Doctor Komarovsky about flat feet in children

Dr. Komarovsky says the following about flat feet in children: 80% of parents worry about this topic in vain, and unscrupulous manufacturers of various drugs for the treatment of pathology profit from parental illiteracy. The golden rules of a famous pediatrician regarding the prevention and treatment of flat feet, which parents can take into account.

Nothing about the disease

Flat feet is a foot deformity in which the arches are flattened, shock-absorbing properties are impaired, and internal systems and organs suffer. At school age, flat feet are diagnosed in 40% of children.

How to avoid such deplorable statistics - Dr. Komarovsky claims that if from birth one hour a day is devoted to stress on the muscles of the foot, flat feet will not form.

Attention!
Evgeniy Olegovich is a well-known pediatrician, candidate of medical sciences, doctor of the highest category, TV presenter of the author’s program “Doctor Komarovsky’s School.”

According to medical research, pathological foot disorders are divided into 2 types - congenital flatfoot and acquired. Each form must be treated without fail in order to avoid serious consequences - scoliosis, rickets, varicose veins, clubfoot, and changes in gait.

According to Evgeniy Olegovich, a child’s foot is formed before the age of 12, and therefore it is quite possible to correct flat feet before this period without expensive treatment and surgery.

Symptoms of obesity in children

Primary obesity (nutritional-constitutional) is characterized by:

Uniform fat deposition.
Increased appetite. Characterized by an almost constant feeling of hunger, which does not go away even after a large meal.
Normal or tall height.
Delicate, elastic skin. Sometimes pink stretch marks (skin lesions in the form of stripes) and keratosis pilaris (small raised rashes on the skin) are observed.
Earlier or delayed sexual development.
Girls experience early menstruation.
Flat feet and X-shaped knee deformity.
Increased blood pressure.
Shortness of breath is common. It occurs even with light physical activity.
Headaches in the morning associated with decreased oxygen at night.
A decrease in the child’s self-esteem, the development of depression, which negatively affects the child’s education.

In more severe cases, Pickwick syndrome may develop . This syndrome is characterized by a rapid increase in body weight, narrowing of the upper respiratory tract, cardiorespiratory disorders (rapid breathing, rapid pulse, poor circulation), drowsiness or falling asleep while standing.

It is important to exclude the development of Pickwick's syndrome.

Hypothalamic syndrome of puberty is characterized by:

The onset of obesity in early childhood. Children aged 11-13 years become especially fat, so they look older than their peers.
Formation of uniform obesity according to the female type (deposition of fat on the hips and lower abdomen).
Tall.
Enlargement of the mammary glands.
The appearance of pink stripes on the skin of the abdomen, shoulders and thighs - stretch marks.
Increased blood pressure.
Constant feeling of hunger. The feeling of hunger especially occurs in the second half of the day, towards night.
Thirsty.
Frequent and copious urination.
Accelerated sexual development. Young men often exhibit pseudoeunuchoid body features, enlarged mammary glands, hypersexuality, and are prone to early sexual activity. Girls may experience increased male-pattern hair growth and menstrual irregularities.

Causes of pathology

Congenital curvature of the foot occurs during fetal development and progresses under the influence of certain factors:

Deficiency of vitamins and microelements in the mother’s body;
Bad habits – smoking, alcoholism;
Diabetes;
Endocrine disorders.

Such a curvature of a child’s foot can be noticed at 2 months of life; it is important to remember that the pathology is rapidly progressing, and in advanced cases, even surgery will not be able to give the desired result.

Acquired deformity is often associated with mistakes made by parents in the development of the child’s musculoskeletal system - obesity, lack of activity, early getting on their feet (incorrect use of walkers), purchasing shoes without arch support, unfair treatment of the identified pathology.

Attention!
Dr. Komarovsky urges parents not to panic, because all children have flat feet, and if the load on the legs is properly organized, then as they grow up, the musculoskeletal system will normalize.

Incorrect development of the arch of the foot is detected in children after 3-5 years of age; the disorder can be suspected by the child’s clubfoot, when when the baby walks, emphasis is placed on the outer or inner part of the foot. Shoes wear out more on one side than the other. Only an orthopedist can make a correct diagnosis.

Reasons for the progression of flat feet

Causes of obesity in children

Excessive quantity and improper quality of child nutrition, which leads to changes in the functioning of centers in the brain that are responsible for appetite.
Hereditary factors.
Traumatic brain injuries. Often such injuries occur during childbirth.
Infections (neuroinfections).
A tumor that affects the hypothalamus. The hypothalamus is a brain structure that performs various functions, including regulating appetite and satiety in a child.
Chronic foci of infection in the nasopharynx and paranasal sinuses.
Stress.
Use of hormonal contraceptives by adolescent girls.
Pregnancies and abortions in minor girls.

The above reasons play a role in the development of primary obesity (i.e. obesity as an independent disease). It is worth noting that there are cases when obesity develops secondary to other diseases.

There are cases when obesity develops against the background of other diseases.

Treatment of flat feet

Treatment of hallux valgus is aimed at strengthening the ligamentous apparatus, foot muscles, and proper formation of the arch. Among the methods for correcting a child’s foot are the following methods:

Daily gymnastics - walking on massage mats that imitate an uneven surface, rotating the feet in different directions, bending/extending the fingers, rolling toys on the floor, grasping small objects with the toes, drawing on paper, walking in a “duck step”;
Foot massage to eliminate swelling and pain. Doctor Evgeniy Olegovich is skeptical about this procedure, considering it useless at the stage of treating flat feet; it is better to organize the active activity of the toddler, and use massage as a tool for satisfying and relaxing the body;
Physiotherapy - electrophoresis, currents, magnets, to increase muscle tone, strengthen tendons, improve blood flow;
Wearing high-quality shoes - durable soles, breathable insoles, arch supports, stable heel, rounded toe, comfortable fit. The size of shoes for growth should not exceed 12 mm. An orthopedist can prescribe individual orthopedic insoles for a child to treat and prevent flat feet;
Walking barefoot on grass, pebbles, sea sand;
Complete nutrition to provide the growing body with the necessary vitamins and microelements, necessarily calcium and vitamin D.

Komarovsky says about the treatment of flat feet in children: “The best pastime for a child is active games, and if you do not provide a TV and tablets in return for this, then the child will not have problems with the development of his feet.”

The ideal solution for the prevention of pathology is a wall bars, where you can walk on a log or climb a ladder. Parents can also add devices for pulling up, to strengthen the abdominal muscles and activate the entire motor system.

Treatment of flat feet in children

Massage technique according to Komarovsky

In order for muscle tone to normalize and the arch of the foot to form correctly, it is necessary to create the appropriate conditions. These include regular walking on uneven surfaces and other preventive measures. Don't forget about massaging, which is easy to do yourself. The procedure triggers improved blood circulation and promotes muscle tone.

Experts recommend massage for flat feet in young children at home. You need to start with light stroking, covering the area of the lower leg and ankle joint. Every day you need to rub the leg with your palm, work on the finger and the outer arch separately. Perform circular movements without jerking. The doctor advises to gradually complicate the technique and combine exercises.

An orthopedist can offer a large selection of special foot massagers. Choose models made from natural raw materials. In advanced cases of flat feet, a course of therapeutic massage is necessary. It must be carried out by a specialist. Apply moderate pressure so that the muscle does not tense. When massaging the feet of a child of the first year of life, you need to use your fingers and hand - this is what the instructions say.

Gentle tangential movements should be used at the beginning and at the end of the session. They are needed to establish contact with the baby at the beginning of the procedure in order to relax the joint. If the baby is capricious, nervous or crying, check the technique - the child may be unwell. This should be regarded as a contraindication to the procedure.

Forecasts for the future

If flat feet are detected in a child at 2 years of age and preventive measures are taken by the age of 5, the disease can be completely eliminated without the use of medications and surgical agents.

If flat feet are detected late and proper medical care is not provided, then the disease can cause curvature of the spine, problems with the pelvis, and the cervical region of the central nervous system. In the future, the patient may find himself in a wheelchair.

Flat feet in children according to Komarovsky is a banal foot deformity, but if parents are negligent it can lead to irreversible consequences.

How flat feet harm your health

Poor posture

Flat feet directly affect the formation of posture. Improperly distributed load on the feet leads to curvature of the spine and prevents all muscles from functioning properly. The unnatural position of our body can lead to disruption of blood circulation and breathing, displacement of internal organs and serious problems with the musculoskeletal system.

Increased fatigue

If the body is in an unnatural position and the back is excessively bent, less air enters the lungs when sighing. Accordingly, less oxygen enters the body, and this negatively affects the functioning of the respiratory and cardiovascular systems and even affects the activity of the brain. Due to lack of oxygen, fatigue, lethargy, and drowsiness appear.

Moreover, you must agree that it is difficult to concentrate on something important due to the accompanying pain and discomfort in the back caused by the incorrect position of the spine. In addition, heaviness and fatigue in the legs greatly distract from the work process. All muscles of the musculoskeletal system are too tense, so the body gets tired faster, and productivity decreases during the day.

Headache

Flat feet negatively affect the spine, which causes improper pressure on the intervertebral discs and contributes to the formation of an unnatural position of the head and neck. This often leads to headaches.

In addition, due to flat feet, the shock absorption of the foot does not work properly. With each step we take, the shock wave from the collision of the foot with the surface spreads from the heels to the cervical spine. Its strength is easy to calculate: it is 2/3 of your body weight multiplied by the number of steps during the day. Typically 2-3% of this load reaches the brain. If the foot does not perform the shock-absorbing function properly, then with each step the brain receives a much greater shock, which, of course, can also manifest itself as a headache.

Corns

Due to a violation of the biomechanics of gait, corns (calluses) form on the soles of the feet. Often they indicate the presence of pathology, including flat feet. This is how the feet try to protect themselves from strong shock loads. The longer your feet are exposed to improper pressure, the thicker and rougher the skin becomes. Corns are usually removed using a cosmetic procedure, getting rid of the external manifestations of the problem, and not the cause.

Calluses are a signal that your feet need support. This symptom is usually ignored and is very rarely associated with any orthopedic disease. Even though in such cases the legs often get tired, the knees and spine hurt.

Varicose veins

Few people realize that flat feet often cause the development of varicose veins. A unique feature of the venous system is the presence of valves that direct blood directly to the heart. Most of the venous valves are concentrated in the lower leg. When we move, the muscles in it contract, squeezing blood out of the veins and stimulating its flow to the heart. This mechanism is called the muscular-venous pump of the leg - it returns about 75% of the blood to the heart.

Impaired spring function of the foot caused by flat feet negatively affects the functioning of the muscle-venous pump. Due to flat feet, the muscles and ligaments of the lower leg are overloaded and tense, which interferes with the functioning of the muscular-venous pump. The outflow of blood is disrupted, the pressure in the veins increases, and they expand.

Fever in a child: how to bring down the temperature

Why does the temperature rise during illness?

The body has its own “climate control” system, which is responsible for the constancy of body temperature. During inflammation, substances are produced that change the settings of the thermoregulation center, and the temperature begins to be maintained at a higher level. This makes a certain sense: in conditions of elevated temperature, bacteria and viruses feel less comfortable, and the immune system, on the contrary, begins to work more actively. This is a fever - with its help the body fights infection. Fever should be distinguished from heatstroke - there is no protective meaning in it, and the temperature rises due to the fact that the body simply does not have time to cool down (usually due to heat, physical stress and lack of water).

What temperature is considered normal?

Body temperature is very variable and depends on age (the younger the child, the higher his temperature), time of day (usually higher in the evening), physical activity, and also on the method of measurement - thus, the 36.6 ° C familiar to everyone is very arbitrary and There is simply no single standard.

How to measure temperature?

We are accustomed to measuring temperature under the armpit; in many countries, measurements are taken in the mouth or rectum (these indicators are higher). Electronic thermometers are preferable to mercury thermometers - but it must be borne in mind that in order to get an accurate result after the sound signal, you need to leave the thermometer for a few more minutes. Not everyone does this, and therefore the indicators of an electronic thermometer are sometimes unfairly considered to be underestimated. There are also ear and non-contact infrared thermometers, but their readings are not highly accurate.

When should the temperature be lowered?

In itself, high temperatures up to 41 ° C are not life-threatening. The temperature needs to be brought down if the child feels unwell, and the numbers on the thermometer are of secondary importance. If a child has chronic diseases, then it is worth discussing this issue with the attending physician in advance, and if a high temperature appears in a baby under three months old, this is a reason to call an ambulance. In all other cases, you should focus on the child’s well-being: if he is lethargic, complains of a headache and general malaise already at 37.9 ° C, you have the right to give an antipyretic drug. And if a child can barely sit still with a thermometer, you should not run after him with medicine, even if the thermometer reads almost 39 °C.

Many people think that the higher the child’s temperature, the more dangerous and severe the infection he faces, but this is not entirely true. The immune system has not yet fully formed and attacks any infections with all its might. This is why a child’s temperature can rise significantly with a banal ARVI, while this usually does not happen in adults.

How to lower the temperature correctly?

First of all, you need to make sure that the child drinks a lot and does not overheat additionally - to do this, you need to remove excess clothes and blankets from him and open the window slightly so that the room is not stuffy. You can wipe with warm (not cold) water - the cooling effect is achieved due to the evaporation of water from the surface of the skin. And finally, if you feel unwell, you can give an antipyretic drug - it will return the thermoregulation center to maintaining the original, normal temperature. The most effective method is to give an antipyretic, and after half an hour, wipe the child with water.

The only two medications allowed for children with fever are ibuprofen and paracetamol (acetaminophen). They are available in the form of suppositories and syrups under different trade names.

The dose is calculated by weight, not by age of the child.

Ibuprofen: single dose - 10 mg per 1 kg of child's weight. Can be given every 6 hours no more than 4 times a day.

Paracetamol: single dose - 10-15 mg per 1 kg of child's weight. Can be given every 4-6 hours, but no more than 4 times a day.

The drugs begin to act 30-60 minutes after administration and reduce the temperature by about 1-2 °C (and not up to 36.6 °C), while improving well-being. If more than 3 hours have passed after taking one of them, and there is no effect, you can change the drug and start using another, but do not alternate them each time.

When to call an ambulance?

Fever itself is not a reason to panic. It is better to seek emergency medical help if there are so-called red flags:

disturbance of consciousness, convulsions;
dehydration (lack of urination, tears when crying, dry mucous membranes);
breathing problems (sharp increase in frequency, difficulty breathing, appearance of uncharacteristic sounds);
the appearance of a rash that does not fade when pressed (if you press a glass glass tightly to the site of the rash, the rash remains bright);
severe headache even after taking antipyretics;
incessant vomiting;
persistence of poor health and fever of more than 40 ° C after taking antipyretics;
acute abdominal pain;
age up to 3 months.

All other situations most likely do not require emergency assistance. So, if ear pain appears, you can give your child a painkiller (the same ibuprofen) and calmly wait for the pediatrician. But if you think that something is wrong with your child and he is behaving unusually, you should take your child to the doctor as soon as possible.

What not to do?

It is strictly forbidden to use aspirin as an antipyretic in children due to the risk of a fatal complication - Reye's syndrome. In addition, you cannot:

give analgin and soluble combination drugs “against colds” (like Theraflu) as an antipyretic;
rub with alcohol and vinegar due to the risk of poisoning (the permeability of children's skin is higher than that of adults);
wrap the child up and wait for him to sweat;
use mustard plasters due to the risk of burns;
take antibiotics on the third day of fever. There are many viral infections in which the temperature lasts longer than 5 days. If the fever persists, you need to see a pediatrician rather than take antibiotics.

Don’t just take your child’s temperature, just in case he’s healthy. If something is wrong with your child, you will notice it without a thermometer. Believe me, it is very easy to see that a healthy child’s temperature is above 37 °C. Coping with your anxiety and making sure that this temperature is normal for him is much more difficult.

And finally, there is no need to panic. Fever is an everyday thing. A sick child needs a calm mother who will give him something to drink if necessary, give him medicine, wipe him off with a damp towel and just be there.

Diagnosis of obesity in children

The main condition for diagnosis is excess body weight.

To assess body weight, special tables are used that allow you to determine the ideal body weight depending on the gender, age, and height of the child.

In everyday practice, pediatricians use body mass index, which you can calculate at home. It is determined by dividing body weight in kilograms by height in meters squared (kg/m2). A BMI greater than 30 indicates the development of obesity in a child.

In addition, to make a diagnosis, the doctor may prescribe:

General blood analysis.
Biochemical blood test (lipid profile).
X-ray of the hand. Allows you to determine bone age, which may differ from the passport age.
X-ray of the skull in two projections. It will allow you to judge the pathology of the pituitary gland, as it shows the state of the anatomical structure - the “sella turcica”.
Consultation with a neurologist.
Consultation with an ophthalmologist.
Determining blood sugar levels, as well as carrying out a sugar load to identify disorders in carbohydrate metabolism.
Hormonal examination.
Calculation of the insulin resistance index, or as it is also called the HOMA index. In healthy children and adolescents, the HOMA index is <3.5.
Determination of leptin levels in the blood.
Ultrasound of the thyroid gland.
Consultation with a geneticist – according to indications.