Platypodia (planovalgus deformation of the feet)

Ploskovalgusnaya deformation of the feet is accompanied by a flattening of the longitudinal arch, valgus position of the posterior, abduction-pronation position of the anterior part.

ICD Code 10

• M.21.0 Flat-lingual deformation of feet.
• M.21.4 Flat feet.
• Q 66.5 Congenital flat feet.

Epidemiology of flat feet

Flattening - a fairly common deformation, according to different authors, from 31.8 to 70% of all foot deformities. Particularly large percentage of flat feet in preschool and primary school age children.

[1], [2], [3], [4], [5], [6], [7]

The causes of flat-toothed deformation of feet

One of the causes of flat and flat-footed feet at this age is the general weakness of the tendon-muscle apparatus of the lower limbs, as well as dysplastic changes from the skeleton of the foot.

In the formation of flatfoot there are a number of theories explaining the etiopathogenetic mechanisms:

• static-mechanical theory;
• the introductory theory;
• anatomical theory;
• the theory of constitutional weakness of connective tissue;
• theory of hereditary muscle weakness.

Classification of flat feet

From the etiological point of view, there are five types of flat foot:

• congenital:
• traumatic:
• rachitic;
• paralytic;
• static.

Congenital flat feet can be of varying severity (mild, moderate and severe). The most severe degree of congenital flat-foot deformity of the feet, the so-called rocking-stop, occurs in 2.8-11.9% of cases and is immediately apparent at birth. The etiopathogenesis of this deformation has not been completely studied to date. The most likely cause of deformation is the developmental defects of the rudiment, the delay in its development at a certain stage of embryonic formation. This deformation is regarded as an inborn ugliness.

Acquired flat feet can be:

• traumatic;
• paralytic;
• static.

In recent years, the view on the genesis of static flatfoot has undergone changes and now has a broader interpretation. Among the children with static flat-wings deformity, the dysplastic changes in the skeleton of the foot, combined with neurologic symptoms or metabolic disorders of connective tissue, were detected in 78%.

Paralytic flat feet is a consequence of paralysis of the muscles that form and support the arch of the foot. The cause of traumatic flat feet is the consequences of ankle and foot injury, as well as damage to soft tissues and tendon-ligament apparatus.

There are flat feet of light, medium and severe degree. Normally, the angle formed by the lines drawn along the lower contour of the heel and first metatarsal bone with the apex in the region of the scaphoid bone is 125 °, the height of the longitudinal arch is 39-40 mm, the angle of inclination of the calcaneus to the plane of support is 20-25 °, the valgus the position of the rear part of the foot is 5-7 °. In preschool children, the height of the longitudinal arch of the foot can normally range from 19 to 24 mm.

With a mild degree of flatfoot, the height of the longitudinal arch of the foot is reduced to 15-20 mm, the height of the arch is reduced to 140 °, the angle of the calcaneus is 15 °, the valgus position of the posterior part is up to 10 °, and the anterior margin of the foot is within 8-10 °.

The average degree of flatfoot is characterized by a decrease in the arch of the foot to 10 mm, a decrease in the height of the arch to 150-160 °, with an angle of inclination of the calcaneus to 10 °, a valgus position of the posterior part and anterior retraction of up to 15 °.

A severe degree of flatfoot is accompanied by a decrease in the arch of the foot to 0-5 mm, a decrease in the angle of the arch of the arch of the foot to 160-180 °, the angle of inclination of the calcaneus bone is 5-0 °, the valgus position of the posterior part and the departure of the forelimb more than 20 °. If the degree of deformity is severe, correction does not respond, there is a constant pain syndrome in the joint Shoparova region.

[8], [9], [10], [11], [12], [13], [14]

Conservative treatment of flat feet

Usually complaints of parents on the flat feet of a child appear when the child starts walking alone. It is necessary to distinguish between the physiological flattening of the arch of the feet of a child who has not yet reached the age of three and a flat-valgus deformation requiring observation of the orthopedist.

If the axis of the calcaneus is located along the midline, there is a moderate flattening of the arch of the feet when loaded in young children, you can limit your muscles to lower limbs and wearing shoes with a hard back. If the child has a valgus deviation of the posterior part and flattening of the arch of the feet, complex restorative treatment should be used.

Treatment of flat-deformed deformations includes massage of the internal group of muscles of the legs and feet, plantar muscles with courses of 15-20 sessions 4 times a year, thermal procedures (ozocerite, paraffin, mud applications), corrective exercises aimed at forming the arch of the feet. It is also necessary to introduce exercises in the regime of the child's day aimed at strengthening the musculature-supporting muscles. This can be achieved by using gymnastics, which consists of riding a cylindrical object, walking on the toes and outside legs, lifting an inclined board, twisting the pedals of a bicycle or an exercise bike barefoot, etc. Good results in strengthening the muscular system are achieved with active exercises in the pool with the instructor for training therapeutic swimming. With adequate response of the child as an auxiliary tool, the use of electrostimulation of the musculoskeletal muscles of the foot is recommended.

In cases where the feet retain the valgus position and without strain, there is a strain of the sinews of the fibular group of the muscles and extensor of the foot, it is recommended that gradual gypsum corrections be performed in the position of reduction, varus and supination of the foot for 1-2 months, until the foot is placed in the middle position. Later on during sleep, the fixation of feet with gypsum longots or tutors continues for 3-4 months and the supply of patients with orthopedic footwear.

Of no small importance is the proper use of special insoles and orthopedic shoes. In children up to the age of three, the use of orthopedic footwear is not always advisable, since it restricts movement in the ankle joint and is recommended only when the foot is deformed in patients with moderate to severe deformity. With an easy degree of deformation, use ordinary footwear with a hard back and an insole with a footrest under the heel and a longitudinal arch of the foot. In patients with moderate to severe deformity, orthopedic footwear provides a rigid outer burtz and a flank, a supinator for the posterior section and an arch of the longitudinal arch. It should be remembered that wearing orthopedic shoes requires regular training to strengthen the muscular apparatus of the lower leg and foot.

Treatment of congenital planovalgus deformation of the feet of a severe degree, the so-called pumping-rocking foot, should be started from the first days of the child's life, when the tendon-ligament apparatus is not retracted and can be stretched. The complexity of the correction lies in the fact that the talus bone, which is located almost vertically in the ankle fork, is rigidly fixed. Step manual corrections with fixation of gypsum bandages should be carried out in specialized orthopedic centers.

The change of plaster dressings with the purpose of correction of deformation is made 1 time in 7 days before the complete correction. If the deformity is eliminated, the limb is fixed in the equino-varous position for another 4-5 months, and only then the child is transferred to specialized orthopedic footwear. At the time of sleep the child is provided with a removable gypsum lint or tutor. Long-term restorative treatment aimed at correction of the arch of the foot, massage of the supporting muscles, muscles of the lower extremities and the trunk is carried out. It is possible to use electrostimulation and acupuncture of the muscles of the foot and lower leg.

Congenital heel-valgus deformation of the foot in children is considered the most easily amenable to conservative treatment. With this pathology, there is a significant tension in the anterior tibial muscle and extensor of the foot, valgus deviation of the anterior part, with a sharp weakness of the triceps muscle of the tibia. The deformation is caused by the incorrect position of the feet in the womb. This is indicated by the heel position of the feet when the child is born. The rear of the foot touches the front surface of the shin and is fixed in this position.

Conservative treatment is aimed at removing the foot in the equinus and varus positions by correction with gradual gypsum dressings or by imposing gypsum longi in the position of equinus and varus deformation of the foot and bringing the anterior section. After the removal of the foot to the equinus position at an angle of 100-110 °, restorative treatment continues: the muscles massage on the back and inner surface of the shins, paraffin applications on the shins and feet, exercise therapy, the foot stops fixing the foot with a gypsum langette at an angle of 100 °. Children enjoy ordinary shoes. The need for surgical treatment is rare and is aimed at lengthening the muscles of the extensor of the foot and fibular group.

[15], [16], [17], [18], [19]

Operative treatment of flatfoot

Operative treatment to correct the deformation is rare. The percentage of operated patients in relation to those under supervision is no more than 7%. If necessary, plastic tendons are performed on the inner surface of the foot, supplemented by extraarticular arthrodesis of the subtalar joint according to Grice. In pediatric adolescents with the painful contractural form of flatfoot, the shape of the foot is formed with the help of a three-joint arthrodesis.

The optimal age for surgical treatment of severe degree of congenital flat-foot deformity of the feet in the case of lack of success of conservative treatment is 5-6 months. The lengthening of the tendons of the retracted muscles, the release of the foot joints along the outer, back, inner and anterior surfaces, the open correction of the talus to the ankle joint, restoration of the right proportions in the joints of the middle, anterior and posterior parts of the foot by creating a duplication of the tendon of the posterior tibial muscle.