Plano-valgus foot deformity

Today, planovalgus foot deformity is one of the most common problems in traumatology and orthopedics.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 promptly diagnose 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 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 function of the tendon of the posterior tibial muscle.As a result, the axis of the foot becomes distorted.This is accompanied by a lowering of its middle section and a turn of the heel outward with its inner part adjoining 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 taking a standing position with the ankles touching each other.

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.This:

• 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, pain, which tends to intensify with mechanical action.
• Arthrosis – degenerative-dystrophic changes in cartilage 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 with each other and immobilize the joint.With plano-valgus foot deformity, arthrosis can affect not only the joints of the foot, 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 sharp pain in the heel area when walking.This is often accompanied by inflammation of the Achilles tendon.
• Osteochondrosis is degenerative-dystrophic changes in the intervertebral discs, which leads to a decrease in their height and creates the preconditions for the formation of protrusions and intervertebral hernias.
• Curvature of the spine - can manifest itself as 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 plane.This leads to changes in the support points of the foot and 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 may result from:

• congenital connective tissue disorders;
• progression of flat feet of any type;
• injuries of the lower extremities, especially bones and ligaments of the feet;
• osteoporosis, i.e. a disease accompanied by a decrease in calcium content in the bones, which leads to increased 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, which is caused by increased load on the foot and overstretching 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 labor for a long time;
• wearing incorrectly selected shoes, i.e. excessively narrow and/or high heels, which leads to impaired distribution of the load on the foot;
• abnormalities of the foot.

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 baby begins to walk.Often in such situations, disorders quickly worsen as a result of choosing the wrong shoes, insufficient physical activity, or, conversely, excessive and inappropriate physical activity.

In most cases, plano-valgus 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, plano-valgus foot deformity 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 foot deformity is characterized by a gradual increase in the intensity of symptoms.Therefore, if initially 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 significantly complicate simply movement.The disease is characterized by:

• pain in the foot, especially in the back, worsening after prolonged standing, walking or 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 wearing shoes with heels and prolonged physical activity;
• X-shaped curvature of the legs, which over time leads to pain in the knees;
• displacement of the first toe, gradually leading to changes in 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 a strong curvature provokes a change in the shape of the remaining fingers.As a result, they become curved, take on the shape of claws, and the joints thicken.This is called a hammertoe deformity.

At the same time, in the area 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 leads to difficulties when choosing shoes and makes wearing the ones you already have uncomfortable.

Deformation degrees

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

• Stage 1 – there are still no bone deformities in the foot, but sometimes pain occurs in the area of the posterior tibial tendon, especially after prolonged standing or walking.This may be complicated by tenosynovitis, i.e. inflammation of the posterior tibial tendon.And the angle of the heel relative to the axis of the shin is no more than 10-15°.
• Stage 2 – there is a mild deformation of the foot with the heel bone dislocated 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.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 has already become fixed.In this case, the joints of the hindfoot are no longer amenable to passive movements.The angle of the heel relative to the shin axis is 20-30°.
• Stage 4 – the foot is severely deformed, completely flat, the axis of the ankle joint changes.When performing an x-ray and evaluating the images, a lateral inclination of the talus is visible.This is a direct sign of deltoid ligament failure.The deviation of the heel from the axis of the shin is 30° or more.

There are also degrees of flat feet.To diagnose them, the angle of the longitudinal arch 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 heavy objects, prolonged standing, improper shoes, etc.).

Diagnostics

If signs of 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 results of the examination, 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 not only be possible to determine the causes of the deformity, but also to draw up an optimal treatment plan.

Close attention is paid to the symptoms of the disease, the conditions of their 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 this, an orthopedic examination is required.In this procedure, the doctor evaluates the mobility of the tarsal joints by asking the patient to rise on tiptoes, performing passive movements, and conducting 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 distribution of hair;
• sensitivity of both feet and legs;
• muscle tone of the lower extremities.

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 treatment tactics, which will be aimed at eliminating all existing disorders.

Also, 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 feet 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 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 at stages 3-4 of the disease can patients be immediately recommended for surgical intervention.

So, conservative treatment of flat-valgus foot is always complex.It consists in:

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

Additionally, 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 plano-valgus foot deformity is diagnosed, you should 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 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 deformity.But it is possible to completely cure a flat-valgus foot with their help only if the disorder is diagnosed at stage 1 in children.

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

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

• smoking;
• the presence of chronic diseases that reduce immunity;
• violation of 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.Moreover, 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 there is no positive dynamics, this may be a reason to consider the issue of surgery.

Custom 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 placed in regular shoes instead of those that came with them, and in later stages of pathology development - in special orthopedic ones.

Due to the fact that they are made in accordance with the structural features 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 biomechanics of movements, 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.

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

In the first days, you need to walk with orthopedic insoles for 2-3 hours.This is due to the fact that initially they will cause discomfort, since the leg needs to be readjusted to the correct position.Gradually, the duration of wearing insoles is increased, reaching the maximum possible.In most cases, patients get used to them and can wear them all day without problems after 2 weeks.

If the insoles become deformed or worn out, they should be replaced with new ones.To do this, you will again need to contact an 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 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 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 joints, etc.

Exercise therapy

Physical therapy is an integral component 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 ball;
• walking on toes and then on the outer parts of the feet;
• climbing an inclined board;
• working on an exercise bike or bicycle barefoot;
• grasping and lifting small objects from the floor with your toes;
• grasping and folding a newspaper or towel like an accordion with your 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 that he visit the pool at least 2-3 times a week.

But exercise therapy needs to be done systematically.Therefore, classes should be conducted daily in a comfortable environment without rush.It wouldn’t 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 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, procedures are indicated that have an anti-inflammatory, analgesic, and anti-edematous effect.But they can only be started in the absence of an acute inflammatory process.As a rule, they are prescribed:

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

Kinesio taping

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 supporting points of the foot.But for taping to work, the doctor applying the tapes must have a good understanding of the technique and anatomy.

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

Therapeutic massage

Massage for plano-valgus foot deformity is aimed at normalizing muscle tone of the lower extremities, developing joints and improving trophism by activating blood circulation.Thus, 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, 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 both adults and children.These rugs are distinguished by the presence of different shaped convexities.Therefore, walking barefoot on them helps to train the muscles of the foot 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.

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 severe complications.Therefore, it is important to diagnose a deviation from the norm as early as possible and undergo comprehensive treatment.But if 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 completely 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, the correct anatomy of the foot can be restored surgically.