Flatfoot is a change in the shape of the arches of the foot, accompanied by the loss of its cushioning (spring) functions. Depending on which arch of the foot is flattened, transverse and longitudinal flat feet are distinguished. There is also a distinction between congenital and acquired flat feet. About 45% of all adults suffer from various forms of flat feet. Pathology is more often detected in women. Flatfoot are the cause of pain in the foot that appears during walking. Often, with flatfoot, calluses and corns form on the sole, deformation of Hallux valgus. In addition to X-ray examination, the diagnosis of flatfoot includes plantography and podometry. Treatment consists in the constant wearing of supinators or orthopedic shoes, periodic courses of massage, physical therapy and physiotherapy.
Flatfoot (flat feet) is a change in the shape of the arches of the foot, accompanied by the loss of its cushioning (spring) functions. It is the cause of increased fatigue of the feet during exercise, provokes the development of arthrosis of small joints of the foot, has a negative effect on the spine. About 45% of all adults suffer from various forms. Pathology is more often detected in women.
Flattening of the arch of the foot can be congenital or acquired. Congenital flatfoot account for 3% of all cases of the disease. The cause of the most common acquired form – static flat feet (80% of the total number of cases of the disease) is the weakness of the bones, muscles and ligamentous apparatus of the foot and lower leg. There is a hereditary predisposition to the occurrence of pathology caused by inherited weakness of the ligaments.
The risk of static flat feet increases with an increase in body weight, insufficient physical activity in people of sedentary professions, “standing work” (sellers, hairdressers, assemblers on conveyors, weavers, etc.), the use of uncomfortable shoes, aging. Static flat feet can also develop due to the constant wearing of high-heeled shoes (due to excessive load on the front parts of the foot). Other causes of acquired pathology are:
- Traumatic injuries. Ligament weakness and changes in anatomical relationships between different parts of the foot occur after fractures of the calcaneus, ankles and tarsal bones.
- Polio. The consequence of polio is paralysis of the muscles of the foot and lower leg, which entails a redistribution of the load during walking, weakening of the ligaments and a violation of the relationship between the structures of the foot.
- Rickets. Due to a decrease in the amount of calcium, the bones of the foot are weakened and cannot withstand normal physiological loads. Currently, rickety flat feet are rare.
The foot holds the weight of the body, does not allow a person to fall while walking, plays the role of a shock absorber and lifting mechanism. In performing all these functions, the arches of the foot are of great importance – rigid and at the same time elastic formations that include the bones of the foot, its ligaments and muscles. There are two arches of the foot: transverse (an arc from I to V of the metacarpal bone, which becomes visible if you take the foot with your hand from the sides and squeeze it in the transverse direction) and longitudinal (an arc in the area of the inner edge of the foot). The purpose of the arches of the foot is to maintain balance and protect the body from concussions while walking.
With the weakening of the musculoskeletal structures, the muscles and ligaments of the foot cease to cope with a high load, the foot flattens, “settles”. At the same time, its cushioning function is reduced. Concussions during walking are transmitted to the overlying parts (spine and joints of the lower extremities), in which degenerative changes develop due to constant overload (osteoarthritis, posture disorders, osteochondrosis).
Taking into account the time of occurrence, congenital and acquired flat feet are distinguished. Congenital flat feet is a rare pathology caused by a violation of the development of the foot in the prenatal period. In young patients, the congenital form of the disease is usually diagnosed at the age of 5-6 years, since at an early age the arches of the foot are not yet sufficiently developed, and signs of a flat foot are detected normally in all children. Depending on the changes in one or another arch of the foot , the following forms of flat feet are distinguished:
- Transverse. It is diagnosed in 55-80% of cases. It usually develops in middle-aged people (35-50 years old). Women suffer 20 times more often than men. This type of flatfoot is characterized by a decrease in the length of the foot, fan-shaped divergence of the metatarsal bones, deformation of the I finger (Hallux valgus), which is usually called a “bone” in everyday life, and hammer-shaped toes of the foot.
- Longitudinal. It is detected in 20-29% of patients. It is more often formed at a young age (16-25 years). Accompanied by flattening of the longitudinal arch of the foot. The foot lengthens, spreads out and comes into contact with the support with almost the entire sole.
- Combined. Signs of longitudinal and transverse flat feet are combined with each other. Pathology is usually detected in middle age.
Transverse flat feet
Normally, the transverse arch of the foot, formed by the heads of the metatarsal bones, has the shape of an arch. The main support when standing and walking lies on the heads of the V and I metatarsal bones. With the development of flat feet, the supporting structures of the arch of the foot weaken: plantar aponeurosis, which bears the main load on the retention of the arch, the interosseous fascia and the muscles of the foot.
The support is redistributed to the heads of all metatarsal bones, while the load on the head of the I metatarsal bone decreases, and the load on the heads of the II-IV metatarsal bones increases sharply. The I finger is deflected outward, the head of the I metatarsal bone and the I finger form an angle. Osteoarthritis occurs in the I metatarsophalangeal joint. There are pains, the volume of movements in the joint decreases.
Increased pressure of the metatarsal heads causes thinning of the subcutaneous fat layer on the plantar surface of the foot, causing a further decrease in the cushioning function of the foot. Corns are formed on the sole in the area of the heads of the metatarsal bones.
Depending on the severity of the angle between the I finger and the I metatarsal bone , the following degrees of transverse flatfoot are distinguished:
- I (weakly expressed). The angle is less than 20 degrees.
- II (moderate). The angle is from 20 to 35 degrees.
- III (pronounced). The angle is more than 35 degrees.
As a rule, patients consult a doctor about a cosmetic defect of the foot, less often – about pain during walking, corns on the sole, rough skin growths or inflammation in the area of the I metatarsophalangeal joint (Hallux valgus).
During the survey, it usually turns out that the patient has been bothered for a long time by more or less pronounced burning or aching pains in the foot while walking. Examination reveals deformation of the foot: flattening of its transverse arch, characteristic deformation of the I metatarsophalangeal joint, with pronounced flat feet – hammer-shaped toes.
Longitudinal flat feet
When the longitudinal arch is flattened, the bones, muscles and ligaments of the foot and lower leg are involved in the process. The bones move in such a way that the heel turns inward, and the front parts of the foot deviate outward. The tension of the fibular tendons increases, and the tendons of the anterior tibial muscle decreases. The middle part of the foot expands. The patient’s gait becomes clumsy, when walking, he strongly spreads his socks to the sides.
There are four stages of longitudinal flatfoot:
- the pre-pain stage (prodromal stage);
- intermittent flat feet;
- flat foot;
- flat-footed foot.
At the stage of pre-pain, the patient is concerned about rapid fatigue when walking, pain in the upper part of the arch of the foot and the muscles of the lower leg after prolonged static loads. In the stage of intermittent flat feet, pains appear not only by the end of the working day, but also after standing or walking for a long time. The tension of the muscles of the lower leg is revealed, sometimes their temporary contractures develop. The longitudinal arch of the foot has a normal shape in the morning, but by the evening it becomes flattened.
During the development of a flat foot, pains appear even after small static loads. The foot expands and flattens, the height of its arch decreases. Gradually, the gait begins to change.
There are three degrees of a flat foot:
- I. The stage of the beginning of formation. The height of the arch of the foot is less than 35 mm;
- II. The height of the arch is 25-17 mm. Osteoarthritis begins to develop in the joints of the foot;
- III. The height of the arch is less than 17 mm. The anterior parts of the foot unfold and spread out. The deviation of the I finger to the outside is revealed. At the same time, the pain in the foot is temporarily reduced.
In the absence of treatment, a flat-foot foot is formed in the future, in which pain appears at the slightest static load. There is a valgus deformity (a sharp turn of the foot with the plantar side inside) and pronounced flattening of the arch of the foot.
Diagnostics is carried out by orthopedic doctors. To clarify the type and severity of flat feet , the following methods are used:
- Survey. The specialist finds out the presence of complaints such as pain and heaviness in the legs, swelling by the end of the day, increased fatigue when standing and walking. The orthopedist clarifies the connection of the patient’s work with static overload, weight gain and shoe size in recent years.
- Objective examination. The doctor examines the foot in a free state and under load, evaluates the appearance of the foot, the severity of the arches, the presence of deformities and the volume of movements.
- Foot x-ray. It is performed with a load (with functional tests). It is the main diagnostic method. Allows you to accurately determine the severity of the longitudinal and transverse arch, physiological and pathological angles between the bones of the foot, etc.
- Other techniques. To identify and assess the severity of flat feet, plantography is prescribed (ineffective in infants and obese people) and podometry.
Treatment of transverse flatfoot
Conservative therapy is effective only at the first stage of flat feet. The patient is recommended to reduce body weight, choose comfortable shoes without heels, reduce static loads on the foot. The wearing of special insoles and rollers is shown.
With flat feet of the II and III degrees, surgical treatment is performed. There are many techniques for correcting the deformation of the I finger, however, no operation eliminates the cause of transverse flatfoot – weakness of the ligaments and muscles of the foot. Isolated surgical intervention is possible (resection of Hallux valgus – a protruding bone section) and surgical treatment, including resection of a bone section in combination with joint capsule plastic surgery and tendon transplantation. In the postoperative period, a patient with flat feet is recommended to constantly wear supinators or shoes with special insoles.
Treatment of longitudinal flatfoot
At the stage of pre-illness, the patient is recommended to develop the correct gait (without diluting socks), walk barefoot on sand or uneven surfaces and regularly unload the muscles of the arch of the foot, while standing periodically transferring the load to the outer surfaces of the feet. A patient with flat feet is prescribed exercise therapy, massage and physiotherapy: magnetotherapy, SMT, hydro massage, etc.
At the stage of intermittent flat feet, a recommendation is added to the listed measures to change the working conditions to reduce the static load on the feet. With a flat foot, orthopedists recommend wearing orthopedic shoes and special insoles to the complex of therapeutic measures. With further progression of flat feet, surgical treatment is indicated. At the stage of a flat-footed foot, conservative techniques are ineffective. Various plastic surgeries are performed: resection of bone sections, tendon transplantation, etc.
In the early stages, the prognosis is favorable. In younger childhood, flat feet can be corrected. In adults, complete elimination of pathology is impossible, however, proper selection of shoes, regular special gymnastics, optimization of the load on the legs and the use of orthopedic products can prevent the progression of pathology, minimize or eliminate unpleasant symptoms. In the later stages, even after surgical interventions, pain, movement restrictions and other manifestations caused by secondary changes in the feet may persist.
Preventive measures include examinations of children for the detection and early initiation of treatment of congenital flat feet. Adults are recommended to normalize body weight, avoid static overload, wear comfortable shoes, observe a regime of sufficient physical activity, strengthen the muscles of the feet and shins.
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