Treatment of the hollow foot

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THRUSSELF – THRUSSELF treatment in GERMANY

The high arch of the foot and claw deformations on the toes make shoes uncomfortable.
Calluses at the base of the big toe or little toe.
Mild pain in the arch area of the foot.
The affected foot is stiffer.
The ligaments of the affected foot are more likely to be sprained.

Clubfoot diagnosis in Germany

In German clinics, clubfoot is diagnosed using plantography, in which impressions of the foot are taken on special paper. Another way of diagnosing this pathology is an x-ray of the foot.

A magnetic resonance imaging scan of the spine may be required to determine the cause of the cavus foot and a comprehensive examination by a neurologist to determine the condition of the nervous system.

In the early stages of the disease, conservative treatment is carried out. It consists of a series of physical exercises (remedial gymnastics). If necessary, physiotherapy treatments are carried out.

Doctors recommend wearing orthopedic shoes to relieve pain and prevent further deformity. Some patients can only be treated with special insoles. A foot massage is recommended.

The aim of conservative treatment of hollow foot is to strengthen the arch components of the foot.

Surgical treatment of hollow foot is performed on the soft tissues and bones of the foot. Surgical treatment of hollow foot includes the following methods:

arthrodesis. A surgical procedure to create ankylosis, i.e. immobilization of the joint.

osteotomy. Cutting through the bone with subsequent reshaping.

Severing the longitudinal fascia (plantar fascia). If you have a hollow foot, the longitudinal fascia can be shortened. This is usually done by cutting the longitudinal fascia, which is usually combined with a tendon transfer and an osteotomy of the foot.

causes

Doctors believe that the disease is caused by poorly healed foot fractures and an imbalance in the foot and lower leg muscles. Neuromuscular pathologies that can lead to cavus foot include:

muscular dystrophy;
CEREBRAL PALSY;
meningitis and encephalitis;
Poliomyelitis;
spinal dysraphism;
syringomyelia;
Friedreich's ataxia.

In 20 % of the diagnosed cases of pes cavus, the actual cause of the development cannot be determined.

Symptoms of pathology

The first symptoms are discomfort when walking, rapid fatigue and pain in the problematic lower extremity. Patients emphasize that they have increasing difficulties in choosing footwear - the foot deformity makes it impossible to wear classic shoes, and in advanced cases it is almost impossible. As the disease progresses, the patient's gait changes and the sensitivity of the foot decreases.

The disease is diagnosed as follows:

The doctor examines the foot and measures the height of the arch;
X-rays of the foot and plantography are prescribed (for early treatment when changes cannot be detected by physical examination);
an X-ray of the spine and a general MRI scan are performed.

In most cases, an additional examination is carried out by a neurologist. If there is no obvious cause for the development of a hollow foot, experts speak of a high probability of a malignant tumor in the spine area - an examination and control by an oncologist is necessary.

How do you recognize hollow foot (symptoms and stages)?

The clinical symptoms of hollow feet are ignored by patients at an early stage. Most people attribute the problem to ill-fitting footwear. However, over time it becomes impossible to ignore the existing condition.

In the first stage of cavus foot, the patient suffers from recurrent ankle pain, arch pain and cramps. The second stage is characterized by rapid fatigue, and when trying to wear high-heeled shoes, the pain becomes unbearable and makes walking impossible. The third degree of hollow foot shows the most typical symptoms:

The height of the longitudinal arch of the foot is significantly increased;
the muscles are tense and painful when palpated and do not relax at rest;
The forefoot is splayed;
The toes are spread apart;
Visible deformation of the toe joints;
Dry calluses have formed on the sole, which are very painful and have deep roots.

Before making a diagnosis of cavus foot, it is important to note the presence of accompanying clinical signs. How mobile the foot is, whether there are calf muscle cramps and whether there is hypertonicity.

To confirm the diagnosis, an x-ray should be taken in several projections. This confirms the foot deformity. The degree of hollow foot is determined by the podiatrist using plantography.

In some cases, the doctor orders an MRI scan of the spine, spinal cord and brain. This serves to rule out a neurogenic etiology of the disease.

Cavus foot in a child (with deformity)

A hollow foot can occur in small children because the muscles of the lower limbs are not yet sufficiently developed. This condition can be effectively treated with an individually tailored course of therapeutic exercises.

A hollow foot increases the longitudinal curvature of the child, and abnormal load distribution occurs, which negatively affects the ankle joint, bones of the lower limbs, etc. If the metatarsal bone prolapses at the base of the big toe, there is a compensatory retraction of the heel towards the inner edge. This results in a gradual 'twisting' of the foot with disruption of all the small bones and destruction of the connecting joints.

In children, deformation of the hindfoot occurs. It is characterized by weakness of the triceps muscle and destruction of the arch of the foot. The lowering of the heel below the base of the toes is caused by excessive tension in the flexor tendons of the ankle joint. A persistent contracture of the long toe and a valgus deformity develop.

With forefoot hollow foot, the center of gravity of the foot shifts to the distal toes. This leads to the formation of painful, dry calluses on the metatarsophalangeal joints of the toes.

A hollow foot can develop indirectly if unsuitable footwear is worn. It is characterized by shortening of the plantar tendon and the development of permanent contractures with limited mobility of the foot.

General information

Foot anomalies, as a group of diseases, occupy a special place among congenital pathologies.

Despite the seemingly simple diagnosis, due to the often late start of treatment, the results are not always satisfactory for the patient when he begins to walk on the deformed foot, which also brings with it a pronounced social aspect.

Clinical relevance in outpatient practice The most common foot deformities are.

– Clubfoot (metatarsus varus, metatarsus adductus, clubfoot);
– Congenital flatfoot;
– heel foot;

Metatarsus adductus ('sickle foot').

The outer contour of the foot is convex, the forefoot is lowered. Passive manual corrections are possible due to the plasticity of the foot. In some cases, spontaneous regression in old age is possible.

The child has metatarsus adductus (minimal forefoot adduction) and pes valgus (valgus flat foot).

The cause is hypertension of the tibialis anterior muscle and hypotonia of the tibialis posterior muscle, that is, an imbalance in the tone of the foot muscles that leads to abnormal alignment of the foot.

The most important factor is the type of deformity - rigid (cannot be corrected passively) and non-rigid (can be corrected). According to the photo, the degree of adduction is minimal, so it is most likely a non-rigid deformity.

– Daily physical therapy with trainer, stretching exercises or passive manual manipulation.
– orthoses, footwear.
– Foot and lower limb massage.
– Myostimulation
– Paraffin and ozokerite applications on the lower extremities.

Individual orthopedic insoles. Anti-tip orthopedic shoes with Thomas heel, high toe or back heel, 1 cm heel. 3.
3. foot therapy. Massage of the lower limbs, with emphasis on shins and feet, 4 times a year for 10 sessions. 5.
5. 10 treatments with SMT stimulation on lower legs and feet four times a year.
6) Paraffin ozokerite treatment of the lower legs and feet 4 times a year for 10 treatments. Electrophoresis with euphyllin on the tibial muscles #10, 2 times per year.
8. 1000 IU vitamin D daily - prophylactic dose.
9. Orthopedic observation once every 6 months or more frequently.

FYI – Metatarsus adductus can resolve spontaneously (without treatment) in most children.

If severe deformation or in the absence of a positive trend during follow-up, a graded cast is effective.

If there is residual adduction of the forefoot when walking begins and the child is functionally impaired, wearing varus shoes is indicated.

Treatment

Conservative treatment

Pathogenetic and symptomatic treatment measures are required. Depending on the cause of the gait disorder and the presence of other symptoms, antibiotics, NSAIDs, muscle relaxants and anticonvulsants may be prescribed. Medications are used to improve blood circulation and nerve conduction. Non-pharmacological methods play an important role in all phases of treatment.

An important part of the treatment is exercise therapy using classical methods, mechanotherapy and special simulators. The goal of these exercises is to restore limb function as much as possible and develop new movement patterns. The LFK is supplemented by massage, manual therapy and reflex therapy. Patients are referred for mud treatment, heat treatment and electrical stimulation.

surgical treatment

Patients with gait disorders may undergo the following surgical treatments when appropriate:

Volumetric proceduresIf necessary, the following procedures are performed: removal or aspiration of abscesses and hematomas, removal of tumors.
Circulatory disorders: removal or closureOutpatient clinics: removal, closure and embolization of aneurysms and arteriovenous malformations, thrombolysis, arterial reconstruction and anastomosis for cerebrovascular insufficiency.
traumatic injuriesDecompression trepanation, cranial depression fracture debridement, nerve grafting or suturing, vertebroplasty, corpectomy and spinal stabilization.

Some patients require orthopedic procedures due to secondary musculoskeletal conditions. Muscle and tendon transfers, contracture reduction, arthrodeses and other operations are possible.

3. Gait disorders in the elderly and old people. Guidelines / published by Tkachev ON – 2019 r.

diagnosis

In Germany, treatment of the foot only takes place after a careful diagnosis, which includes the following:

Visual examination by plantography (the imprint of the patient's foot on paper shows the degree of deviation of the axis of the foot from the norm);
X-ray examination to determine the etiology of the deformity and the severity of the disease;
MRI, which is recommended when a spinal tumor or spinal fracture is suspected as the cause of cavus foot;
an orthopedic report - an essential step in the diagnosis that determines how hollow foot is treated in Germany.

treatment methods

Treatment measures include a combination of conservative measures, physiotherapeutic methods and operations. However, the radical treatment of hollow foot is considered extreme therapy in Germany. The final choice of therapy depends on the form of foot pathology, the patient's age and the severity of the process.

Physical therapy in the treatment of hollow foot

The individual therapy complex is developed individually for each patient. It is selected based on the recommendations of the attending physician. With mild foot deformities, warm baths, the use of paraffin preparations and manual massage can eliminate the defect. In later stages of the disease, therapeutic exercises help stabilize (slow down the progression) of the pathological process.

Conservative techniques

In Germany, the treatment of hollow foot is always combined with the following preventative measures:

Proper selection of footwear for everyday use. In this regard, it is very important for women to choose comfortable shoes or boots. They should not have high heels and a wide platform. Doctors recommend paying attention to orthopedic footwear to ensure reliable physiological fixation of the foot.
Use of orthoses. These are special insoles with a raised inner edge, which forms the basis for keeping the arch of the foot in the correct position.
Orthopedic bandages are medical stockings that are used to stabilize the foot.

surgical intervention

Radical surgery is performed when conservative methods and physiotherapy training have proven ineffective. A neurological cause of the disease is also an indication for surgery.

The radical treatment of hollow foot abroad is carried out through an individual selection of the following operations.

Arthrodesis. During this operation, the surgeon creates a solid joint (ankylosis). This procedure requires general anesthesia. After arthrodesis, the foot is no longer physiologically mobile, which significantly limits the benefit of the operation. German specialists can offer more advanced and innovative treatments.
Osteotomy. This method involves cutting the bone tissue and restoring the physiological configuration of the foot. It is a fairly extensive procedure, but the operation is carried out by highly qualified German specialists, so there are no postoperative complications.
Tendon transplantation is a reliable option for an affordable surgical procedure. Foot treatment in Germany corrects the abnormal curvature.
Severing the plantar fascia. It is known that the disease is often associated with shortening and overstretching of the plantar fascia. Therefore, surgical transection of the fascia is sometimes combined with tendon transplantation and bone osteotomy.

Causes and symptoms of hollow foot

The causes of this anomaly are not always clear. However, doctors have identified several factors that can promote the development of hollow foot, including the following

Pathologies of the neuromuscular system (dystrophies, polyneuropathies, neuropathies, poliomyelitis, spinal cord tumors, cerebral palsy, etc.), leading to an increase in the arch of the foot;
Fractures of the heel or talus that have healed abnormally;
The consequences of severe burns.

In addition to the external changes described above, symptoms include fatigue after walking and pain in the ankle area.

Those affected often have unpleasant blisters in the area of the little finger and big toe. Pain in the arch of the foot can also be annoying. Sprains are often diagnosed in this area.

The patient begins to notice that the previous shoes seem uncomfortable. The person tries to lean on the outer arch of the foot, causing even more pain and fatigue.

Diagnosis of the disease

The diagnosis of hollow foot is made using plantography. During this examination, the foot is placed on special paper and the footprint is analyzed.

As you would expect, the center of the footprint is hollow, but the toes and heel are wider than usual.

X-rays are also informative in this case and will definitely show all the points. The doctor may refer the patient for magnetic resonance imaging (MRI) to find out more about the exact nature of the disease.

The doctor may refer the patient for an MRI scan to find out more about the exact nature of the disease. In some cases, a visit to a neurologist may also be necessary.

hollow foot

The causes of this foot deformity include.

Fractures of the heel or ankle bone that have not healed properly.

Beggar's foot is characterized by an increased curvature of the longitudinal arch, that is, an increase in the height of the longitudinal arch.

This deformity is the opposite of flat foot, in which the arch of the foot is usually lowered and flattened.

With a hollow foot, the heel turns slightly inwards and the first metatarsal bone at the base of the big toe falls downwards: the foot appears to 'twist' in its longitudinal axis.

The toes also gradually deform and take on a hammertoe or claw shape: they may be pulled up and the fingernails may be very curved.

In 20 % cases the cause of the hollow foot is unknown.

Neuromuscular diseases cause the arch of the foot to enlarge.

Charcot-Marie-Tooth disease, spinal dysgraphia,

If a patient with this type of foot deformity for the first time has no history of trauma, a spinal cord tumor should be suspected.

In severe deformities, the foot rests only on the tubercles of the calcaneus and the heads of the metatarsals; the metatarsals are not in contact with the ground, which is clearly visible in the plantar impression.

In the forefoot area, there may be an increase in the curvature of the longitudinal arch, which is due to the lowering of the heads of the metatarsal bones, especially the first metatarsal bone.

In other cases, the curvature of the longitudinal arch increases in the area of the hindfoot between the calcaneal tuberosity, the heel bone and the tarsal bones.

A person with hollow feet tires quickly when walking, has pain in the ankles and painful tapering of the sole, especially the big toe. To relieve the pain, stepping on the soles of the feet, that is, stepping on the outer edges of the foot, may help. This causes the feet to tire even faster.

Some manifestations of hollow feet can also be:

information

The greatest experience in Russia in the surgical treatment of patients with thoracic malformations (VDHK, KDHK, Polanda syndrome).

Dr. Pekarski is currently the most sought-after spine surgeon in Israel. Dr. Pekarsky successfully operated on the spine of figure skater Yevgeny Plushenko - video report on Channel 1.

Creation of an individual implant depending on the severity of the deformity. The reception will be hosted by Dr. Pavel Korolev, thoracic surgeon, led.

Watch the video of my seminar 'Deformities of the Foot'.

The first part of the seminar deals with flat feet and valgus problems. In the second part we look at the causes and treatment of hallux valgus, a deformity of the big toe often referred to as a bunion or lump in the toe.

After an initial diagnosis (examination and diagnostic tests), a foot rehabilitation action plan is created. Since every person is different, the spectrum of measures ranges from a one-off treatment (e.g. making individual insoles) to treatment using manual and mechanical methods.

More information about custom-made insoles
For more information about custom orthotics, click HERE

Prices for foot correction treatments

An initial examination and consultation is included in the price of the treatment and the insoles.
Come to me and we will find the most effective method of correction for you.

I meet with patients at my treatment and wellness center
'CdK' at 12B Vesennaya Street, Ryazan.

Telephone appointments and consultations:
+7 (4912) 99-27-37 (Ryazan)
or 8-903-839-27-37

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No breaks or weekends.

Reception is by appointment.

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phone (4912) 99-27-37