Flat feet 1, 2, 3 degrees - prevention, symptoms, treatment and corrective surgery

What is flat feet

A disease of the musculoskeletal system is a change in the shape of the foot with smoothing of its natural arches. Women are almost four times more likely to get the disease. The foot has a complex structure and is a harmonious, well-coordinated mechanism that includes bone elements, tendons and muscles.

The bone frame has 3 sections:

tarsus - includes seven short spongy bones in two rows;
metatarsus - consists of five short tubular bones, the heads of which are connected to the phalanges of the fingers;
fingers - include 3 phalanges: nail, middle, main, with the exception of the thumb, which does not have a nail phalanx.

From birth, a person has an almost flat foot; as it grows, it acquires natural curves - arches. They increase gradually to normal values. After the final formation of the foot, the growth zones close. The arches are an important structural element that ensures the functionality of the foot. Every person has two vaults:

Transverse - less noticeable, looks like an arch at the base of the fingers. It is supported by ligaments, tendons, and the adductor pollicis muscle.
Longitudinal - a curve on the inside from the heel to the joint of the big toe, which is clearly visible.

Due to properly formed arches, the foot performs a number of important functions:

responsible for balance and the ability to walk on uneven surfaces;
acts as a shock absorber and softens shocks when walking;
distributes the load on the body during movements.

The arches help maintain normal movement; if they are properly shaped, the ankle, knee, and hip joints are not overloaded and function fully. Normally, the foot has three points of support: the heel, the head of the 1st and 5th metatarsal bones. With flat feet, they change, which greatly affects the mechanics of walking. This leads to various disorders of the musculoskeletal system.

The spine is also subject to stress when walking, so its work also depends on the condition of the foot and its arches. If they are changed, they can no longer cope with their functions to the required extent. This causes the overlying structures to take over the functions of the foot. But since this is unusual for them due to the additional load on the joints, the spine undergoes various pathological changes much earlier.

Causes of occurrence in children and factors that cause pathology

There are many situations that in one way or another affect the health of children's feet. The main factors that can provoke the development of the disease, but do not yet guarantee its occurrence:

heredity - if mom or dad had such problems, then the child will have to immediately purchase preventative shoes and engage in therapeutic exercises;
foot injuries;
excessive load (due to large body weight or initial obesity, during weightlifting, with constant weight lifting);
rickets;
muscle weakness due to insufficient physical development, lack of physical education;
paralysis (for example, cerebral palsy).

Studies have been conducted that urban children who constantly wear shoes (rather than barefoot) develop this disease more often than their rural peers. In addition, due to the lack of physical activity, instead of which smartphones and computers are used, posture is disturbed, which also affects the appearance of problems of the lower extremities.

Causes

Taking into account statistical data, the pathology is congenital in approximately 3% of all identified cases of the disease. Flat feet can occur at any age due to a variety of reasons. Flattening of the arches can be caused by:

excess body weight;
pregnancy;
heavy physical activity;
wearing uncomfortable, tight shoes, their incorrect selection for sports activities, which can also cause injury;
a sedentary lifestyle with a lack of stress on muscle tissue, which contributes to its weakening and the inability to maintain the correct position of the foot;
work that requires you to constantly stand on your feet;
diseases of the joints and connective tissue, leading to foot deformation;
potassium deficiency and disturbance of its metabolism;
limb injuries.

The cause can also be diseases of the central nervous system, in which sensitivity and movement in the legs are impaired or completely disappear. But shoes still take the leading position among all risk factors. This is confirmed by the fact that women suffer from flat feet much more often than men. Wearing shoes with a heel higher than 4 cm is already a threat to the foot, and the higher it is, the greater the likelihood of developing foot deformity and its complications.

When wearing heels, the center of gravity shifts, the angle of inclination in the ankle increases, which overloads the forefoot. Due to such a load, the transverse arch begins to change, which ultimately leads to flat feet. But not only heels are dangerous, but also shoes with completely flat soles, especially for children when the period of formation of the foot has not yet completed. To eliminate this risk factor, adults need to wear shoes with a heel height of no more than 3-4 cm, and children - 1-1.5 cm.

Flat feet: minimally invasive surgery as an alternative to lifelong arch supports

Flat feet are a deformity that cannot be fixed without proper ongoing treatment and progresses slowly but surely. And by a certain age, usually from 18 to 35 years, it begins to make itself felt. Then the patient again turns to the orthopedist, who gives him the same recommendations. More conscious patients listen to these recommendations and achieve a reduction in pain and discomfort. But more often, as a result of simple laziness, patients return to their problems again after a while.

It must be said that flat feet with the appearance of discomfort, pain, and a burning sensation after a long walk can be a strong limiting factor. People suffering from this disease stop walking a lot, preferring motor transport to walking, refusing hikes and excursions. In general, this can be considered as a slight, but still deterioration in the quality of life. Wearing uncomfortable model shoes plays a negative role in the development of flat feet. And if we add to this the epidemic of civilization - obesity, which also slowly but surely progresses over the years in many city residents, then excess weight and flat feet begin to indirectly reinforce each other, limiting a person’s physical capabilities [2].

Analyzing the life histories of patients, one often encounters the fact that flat feet occur in most or all members of the patient’s family. But it must be said that it is not inherited. A structural feature of connective tissue can be transmitted genotypically, and the formation of flat feet is determined phenotypically, for example, by wearing dress shoes. As evidence of the genotypic properties of connective tissue, one can cite the fact that in patients with flat feet one can often find a triad in the form of varying degrees of flat feet or foot deformity, an umbilical or inguinal hernia and varicose veins in the form of varicose veins of the lower extremities, varicocele (in men ) or spider veins. As evidence of the phenotypic development of flat feet when urban residents wear everyday shoes, one can present a study by scientists who studied the gait of Maasai who do not wear shoes. The research data was amazing - not a single member of the Maasai tribe was found to have flat feet [3].

A feature of the development of flat feet and the cause of drooping of the longitudinal arch of the foot is the supination of the heel bone, i.e., its rotation outward relative to the talus. Thus, the foot begins to roll towards the midline of the body [4]. In advanced stages of the disease, the process of the scaphoid bone “touches” the floor. Figure 1 shows that the process of the scaphoid, which is located below and slightly anterior to the ankle, is located at a distance of 1 cm from the floor surface.

One of the most successful solutions to the problem of flat feet is minimally invasive intervention - extra-articular subtalar arthroeresis. This method of surgical correction of foot deformity allows you to quickly raise the “sagging” arch of the foot and is not as traumatic as osteotomy of the calcaneus, which requires long-term rehabilitation.

The essence of the operation is very simple: installation of a cone-shaped structure in the sinus tarsi (tarsal sinus), more often found in the specialized literature as the calcaneal-talar or subtalar sinus. Installation of such an implant prevents pronation rotation of the calcaneus around the talus. In this case, sufficient supination is achieved, allowing the arch of the foot to be significantly raised.

The history of the use of this method began with Chambers [5], who in 1946 proposed a similar operation using a bone graft. Also, Grice [6] used a bone autograft from the bones of the patient’s lower leg for arthrodesis of the calcaneal-talar joint with correction of valgus deformity in flat feet of paralytic origin. Fibula autograft was most often used. The surgical trick of this technique was that the autograft was collected subperiosteally. The preserved periosteum was sutured, and after some time a full-fledged bone appeared in the defect area. The inconvenience of the technique was that it was necessary to select the size of the autologous bone to the diameter of the talus sinus, and it was necessary to strive for the same size of grafts on both feet. One of the complications of the technique was migration of the graft, so it had to be additionally fixed with a wire. Subtalar arthroeresis gained greater popularity in the United States when Subotnick [7] described the placement of a cone-shaped silicone implant into the sinus tarsi. In 1976, Smith [8] described a method of impacting a polyethylene block into the subtalar sinus. Later, Lundeen [9] modified the outer part of the block to achieve better correction. Modern orthopedists more often use cone-shaped or pyramidal-shaped implants made of titanium alloys (Fig. 2). Some manufacturers cover the implant with a polyethylene layer to soften the load on the bone.

The surgical technique is simple to perform. The patient is placed in a supine position. A compressive tourniquet is applied to the lower third of the leg. A longitudinal incision is made along the outer surface of the foot slightly anterior to the lateral malleolus in the sinus tarsi projection. Using special try-on expanders, the required size of the endorthosis is selected. Then the implant itself is installed to a depth of approximately 1.5 cm from the edge of the heel bone [10]. This is the optimal distance to achieve the necessary correction and not fall into the sinus.

We used this technique in 57 patients operated on between 2011 and 2014, of which 49 were women aged 18 to 43 years and 8 men aged 27 to 38 years. Of the 49 patients, 5 were operated on (bilateral surgery - arthreroeresis) for exclusively longitudinal flatfoot, the remaining 44 were operated on for both longitudinal flatfoot and forefoot deformity - hallux valgus. Among 8 men, all were operated on exclusively for longitudinal flatfoot. The operations were performed under spinal anesthesia. In the case of a combined operation on the anterior and posterior sections, the patient remained in the hospital for 2 days, in the case of bilateral arthroeresis - 0.5–1 days. In the early postoperative period, a standard regimen of medication was used: antibacterial, anti-inflammatory and analgesic therapy; we gave preference to the drug lornoxicam (Xefocam®).

Postoperative observation showed that the majority of patients rated the result as excellent: 54 patients noted that pain in the feet did not bother them and there were no restrictions in physical activity. The 3 remaining patients also noted the absence of pain and discomfort that was present before the operation, but there was discomfort in the form of aching pain at the end of the day with prolonged stress in the subtalar sinus area. It was interesting to note that all 3 patients were women under 22 years of age; after 1–1.5 years, the implants were removed; no pain was noted; return of the deformity was 20% according to radiographic data. The patients were taken for follow-up.

1–1.5 years after installation of the implants, most patients noted that there were changes in gait and a decrease or disappearance of discomfort associated with pain in the lumbar region. This once again confirms the dependence of static and dynamic dysfunctions of the spine on the severity of flat feet.

Clinical results after subtalar arthroeresis are presented in Figures 3–6.

The minimally invasive method, in which the surgeon does not perform aggressive interventions, is a significant advantage that can greatly reduce the number of bed days, as well as the rehabilitation period. To reduce pain in the early postoperative period, we used lornoxicam in 2 dosage forms: Xefocam® lyophilisate 8 mg in a bottle for the preparation of a solution for IV and IM administration and a quick-release tablet form of Xefocam® Rapid 8 mg according to the recommended regimen, which allows you to achieve the most adequate analgesic effect during minimally invasive operations [11]. The drug use regimen was as follows. In the case of combined surgery on the forefoot and hindfoot, intravenous administration of the drug Xefocam® was performed during a 2-day hospital stay; the daily dose depended on the severity of the pain syndrome [12]. It should be noted that on the 1st day after surgery, no patient required additional administration of narcotic analgesics. Next, the patient was discharged with recommendations to take the fast-release tablet form of Xefocam® Rapid 8 mg for pain. The pharmacokinetics of the drug Xefocam® Rapid is comparable to the dosage form for intramuscular administration. The time for the onset of its analgesic effect is reduced to 10–15 minutes. This success was achieved thanks to the unique structure of the tablet - the drug is in microgranules coated with a buffer substance, which, when reacting with gastric juice, creates a slightly alkaline environment where the active substance - lornoxicam - quickly dissolves and is absorbed into the blood. The time to reach the maximum concentration of Xefocam® Rapid is higher than that of the tablet form and is equivalent to the time to reach the maximum concentration for the injection form. Due to this, the same speed of action is achieved as that of injectable drugs.

In the case of isolated surgery on the hindfoot, where the pain syndrome was much less pronounced, we managed with a single intravenous administration of the drug Xefocam® up to 16 mg, then upon discharge we also recommended Xefocam® Rapid 8 mg for pain. All patients reported sufficient pain relief in the first days after surgery. As the pain syndrome regressed, Xefocam® was discontinued within 4–10 days.

The main reason for us to choose lornoxicam over other non-steroidal anti-inflammatory drugs was the results of comparative studies of pain relief in patients after orthopedic surgery between lornoxicam (Xefocam®) and narcotic analgesics.

In a randomized, double-blind study on 76 patients who underwent surgical autoplasty of the anterior cruciate ligament with a graft from the patellar ligament, Xefocam® for injection (IM) at a dose of 16 mg demonstrated superior analgesic properties compared to intramuscular injections of tramadol at a dose of 100 mg [14].

Pain relief was assessed by the researchers using a 5-point verbal rating scale 8 hours after administration of Xefocam® for injection (i.m.) 16 mg and tramadol (i.m.) 100 mg.

A higher score for pain relief during the first 8 hours after surgery was obtained in patients who received intramuscular injections of Xefocam® at a dose of 16 mg, compared with those who were treated with tramadol at a dose of 100 mg (17.1 versus 11 .8 respectively, p<0.05).

Another important factor in choosing the drug Xefocam® was the level of safety, which was also confirmed by clinical studies.

In patients receiving Xefocam®, the risk of any side effect was significantly lower than in patients from the comparison group (p<0.01) [13]. The risk of developing side effects from the cardiovascular system and gastrointestinal tract was also significantly lower in patients receiving Xefocam® compared to that in the group of all active comparator drugs (p<0.01), which may be a consequence of the inclusion of opioids in the comparison group , known to cause nausea and vomiting. In this meta-analysis, nausea and vomiting were the most common gastrointestinal side effects reported in all groups compared. This may explain the significantly lower risk of side effects when taking Xefocam® than when taking the group of all active reference drugs (Fig. 7).

Complete rehabilitation of patients with isolated surgery on the hindfoot took place in different periods - from 3 to 8 weeks. We attribute this variation in terms to the individual characteristics of patients and the level of pain threshold. Complete rehabilitation of patients who underwent combined surgery required more time and reached 2.5–3 months. This was mainly due to the severity of the forefoot intervention.

An analysis of our own results and the experience of foreign colleagues allows us to assert that this minimally invasive technique is indeed highly effective in the treatment of longitudinal flatfoot and allows us to achieve a lasting positive result in a short time. Long-term results up to 3 years show that up to 95% of patients are satisfied with the result of treatment and rate it as excellent. Low surgical risks, minimal surgical invasion, and a quick rehabilitation period are significant advantages, and, accordingly, this method can be considered as a high-quality alternative to conservative treatment.

Classification of flat feet

According to the nature of the changes in the arches, transverse, longitudinal and combined flat feet are distinguished. In the latter case, flattening of both the transverse and longitudinal arches is observed. Taking into account the reason that caused the pathology, the following types of flat feet are distinguished:

rickets – applies to children with rickets. During the period of intensive growth, the supply of minerals to the bone tissue is disrupted, it weakens and becomes more pliable. This is reflected in the foot as deformation due to the heaviness of the child’s weight;
traumatic – the result of injuries: bone fractures, damage to joints, tissues of the arch;
paralytic – associated with paralysis of the muscles of the arch;
static – the result of heavy loads that the muscular-ligamentous apparatus cannot cope with;
congenital – occurs against the background of congenital malformations of the elements of the foot.

Taking into account changes in the bone frame, height and angles of the arch, 3 degrees of longitudinal flatfoot are distinguished:

The bones of the foot are not changed, the arch angle is up to 140 °, the height is 3.5-2.5 cm.
The talus is characterized by shortening and increased prominence of its neck. Arch angle up to 155°, height 2.4-1.7 cm.
A large protrusion appears on the heel bone, the heel moves outward, the foot turns inward, and the big toe is retracted outward.

Normal indicators are considered to be an arch angle of 125-130°, height 3.9-3.6 cm.

Transverse flatfoot has 4 degrees, which takes into account the angle between the first and second metatarsal bones and the angle of deviation of the big toe. Normally, these indicators are less than 9 and less than 14, respectively. The higher the indicators, the higher the degree of transverse flatfoot. There are primary and secondary flat feet. The first occurs as an independent disease, the second - as a result of other pathologies.

Will there be pain after surgery for longitudinal transverse flatfoot?

Each surgical intervention is associated with certain pain sensations. As a rule, we try to reduce pain after surgical treatment of longitudinal transverse flatfoot to a minimum. Typically, before surgery, the anesthesiologist administers a drug block that numbs the foot for about 30 hours. After this, the worst wave of pain is over and treatment of longitudinal transverse flatfoot can be carried out using conventional medications. We will do everything possible to relieve the patient from pain.

Symptoms

Signs of flat feet depend on the severity. In the early stages of development, symptoms are mild, patients do not feel discomfort. If there is no heavy physical activity, the development of the disease can drag on for years without much impact on well-being or ability to work. But still, upon detailed questioning, patients notice a number of symptoms that are usually not paid much attention to:

increased fatigue of the legs during prolonged walking and standing;
aching pain in the feet at the end of the day;
slight swelling of the feet;
tightness of the calf muscles;
problems with choosing shoes;
the appearance of rough skin (corns) in the area of the thumb.

With flat feet, there are a number of external signs: the inside of the shoe wears out quickly, the foot increases in size, so you have to buy larger shoes. Even high-quality shoes that previously fit become uncomfortable, so a person is forced to purchase more spacious ones.

As the disease progresses, all of these signs become more pronounced. The main symptom is pain, most often it is noted in the foot, calf muscles, and under the knee. In later stages, pain appears in the joints of the limb, sacral, and lumbar spine. It does not appear spontaneously, but gradually, and increases taking into account the load on the body. It is especially pronounced towards the end of the working day if a person has been walking and standing for a long time.

How is the operation of longitudinal-transverse flatfoot performed at the Gelenk Clinic?

Surgical treatment of longitudinal-transverse flatfoot with inflammation of the tendon of the tibialis posterior muscle

The method of performing surgery for longitudinal-transverse flatfoot depends on the original cause of the disease. In cases of mild inflammation of the tibialis posterior tendon, only the inflamed connective tissue around it is removed (synovectomy). If necessary, the tibialis posterior tendon can be shortened and re-sutured.

At a progressive stage of tendon destruction or when it ruptures, doctors use an autogenous graft. The main condition for successful transplantation is the healthy condition of the tibialis posterior muscle (Musculus tibialis). The transplanted tissue (graft) is taken from the foot area. The nearby long toe flexor tendon (flexor digitorum longus tendon or Musculus flexor digitorum longus) is well suited for this procedure. The limitation of the patient's mobility due to tendon displacement is almost imperceptible - only the mobility of the toes can decrease slightly. Often, muscle strain due to tendon displacement may be associated with additional interventions to maintain bone health.

Image of longitudinal-transverse flatfoot with weakened tibialis posterior tendon (yellow). This tendon is responsible for the normal condition of the longitudinal arch of the foot. Rice. right: operated longitudinal-transverse flatfoot. A taut tibialis posterior tendon and autogenous bone graft straightens the longitudinal arch of the foot again. © joint-surgeon

Osteotomy of the calcaneus

If the development of longitudinal-transverse flatfoot is caused by damage to the calcaneus, surgeons at the Gelenk Clinic in Germany perform displacement surgery (corrective osteotomy). The inward deviation of the heel bone changes the direction of the Achilles tendon, which promotes full straightening of the foot.

An arched method for correcting longitudinal-transverse flatfoot is the implantation of a special bone wedge into the heel bone, which holds the desired correction in the correct position. This insert is often taken from the iliac crest (Hinterman technique or Evans procedure).

Arthrodesis (creating immobility) of the talus

If prolonged improper loads have caused painful arthrosis of the ankle joints in elderly patients, and if this pain is associated with tendon deformation, often only a technique such as arthrodesis will help restore the original healthy function of the joints. In some cases, triple arthrodesis is recommended. During this operation, all joints of the talus are immobilized: back/down to the calcaneus, forward to the scaphoid, as well as the connection between the calcaneus and the cuboid bone.

Transverse-longitudinal flatfoot, stages

Most often, a combination of transverse and longitudinal flatfoot in both feet is diagnosed. Unilateral damage is usually associated with various injuries. Symptoms vary depending on the extent (stage) of the disease.

In the first, the ligamentous apparatus weakens, but the foot still retains its natural shape. During this period, a person feels the first unpleasant symptoms after prolonged stress on the legs in the form of burning, fatigue in the limbs, which disappear after rest. For some people, already at the first stage, the gait becomes less flexible.
At the second stage, changes in the foot in the form of flattening of the arches are visible to the naked eye. It becomes wider, spread out, and in the area of the thumb you can notice a small protruding tubercle. The pain becomes constant, spreading above the foot to the lower leg and knee joint. The gait changes even more - clubfoot occurs.
At the third stage, the changes are sharply expressed, which provokes degenerative-dystrophic lesions of the joints. The disease also affects the condition of the spine, especially the intervertebral discs, which can cause osteochondrosis, intervertebral hernias, and curvature of the spine. Pain in the limbs accompanies a person constantly and gets worse all the time. At this stage, a person’s performance decreases and even walking short distances causes difficulties.

Who performs surgery for longitudinal-transverse flatfoot?

A very important element for the employees of the Gelenk Klinik orthopedic medical center in Germany is the close connection between doctors and patients. This means that your attending physician will take care of you from the day the medical history is taken until the operation of longitudinal-transverse flatfoot. Your orthopedic specialist will provide you with appropriate care during the postoperative period. This way, you will have a contact person who understands your situation and can answer all your questions at any time. On the territory of the Gelenk-Klinik in Gundelfingen in Germany there is a Center for Foot and Ankle Surgery, which is distinguished by its high quality standards, as well as many years of experience in the treatment of longitudinal-transverse flatfoot. Experts in the field of foot and ankle surgery are Dr. Thomas Schneider and Dr. Martin Rinio.

How to independently determine the presence of flat feet

In addition to identifying symptoms characteristic of the disease, you can additionally conduct a simple test at home for the purpose of tentative diagnosis. Lubricate the sole of the foot with any coloring substance, for example, fatty cream. Place a sheet of white paper on the floor and leave your foot print on it. The main thing is that the load on the foot is uniform, that is, you need to stand in your normal position, without deviating to the side.

Using a pencil, draw a parallel line from the heel to the big toe and another line perpendicularly - from the deepest neckline to the outer edge of the foot. Next you need to evaluate the print. If it occupies half or more of a perpendicular line in the area of the narrowest part of the foot, this may indicate the presence of flat feet. The norm in children and adults is different, so this test in children can indicate the normal development of the structure of the foot.

The main symptoms of flat feet in children and its types

Most signs are visible to the naked eye. The parent himself can determine them:

uneven wear of heels in a child over 5 years old;
complaints of fatigue when walking, pain in the back and legs;
clubfoot;
stepping on the inner edges of the sole.

If each of them is detected or periodically repeated, you must make an appointment at the clinic with a therapist or orthopedist and consult about complaints.

Moms and dads can independently determine by the direction of spreading:

increase in the transverse size of the feet;
change in longitudinal length;
increase both along and across the leg.

Diagnosis of the disease

Identifying flat feet begins with taking a medical history to find out what foot complaints the patient has and when they began. Next, they proceed to the inspection, where special attention is paid to the following points:

foot skin color;
presence of thickened skin, calluses;
position of the big toes when the foot is tightly closed;
the presence of deviations of the foot inward or outward;
changes in the anterior and calcaneal regions.

Even without instrumental diagnostics, based on complaints and examination, flat feet can be suspected based on the following points:

the presence of a protruding “bone” near the thumb;
wear on the inside of shoes;
rapid fatigue in the legs during prolonged walking or standing;
an increase in the volume of the foot - the inability to wear your favorite shoes that previously fit;
swelling, aching pain in the legs, feeling of heaviness at the end of the day;
discomfort when wearing high-heeled shoes;
violation of posture and gait;
Difficulty maintaining balance when squatting.

To make an accurate diagnosis, determine the degree of deformation, and select the most effective treatment tactics, patients are required to undergo a number of studies.

Computer plantography

An improved and accurate method for diagnosing foot diseases using foot prints. The technique is simple, painless and highly informative. Before the examination, the doctor enters all information about the patient into the computer system. The patient stands barefoot on a special platform that looks like glass. The device scans, and in order to obtain more accurate information, the examination is carried out in different planes.

Podometry

A method for diagnosing flat feet with determination of the Friedland index of the longitudinal and transverse arches. It represents the ratio of the height of the foot to its length as a percentage. Normally, the longitudinal arch index is 29-31%. If the indicator decreases, this indicates flat feet. The transverse arch index should not exceed 40%.

Podography

A research method for studying the biomechanics of walking. The procedure is carried out using special equipment - shoes with metal plates and a metal-coated track. During podography, the duration and width of the step, turn of the foot, and gait characteristics are recorded.

X-ray examination

It is necessary to identify changes in the bones of the foot, determine the degree of the disease, and monitor dynamics during treatment. Using X-ray images, you can accurately determine the height of the arch, the angle of the longitudinal arch, and the intermetatarsal angles.

Conditions of accommodation at the Gelenk Clinic

Orthopedic Clinic Gelenk Klinik in Gundelfingen near Freiburg, private room
As a rule, during an inpatient stay at the clinic you are in a separate room with shower and toilet. In addition, we provide you with towels, a robe and slippers. You can also use the minibar and safe. In addition, each room has a TV. You only need to bring your own medications, comfortable clothes and nightwear. After longitudinal-transverse flatfoot surgery, we guarantee round-the-clock care by qualified nursing staff and experienced physiotherapists. Basically, the length of hospital stay after surgical treatment of longitudinal-transverse flatfoot is three days. Your family members can stay at a hotel that is a few steps away from the clinic. We will be happy to take care of your hotel room reservation.

Treatment of flat feet

Flat feet are treated conservatively, surgically, which is decided individually taking into account:

age of the patient;
degree of disease and its progression;
presence of complications;
mobility restrictions.

Regardless of the chosen method of treatment, one cannot count on a quick result, since the disease is difficult to correct. It takes time, patience from the patient and concentration of his energy on treatment. The effectiveness of therapy is higher in children, since their arches are still forming and are easier to influence.

Conservative therapy

This type of therapy is aimed at reducing the rate of disease progression, preventing complications, maximizing relief from negative symptoms and includes a number of measures.

Massotherapy

The essence of the technique is to influence ligaments, biologically active zones, muscles in order to increase blood flow, improve metabolic processes, get rid of fatigue in the legs, and normalize muscle tone. Therapeutic massage is prescribed at any stage of flat feet; it is especially effective in the early stages of the development of pathology. The procedure must be performed by a specialist, but self-massage at home is allowed. In addition, it is necessary to use mats, massage rollers, balls and other special devices.

When flat feet are detected in children, it is recommended to walk barefoot as much as possible on various uneven surfaces: stones, sand, grass. If this is not possible, walk on a massage mat. Walking on different types of convexities affects multiple biologically active points, which the foot is very rich in. Massage mats are used not only for therapeutic purposes, but also for preventive purposes.

Physiotherapeutic procedures

Effective for all stages of flat feet, especially for pain and impaired joint mobility. Physiotherapy is used only in complex treatment. Her goal:

reduce inflammatory processes;
relieve pain;
improve blood circulation;
normalize muscle tone;
strengthen the vaults.

Physiotherapy procedures include electrophoresis with medications, phonophoresis, and magnetic therapy. Shock wave therapy deserves special attention. It has a beneficial effect on cartilage and bone tissue, destroys salt deposits without having a damaging effect on healthy cells.

Exercise therapy

Regular, long-term and properly selected exercises show high effectiveness in the initial stages of the disease, especially in combination with other methods of conservative therapy. Physical therapy is prescribed to all patients. Effect of exercise therapy:

improved blood circulation;
strengthening muscle tissue and ligaments;
formation of correct arches;
improvement of gait and foot placement.

A set of exercises is selected for each patient, taking into account the severity of the disease, age, concomitant pathologies and other nuances. The first classes should be conducted by a specialist so that the patient can master the correct technique for performing the exercises; in the future, the person can practice independently at home.

It is better to perform exercises in the morning; you need to do them before the muscles become tired, and increase the load gradually. Swimming has a positive effect on the entire musculoskeletal system. Regular exercises have a positive effect not only on the condition of the foot, they become an excellent prevention of spinal curvature and osteochondrosis. By strengthening the back muscles, the spine will receive additional support.

Orthopedic insoles

Properly selected shoes and orthotics significantly improve the quality of life. It allows you to correct structural changes in the foot, evenly distribute the load on the foot in order to remove overload from other parts of the musculoskeletal system. Custom orthopedic insoles are especially necessary:

athletes;
pregnant women;
persons who experience heavy stress on their legs due to a certain type of activity: sellers, hairdressers, surgeons.

Insoles correct incorrect foot position relatively quickly and painlessly. They perform a passive correction - they relieve many of the unpleasant symptoms of flat feet, but do not improve the condition of the muscles. Insoles should not be used as the only method of treating the disease; it must be complemented by other methods. General functions of orthopedic insoles:

improvement of the general condition of the patient;
support of arches in normal position;
improvement of blood circulation in the extremities;
reduction of fatigue, pain, heaviness in the legs;
reducing the likelihood of complications;
increasing stability during any physical activity.

Wearing orthotics not only makes life easier, but also stops the further progression of the disease.

Surgery for flat feet

If conservative therapy does not produce results, the disease progresses, complications develop, in such situations the issue of surgical treatment of flat feet is decided. In the final stages of transverse, longitudinal and combined flatfoot, this is the only way to improve the patient’s quality of life.

There are about 500 methods of surgical treatment, all of them can be divided into three groups:

on soft tissues;
on the bones;
combined.

Most often, operations are used to move tendons in order to tighten and correct the position of bones and form a normal arch. Often, an osteotomy is performed, in which surgeons make an artificial bone fracture in order to later move the bone fragments into the desired position.

In very rare cases, arthrodesis is performed. This is an operation in which the articular surfaces of certain bones are fused with special clamps to ensure their immobility. Often, combined flatfoot is combined with hallux valgus - the formation of a protruding tubercle (bone, bump on the foot) in the area of the big toe. During surgical treatment, this callus is additionally removed, since it also negatively affects the functionality of the foot.

How to correct flat feet in a child or adult, is it possible to correct congenital pathology?

There are two main treatment methods - conservative and surgical treatment.

Conservative methods

After an x-ray, the orthopedic surgeon may prescribe one or more of these correction methods:

exercise therapy;
taking a non-steroidal anti-inflammatory drug to relieve pain and inflammation;
massage that increases blood circulation in the legs and metabolism;
the use of arch supports that strengthen weakened muscles;
selection of corrective and supportive shoes;
Carrying out herbal foot baths to relieve joint pain, fatigue and tension.

The listed methods do not allow correcting transverse or other flat feet in adults; they act as a means of containing the disease and alleviating the condition. For children the prognosis is much better. The main thing is to detect congenital or acquired pathology in time and begin treatment.

Surgical methods of treatment

Surgical treatment is indicated for adults after conservative methods have been tried without visible results. Depending on the individual characteristics and type of disease, the following manipulations can be performed:

removal of the phalanx, which has grown pathologically;
cutting out the metatarsophalangeal joint, after this procedure the ligaments are fixed with metal fasteners;
removal of growths on the bone tissues of the foot;
and etc.

After this, it is necessary to go through the rehabilitation stage, during which physiotherapy is performed and a gentle load regimen is prescribed.

Prevention of flat feet

The main way to prevent it is to wear the right shoes. The sole should be thick and soft, the heel no more than 4 cm. Other recommendations:

if you have a predisposition to the disease, if possible, avoid work that involves prolonged stress on your legs;
form your gait correctly - do not point your toes apart when walking;
walk barefoot on uneven surfaces - stones, sand, earth, gravel;
stand on high heels as little as possible;
when exercising for a long time, wear insoles;
after a working day, do a foot massage;
correctly dose the load, avoid overload.

Proper, balanced nutrition is very important to avoid deficiency of vitamins and microelements, especially calcium.

Flat feet may seem like a harmless disease only at first glance, but if left untreated, it progresses and causes a number of complications. They can be arthritis, arthrosis, hallux valgus, herniated intervertebral discs and other pathologies. Timely consultation with a doctor will help reduce the severity of symptoms and prevent the progression of the disease.

Do flat feet need to be treated in adults?

Despite the apparent non-seriousness of the disease, it is a fairly rapidly progressing pathology that is difficult to treat.

If flat feet are not treated, the deformity of the foot constantly increases, and the big toe can become bent. And in such cases, as a rule, only surgery can help the patient.

Flat feet can be completely cured only in childhood, and in adults treatment is aimed at slowing down the development of the disease.

The earlier flat feet are detected, the more favorable its treatment and correction will be!

Treatment with orthopedic shoes

Wearing orthopedic shoes is a must for patients with flat feet. These shoes are made specifically for the treatment and prevention of flat feet. Currently, orthopedic shoes come in different models and styles. You can choose any model to suit your taste. What should these shoes be like:

Low heels up to 4 cm, but flat soles are prohibited. There must be a heel. This will provide conditions for the correct placement of joints and muscles.
The shoe size must match the size of your feet. Clearly according to the parameters, so that it is not wider and not narrower. Otherwise there will be no therapeutic effect. The situation may even worsen, and flat feet will develop to the next degree.
Mandatory fixation with a hard back.

“The ideal shoe should have a 3 cm heel, a flexible sole, a firm heel, a slight instep and made of leather, suede or nubuck” ©

Physical therapy exercises

It is recommended to regularly do physical therapy exercises. This type of exercise has a significant effect in the treatment of flat feet. The techniques are not at all complicated and generally do not require special tools. Most of them can easily be done at home. Or you can visit a special exercise therapy room. Here are the exercises to use:

flexion of the foot;
circular rotations of the ankle;
walking on uneven surfaces such as sea pebbles;
squats on toes;
rolling a needle roller from one foot to another;
the famous “swallow” exercise;
pumping from heels to toes.

Exercise therapy exercises occupy an important place in the fight against flat feet. This is a useful exercise for your legs that heals both adults and children. “A lot of exercises have been created to treat flat feet in people. But the most important thing is to stick to the schedule for completing them and not miss a single lesson. You should spend at least half an hour a day doing exercises to treat flat feet. Ten minutes every other day will give you practically nothing.”

Therapeutic massage for flat feet

With the help of massage, the muscles become toned, improve blood circulation in the feet and relieve pain.
Usually 10 to 15 sessions are prescribed. Massage movements are performed on the limbs from the toes to the lower back, since the entire system is connected and treated comprehensively. Here are the necessary techniques:

The toes are extended and bent.
Stroke the skin with your palm or knuckles.
The arches of the feet and toes tingle.
Rub the sole with your fingertips in a circular manner, affecting the points.
Patting, tapping and pressing produce vibrations.

Methods for treating bow legs

Treatment for clubfoot depends on the patient's age and severity of the disease.
As a rule, the congenital variant of the pathology is easiest to correct in early preschool age. It is very important that the effectiveness of therapy depends on the time of initiation - the earlier the disease is detected and treatment started, the greater the likelihood of recovery. For mild forms of pathology, conservative treatment is carried out: ● physical therapy using bandages to fix the feet. All exercises must be carried out under the strict supervision of a specialist; ● temporary application of plaster casts, especially in the case of a congenital form of the disease; ● therapeutic massage to normalize the tone of the foot muscles. Conducted in the form of a course of 10-15 sessions. After its completion, the course can be repeated after a few months; ● wearing special orthopedic shoes that allow you to correct the position of the foot; ● physiotherapeutic procedures - magnetic therapy, the use of therapeutic mud, etc.; ● if clubfoot occurs due to damage to the nervous system, then Proserin may be prescribed. This is a medicine that allows you to restore neuromuscular transmission of impulses. It is important to note that any medications should be prescribed only by your doctor.

In severe cases, surgical interventions are recommended. They allow you to adjust the length of the ligaments and muscles, and with the subsequent wearing of special shoes, these effects are consolidated. Surgeries usually lead to complete restoration of the position of the foot. Thanks to this, children and adults with flat feet and bowed legs can lead an active lifestyle without any discomfort.

Who to contact for flat feet

If you detect any signs of flat feet or club feet in children, you should immediately consult a doctor.
We recommend consulting with a paid pediatrician. He will conduct an initial examination and determine whether an examination by an orthopedic traumatologist is required. How does an appointment with a specialist usually take place? Examination of a child or adult with suspected pathology includes several stages: ● with a congenital variant, parents note an unusual position of the foot and a waddling gait in childhood; ● in adult patients, signs of flat feet are revealed when examining the foot. It is in the wrong position and turned inward; ● to assess the condition of ligaments, tendons and the condition of the arches, ultrasound and other instrumental diagnostic methods are performed. They allow you to confirm the diagnosis and determine treatment tactics.

The Doctor Anna clinic is very popular among adults and children with clubfoot. The doctors of the medical center have extensive positive experience in eliminating diseases of varying severity. The convenient location of the clinic near the metro station makes visiting it accessible at any time of the day. You can make an appointment by phone or by leaving a request on the website.