tenotomy Achilles tendon. After the restoration of the arch of the lumbar head talus produce transplant long peroneal the muscles on the inside edge of the foot. If after this operation there is a tendency to relax, use Introduzione ankle-boat-replacement.
In cases where the bloodless lumbar head talus unable to reposition produce resection of her head and adjacent articular surface of the scaphoid, and to correct pronating provisions heel - wedge resection ankle-heel replacement basis of the wedge, facing inwards.
Instead wedge resection M. I. of Kaslik recommended more economical sickle resection - excision narrow Crescent of the wedge behind laparoscope articulation.
When pes plano-valgus contractus (reduced flat foot)when the pain is intense and walking is not possible, the treatment is reduced to calm the pain and translation foot of contractural pronating position supination. In light of cases are limited to full peace, thermal treatments, and upon termination of acute pain, disappears when the contractions of the muscles, for 10 days impose removable cast in position supination.
When cross-P. treatment is primarily in the restoration of transverse arch by a circular of bandaging and unloading by orthopedic insoles with application of thermal treatments and massages. In case of the failure of the conservative treatment of recourse to the rapid contraction of the transverse arch silk threads or nylon tapes.
Paralytic flat feet should be appointed shoes with laying of the vault and holding a foot from algorovania. On the night recommend plaster or plastic bus that hold the foot in position supination and extension. Prescribed physiotherapy, balneology and medical treatment. Surgical treatment is to stabilize the foot poltaranin arthrodesis and tendon transplant long peroneal muscles on scaphoid or I sphenoid bone. In the following it is shown wearing orthopedic shoes.
Prevention. Along with wearing sensible shoes should include special exercises aimed at strengthening the neuro-muscular and ligamentous apparatus stop.
The prevention and treatment of initial degrees of flatfoot also contributes to walk barefoot on uneven ground, on the sand and in the pine forest, which has a "reflex of sparing".
Therapeutic exercise. In addition to General health improving effect, medical gymnastics in P. used to strengthen the ligaments and muscular foot and leg, hold arches of the foot in position, reduce fatigue during long walk. Special exercises for foot, include in the morning hygienic gymnastics, procedures, therapeutic exercises are performed in different starting positions - lying, sitting, standing (Fig. 5). Each exercise should be repeated 8-10 times. Very useful when P. various types of walking barefoot on the sand, on their toes, heels, on the outside of the foot. Complexes of special exercises for foot should be repeated 2-3 times during the day, especially between work and long stay on his feet.

exercises for flat feet in pictures
Fig. 5. Therapeutic physical exercises for flat feet: 1 - simultaneous raising on socks at maximum pulling the body up; 2 - roll from heel to toe and back; 3 - transition in a standing position on the outer edge of the foot with the subsequent return to its original position; 4 - foot by foot turn to the inside ("Comalapa"), while lifting-toe on each step; 5 - alternate grasping the toes of different subjects.