Shallow valgus deformity in children

Roller skating, hockey and figure skating are strictly prohibited until the lower limbs are stabilized. Children with valgus deformity have their feet tilted inward, making the problem worse. Skateboarding and scooter riding should also be reduced to a minimum.

Foot deformities in children – what is important to know?

The term 'foot deformity in a child' sounds scary and confusing. In reality, if you heard such a diagnosis from a doctor or understood it yourself from books and the Internet, there is no need to panic. This article explains what foot deformity in children is and what you can do to prevent it.

As the name indicates, foot deformities – a change in their shape. It can be inherited or acquired.

The baby's feet begin to form as early as the 4th to 7th week of pregnancy - many women are unaware of their special condition at this stage! However, there is no longer any way to influence the development of the legs in general and the foot in particular, so rest assured.

In most cases, the pathology begins to develop when infants begin to walk. It occurs more often in children who are actively trained to walk by their parents. Walking early is harmful to the spine and legs.

Therefore, to Dr. To quote Komarowski: 'The child must want to sit and walk independently' (Section 1.7.5 of the book). (Section 1.7.5 of the book 'Child Health and Family Common Sense').

Types of deformities:

Orthopedists will give us a dozen, if not more, types of this problem. Luckily, the average person doesn't need to know them all. The most common are of two types:

• valgus . – Also known as x-shaped. Externally, it looks like the feet are turned outward, and the main load falls on the big toe and the inside of the foot.
• Varus, or O-shaped, looks exactly the opposite. – The child's feet appear to be turned inward and resting on the outside of the foot. This not only leads to distortion of the arch of the foot, but also the axis of the foot. Some refer to this as 'meningeal foot'.

About the disease

The pathology consists in an axial deviation of the lower part of the foot. From the outside it looks as if the foot is turned outwards and there is a large gap between the ankles. A child with this defect walks with their feet cross-legged, with the front foot turned in opposite directions. If the foot is flattened, doctors speak of a flat foot deformity.

With hereditary foot hyperflexion and congenital anomalies, flat feet are detected almost immediately after birth. However, most often the pathology is discovered when the child begins to walk. In these cases, the deformities progress rapidly due to excessive, age-appropriate or inappropriate physical activity. When walking, the load on the legs and spine is incorrectly distributed. It is displaced to the inside of the foot, causing severe pain after walking or standing for a short time.

Types of foot deformities in children

Depending on the cause, the following types of foot deformities can be distinguished

• Traumatic: They occur after an injury;
• Static: caused by incorrect posture;
• Corrective: as a result of inadequate treatment of clubfoot in the child;
• Structural: caused by a congenital malformation of the heel bone
• Compensatory: caused by the tibia and the short Achilles tendon.

The severity of the pathological process is as follows:

• mild: deviation of the heel bone by 5 - 10 degrees and the angle of the longitudinal arch by 130 - 140 degrees;
• moderate: the calcaneal deviation is 10 – 15 degrees and the longitudinal arch angle is 141 – 160 degrees;
• severe: the angle of the calcaneal deviation is more than 15 degrees and the angle of the longitudinal arch is 161 – 180 degrees.

Treatment options for children with flat foot deformity (literature review)

This article reviews the literature on modern treatment methods for children with flat foot deformity. Basic concepts, etiology and pathogenesis of the disease, as well as conservative and surgical treatment methods for pediatric flatfoot deformities are presented, with an emphasis on minimally invasive procedures. One of the currently most popular methods of surgical correction of valgus arched foot deformity in children is arthrodelectrophy of the subtalar joint.

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Introduction

Valgus flat foot deformity is one of the most common orthopedic pathologies detected during the initial examination by the pediatric orthopedist. The prevalence is very high [13, 14, 23, 24, 28]. For example, this pathology occurs in 81.2 % of small children (2) and in older age groups in about 15 % of adults. Although new surgical treatment methods for this pathology have been developed and introduced into clinical practice for many years, and previously known methods have improved, the diagnostic criteria and treatment principles for flat feet are still an important topic of discussion.

Etiology and pathogenesis

In young children, the main causes of flattening of the arch of the foot are excessive thickness of the subcutaneous layer on the surface of the sole of the foot and physiological Hypermobility of the joints..

There are two main theories about the development of flat feet. The first, the so-called muscle theory, assumes an underdevelopment (hypoplasia) of the muscles that form the arch of the foot, which over time leads to a flattening of the arch and the formation of a flat foot [5, 18]. The authors of the second, the so-called 'muscle theory', assume that the muscles that form the arch of the foot are underdeveloped (hypoplasia), which leads to a flattening of the arch over time [5, 18]. Ligament theory, are of the opinion that the main role in the formation and maintenance of the longitudinal arch of the foot is attributed to the ligaments and bones and that the muscles, as a dynamic stabilizer, are activated only when the axial load to maintain balance increases, e.g. B. when walking on uneven ground to protect the ligaments from overload and stretching [10].

It is believed that a number of factors may be involved in the delayed formation of the normal (physiological) arch of the foot. One of these factors is genetic disorders. Therefore, the occurrence of familial forms of flat feet is no coincidence (28). Severe valgus deformities in Down and Ellers-Danlos syndromes represent different variants of the disease. Perinatal CNS trauma may be an additional factor favoring the development of the deformity. Primary CNS injury resulting from perinatal trauma or spondylomyelodysplasia is less likely to be a major factor in the etiopathogenesis of flat foot, but it is possible that neuromuscular defects play an important role in development (4).

Treatment of varus foot deformity

The treatment of varus foot deformity is lengthy and requires great effort from both the child and the parents. Varus deformity is an indication for highly effective physiotherapy methods that balance muscle tone, promote tissue nutrition and optimal growth of these musculoskeletal structures, and improve the function of the joints of the lower limbs.

Varus misalignment of the foot in children requires physiotherapy treatment, massages, physical therapy and the selection of shoes that are optimally and correctly adapted to the child's foot. If the opportunity for conservative treatment of this process is missed, the foot deformity reaches a critical stage and requires surgical treatment and a long series of rehabilitation measures.

Parents play an important role in shaping a positive outcome and must provide their child with corrective footwear, prophylactic massage or exercise therapy, and morning gymnastics.

Foot varicose veins can be corrected with physiotherapy, which is one of the leading non-invasive, painless and highly effective methods of treatment, prevention and rehabilitation in children and adults.

Varus deformity is a permanent cosmetic defect in a child that can lead to adjustment problems in children, which is why early specialized and highly effective medical care is very important.

High-quality medical care is possible in the Belozerova M clinic, where each patient is treated individually.

Which insoles are better for your child?

If your child has been diagnosed with a foot problem, the question that arises for parents is: Which insoles should you buy? In this case, you should contact an orthopedist who will advise you on choosing the right insoles, help you choose the right model and tell you how to prevent orthopedic foot diseases in children.

BAUERFEIND GloboTec Junior was developed by the leading German manufacturer BAUERFEIND specifically for the proper training of children's feet. The insoles put children's feet in the correct position, form a correct arch and prevent the development of flat feet and scoliosis. With orthopedic insoles, your child walks more comfortably, their feet tire less and they can 'walk from morning to night'.

ORTMANN SolaMed Dynamic insoles effectively support the feet and make sporting activities easier and more comfortable for your child. The lightweight and durable SolaMed Dynamic insoles distribute pressure on your child's feet during sporting activities, protect the muscles from overload and reduce foot fatigue. The special padding in the heel area reliably absorbs shocks to the spine and joints during high physical strain. The reduced frame stiffness at the edges of the insole ensures that the natural mobility of the muscles and ligaments of the child's foot is maintained.

ORTMANN SolaMed Easy insoles are suitable for all types of children's shoes with a closed toe and a stiff heel cap. They are suitable for all weather conditions and seasons (when used in seasonal shoes). They are designed to sit in the shoe in relation to the heel. Determines these orthoses in longitudinal-transverse flatness 1-2 degrees and forefoot extension (transverse flatness).

What is clubfoot?

Clubfoot is a serious pathology that belongs to the deformities of the lower limbs. It occurs in young children (up to 7 years of age), but during this period only monitoring and prevention are required as the musculoskeletal system is just forming. By the age of 7, the progression of the disease is usually already noticeable. Before the age of 11, the diagnosis of valgus deformity (X-shaped deformity) is not yet final. The process can regress, but it can also progress further. As you get older, the consequences of X-shaped feet are much more serious.

Externally, the feet resemble the letter 'X', but serious abnormalities develop internally. These can affect the femur or shinbone, and treatment varies depending on the situation.

A valgus deformity of the feet (X deformity): causes

There are several causes of valgum, the main ones include:

• Rickets in children
• Spinal diseases, mostly congenital
• Trauma and femoral fractures leading to unilateral valgum (X-shaped deformation of the legs)
• Severe infections (osteomyelitis)
• Some benign tumors.

The valgum gene is very common in overweight people. If the child is obese, valgum is more likely. The reason for this is simple: the joints are still developing and cannot support the additional weight and become weaker under its influence. Conversely, children who are too thin may have weak muscles.

Women are more commonly affected due to their pelvic structure.

Signs that indicate problems

Signs of valgus deformity become noticeable by the age of 1 year. The parents notice that the feet are not aligned properly when the child tries to take his first steps. The child does not walk on the whole foot, but takes steps on the inner edge, where the arch of the foot is.

If nothing is done, the lower limbs will gradually become X-shaped and the gait will become awkward. Later, the child complains of getting tired quickly and having leg pain when playing with friends. Excessive exercise can cause swelling and cramps in the calf muscles. A characteristic symptom is slipping of the shoes on the inside of the sole.

How is this pathology diagnosed?

The pediatrician may suspect this disease during a routine checkup. However, a final diagnosis is made only by an orthopedist after a thorough examination of the child. These include the following methods:

• X-rays of the feet in 3 projections. The pictures show their distorted position in relation to each other.
• Computed tomography (optoelectronic). It is used to calculate various parameters to assess the severity of the pathological process.
• Podometry. Allows you to determine foot deformities by measuring different parts of the foot and calculating the ratio of the data obtained.

In some cases, the orthopedist may refer the child for an ultrasound scan of the joints.

What is that?

Actually, valgus deformity and flat feet – are different pathologies of the lower limbs, but in children the most common is a combination of a lowering of the arch of the foot, which is typical for flat feet, and a change in the orientation of the foot under load, with a shift to, characteristic of valgus deformity Inside.

A valgus deformity is a deformity in which the child is in an upright position The foot rests primarily on the inside of the foot with the toes and heel facing outward.

Normally the feet should be parallel, meaning you can mentally draw two straight vertical lines when looking at the two standing feet from behind. In a child with a valgus deformity, these lines at the ankle joint are kinked and inclined outward, which is the second name for this deformity. X-shaped deformity of the ankle joint.

With flat feet the situation is much more complicated. All children have physiological flat feet from birth, so at the age of 1-2 years they cannot yet be considered pathological. However, orthopedists treat the problem comprehensively, and the diagnosis - flat foot deformity - appears in the child's medical record.

causes

Valgus curvature can, although quite rarely, be congenital. For some reason, the lower limbs of the fetus develop abnormally even in the womb. It can be observed almost immediately after birth, and by 2 to 3 months of age the diagnosis is usually made.

The disease is more often acquired. Feet may become flat-footed due to excessive stress on the baby's weak feet. This is the case when parents place their child in a walker or jumper too early.

Standing aids should not be used before the age of 9 months.

Since the tendons and muscles of the feet are still weak and some infants also have a congenital weakness of the connective tissue, negative influences associated with heavy strain on the legs can lead to valgus deformities, which, due to age-related characteristics, are a duo with the physiological flat foot in small children and the pathological flat foot in older children.

Those particularly susceptible to this disease are:

• premature and low birth weight infants;
• children with cerebral palsy and other neuromuscular diseases;
• chubby children who are overweight;
• children with hip dysplasia;
• infants suffering from rickets;
• infants who are weak and frequently ill;
• children who wear uncomfortable and too soft shoes that do not support their feet;
• Children who have suffered an injury to the ankle, knee joint, muscle or tendon, or metatarsal bone.

Treatment

The treatment tactics depend on the clinical picture, but should always be comprehensive. The most commonly prescribed treatments include:
– Massage and physiotherapy
The main goal of these techniques is to normalize and improve blood circulation and reduce pain and inflammation.
– Wearing orthopedic insoles and shoes
One method used for patients of all ages is orthopedic insoles to keep the feet in the correct position. Orthoses, insoles and splints are individually adjusted.
– Surgical treatment methods
These are recommended for severe valgus foot deformities and other pathologies. Surgical procedures can be performed on the soft tissues of the feet, on the bones, or on both areas at the same time.

Massage, manual therapy, physical therapy and shock wave therapy, acting only locally on the foot itself, its joints, muscles and the plantar aponeurosis, have a temporary effect, and such treatment cannot be called complete.
Such methods of treating any type of flat foot with its complication of a valgus lesion of the first toe or a hollow foot have no effect on the root cause of the problem, since a holistic approach to the body is excluded. The most important historical assumption of medicine as a science and art of healing - 'It is not the disease but the patient that needs to be treated' - is violated.
The experienced specialists of the Quality of Life Clinic look at the problem from the point of view of the body as a single system. Taking into account the biomechanics and hydrodynamics of the body, we note that the cause of foot pathologies (other than direct trauma) can be, for example, the following. Scarring and adhesions resulting from inflammatory diseases of the pelvis, abdomen and chest, trauma and surgery.
Anomalies of the muscle chain of the lower limbs, pelvis and, of course, the whole body play a huge role. Frequently, the cause of valgus deformity is dysfunction of the hip rotators, external transverse abdominal muscles, and gluteal weakness, collectively referred to as 'closed pelvis'. These factors lead to a strengthening of the longitudinal and transverse arches of the feet, which is responsible for the characteristic visible symptoms.
Overloading and fixation of the dura, for example due to whiplash, craniocerebral trauma or birth trauma, also play a role. All of these problems affect the biomechanics of the entire body and the feet in particular.
To eliminate deformities, it is necessary to treat all pathological connections and movement restrictions that exist in the body of a particular patient, taking into account the individual anamnesis and characteristics of the body. In this case, osteopathy is the most effective treatment method.

preventive measures

To prevent valgus deformity of the 1st toe, it is recommended to wear comfortable shoes with a heel of no more than 5 cm and to prefer comfortable shoes with a flat sole in everyday life. Shoes with a high and unstable heel (stilettos) should only be worn in exceptional cases and for short periods of time.

Weight control, an active lifestyle, more frequent walking barefoot on grass and pebbles and the use of special massage mats are effective preventive measures.

In addition, timely treatment of injuries and inflammation and the use of orthoses are important.

Be healthy in body and mind! And if you have any problems, contact the team of specialists at our clinic who can help you successfully restore your health and quality of life!

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