Flat feet in preschool children: types, signs, symptoms and degrees

1. What is flat foot?
2. Foot development
3. Causes of the disease
4. Types of flat feet in children (longitudinal and transverse)
5. Transverse and longitudinal
6. Signs and symptoms of flat feet in children 3-4 years old
7. Diagnosis of flat feet in children
8. Plantography of the flat foot in a child
9. Podometry
10. Podography
11. Electromyography
12. Why is congenital flatfoot dangerous in infants (children under one year old) and in a child 3-4 years old?
13. What treatment is needed
14. Massage and manual therapy
15. Orthopedic shoes
16. Physiotherapy
17. Physiotherapy
18. Kinesio taping
19. Operation
20. What type of doctor is needed?
21. Does the treatment of children 2-5 years old differ from the treatment of flat feet of a child 6-12 years old?
22. Prevention
23. Conclusion

When a boy’s parents are diagnosed with a foot deformity, some mothers are happy that such an illness will not allow their child to go to military service. At the same time, they do not think at all about the future fate of the young man, because this is not only a cosmetic defect, but is also fraught with the development of diseases of the musculoskeletal system and even internal organs in a more mature age. When a child begins to take his first steps, little attention is paid to a flat leg, because we know that it can have a layer of fat (if the baby himself is very plump). Identification of flat feet in preschool children occurs in the third or fourth year of their life, when the most active period of skeletal formation begins. A diagnosis does not mean that your baby will experience discomfort while jogging or standing in one place for long periods of time throughout his life. If you notice the first signs of the disease in time, successful treatment is possible.

Foot development

There is nothing unusual in the fact that until the age of two, a child does not have the notch we are accustomed to. After all, in this place there is a fat pad, which replaces the arch necessary for an adult. It is necessary to sound the alarm if flat feet are noticed in children at the age of three. Until this time, for proper bone formation, strengthening muscles and ligaments, parents are recommended to allow the baby to run on uneven terrain, preferably barefoot. Let the baby walk on his heels or toes; this, in its own way, will be a special training without the use of medical devices and complexes.

How to warn?

To prevent foot deformities in children, doctors advise parents to follow simple recommendations:

• You shouldn’t put any weight on your baby’s legs before 7–8 months, don’t try to force him to stand on his legs, teach him to walk early. When the child is ready, he will do it himself;
• consult a pediatrician about preventing rickets, walk more in the fresh air on sunny days to ensure a sufficient supply of vitamin D;
• choose the right shoes for your child with a high, rigid heel that helps keep the heel on the axis of the shin, a bendable sole, and an instep support;
• make sure that the child is active, moves a lot, and does not gain excess weight;
• provide adequate nutrition, rich in vitamins and minerals necessary for the proper development of the musculoskeletal system;
• do leg exercises with your child;
• undergo regular examinations by an orthopedist (at 1, 3, 6 months, at 1 year, at 3 years, from 4 years - once a year), especially if there is a hereditary predisposition to orthopedic diseases.

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Causes of the disease

Unfortunately, it is not always possible to identify a congenital disease immediately after birth. In our country, only three percent of children are immediately diagnosed correctly. And, as a rule, this is a hereditary predisposition.

Mothers of older children often ask pediatricians: why do children have flat feet?

Factors contributing to the occurrence of the disease:

• Genetic predisposition. If close relatives had such a pathology, then there is a chance that the baby will also have it.
• Connective tissue deficiency. A poorly developed ligamentous-muscular system leads to constant stress on the muscles, leading to compaction and thickening of the inner part of the foot.
• The increased weight of the baby contributes to improper bone development.
• Traumatic situations (fractures, dislocations).
• Rickets not only deforms the lower part of the leg, but also the entire skeleton.
• Congenital cerebral palsy and previous poliomyelitis lead to paralysis of the musculo-ligamentous apparatus.

What happens with flat feet?

Normally, with each step, we do not rely on the entire sole of the foot, but only on three points: the heel, the base of the little toe and the big toe. The arched shape of the foot provides a spring function: the foot absorbs impacts on the surface, protecting the musculoskeletal system from them.

With flat feet, the shape of the foot changes as the arches of the feet drop and the bottom of the foot becomes flatter. Because of this, when walking or running, we rely on the entire sole, and the load on the feet received from impacts on the surface is distributed incorrectly.

Types of flat feet in children (longitudinal and transverse)

Doctors diagnose three degrees of development of the disease and several subtypes in preschool children.

Transverse and longitudinal

Longitudinal is when the sole lies completely on the floor, resulting in flat feet and an increase in the width of the leg size. It is very painful for the child not only to stand, but also to move long distances. He is not comfortable wearing regular shoes.

There are three degrees of difference:

• Upon visual inspection, bone deformation is not noticeable. During diagnosis, the arch angle is determined to be 130-140 degrees. The child begins to complain about “legs” only during long walks.
• The baby also experiences pain and heaviness. Here the arch angle is more significant and is equal to 141-154°. If a pathology is detected, doctors recommend keeping your toes straight when walking, and not spreading them to the sides.
• With this degree, surgeons perform operations because the baby simply cries from severe pain when walking. Changes are visible to the naked eye.

Transverse degrees of flatfoot in children appear at a later age. Special characteristics of the disease: the toes are strongly curved, resembling round hammers. At the same time, the baby complains about the forefoot; it hurts him to step and stand on his toes. Often, calluses form on the fingers, like those of older people (corns). The leg stops growing in length, takes on a “spread out” appearance and resembles a diving fin.

Doctors also identify a third type (combined), which combines all the signs of previous deformities. In this case, the toes look outward, and the feet themselves form the letter “X”.

When is it time to worry: degrees of transverse flatfoot

The main “beacon” of transverse flatfoot is an inflamed joint of the big toe. According to the degree of its curvature, three degrees of transverse flatfoot are distinguished:

1st degree - the angle of deviation of the big toe is less than 20 degrees, mild transverse flatfoot.

2nd degree - angle of deviation of the big toe - 20-35 degrees, moderately pronounced transverse flatfoot.

3rd degree - the angle of deviation of the big toe is more than 35 degrees, pronounced transverse flatfoot.

Unfortunately, it is possible to correct transverse flatfoot without surgical intervention only at stage 1 of the disease. To do this you should:

• Lose extra pounds, if you have them;
• Avoid high heels;
• Do massage or self-massage of the feet;
• Do therapeutic exercises;
• Wear orthopedic insoles and foot products;
• Reduce the load on your feet.

With grades 2 and 3, you can only stop the progression of flat feet and prevent it from developing further. That is why, as soon as you notice the first signs of transverse flat feet, immediately begin to act. The earlier the better!

Signs and symptoms of flat feet in children 3-4 years old

If your baby often complains to you and experiences pain, then first check his legs for pathology at home. To do this, smear them with oil paints and ask the child to stand on white paper. The fingerprint can be used to make a preliminary diagnosis.

In addition, the development of the disease can be suspected based on the following signs:

• A month after purchase, the sandals quickly wear down.
• The baby complains of pain and fatigue.
• The deviation of the thumb is noticeable.
• The foot itself is severely deformed.
• The child is “clubfooted.” Your comments about correcting the gait lead nowhere.
• My legs swell in the evening. The first calluses and ingrown nails appear.

Massage belongs to the category of spa treatments

– Is there any point in massage before a year, at three to six months?

– In Russia, everyone – adults, children, healthy and sick – are absolutely convinced of the healing power of massage. Throughout the civilized world, massage has long been relegated to the category of spa treatments, that is, it is a procedure that brings positive emotions to a person. There is a section of sports massage that relates exclusively to preparing muscles for stress.

As for massage for children in the first year of life: the human brain develops under the influence of external stimuli. We have sense organs - vision, smell, hearing, taste and tactile sensations. So, neither the vision, nor the hearing, nor the sense of smell of a child of the first year of life can be actively influenced. If we put Raphael's paintings in front of a three-month-old baby or let him listen to Mozart or Haydn, then perhaps we can somehow positively influence his development, but this is quite debatable.

The most developed system of sensations, in addition to taste, is tactile. Stimulation of tactile receptors is an additional positive flow of impulses that can positively affect the development of a child’s brain. This is again largely speculative, empirical reasoning, that is, to a certain extent, theoretically, massage can be useful for a child of the first year of life in terms of optimizing his development.

At the same time, massage for children of the first year of life does not have any special tricks. By definition, this should be stroking with light pressure to stimulate tactile receptors and deep skin receptors. In principle, this can be done by a mother, or a father, or a grandmother with her loving hands - there is absolutely no need to drag a one-and-a-half-month-old child in November for a twenty-minute massage session on public transport to a clinic where children with acute respiratory infections are sneezing and coughing.

And one more thing: if a child reacts negatively to a massage, if he screams and resists, such a massage is not needed under any circumstances. It will not lead to anything good for sure, and maybe it will lead to something bad, because it is known how Russian children react to strangers and especially to strangers related to medicine.

- It's clear. Pillows are also an important point.

– Again, as in relation to many of the above points: there is no medical data regarding the influence of the height or quality of a pillow or mattress on the health of a person, especially a child. From the point of view of common sense: there are cats who like to sleep on the floor, and there are cats who would prefer to choose a softer pillow; in any case, this is chosen by the creature itself. The creature chooses the most comfortable sleeping position for itself.

There is not the slightest evidence of the negative impact of the hardness or height of pillows and mattresses on the human musculoskeletal system. All statements that you need such and such a pillow or such and such a mattress are absolutely unfounded from a scientific point of view.

Again, returning to the intrauterine position of the child.

In utero, a child, at the most fragile age, is in a monstrously crooked position, then he is born, and everything straightens out for him, nothing hurts. Therefore, the safety margin of the human body is large enough for a person to sleep on hard, soft, and even in zero gravity.

What could be bad? This is the quality of sleep. If a person’s sleep conditions do not meet his biological requirements, which are almost impossible to describe, they are purely individual, then the quality of sleep deteriorates, and the quality of life, accordingly, also suffers. Pure common sense. If you put a pillow on your child, conditionally, of the recommended height, but he slides off it and stubbornly sleeps without a pillow, then leave him alone. If you give your child a pillow of the same height, but he knocks it down to sleep higher, then give him a higher pillow and leave him alone!

Diagnosis of flat feet in children

At the first suspicion of pathology, it is necessary to promptly contact an orthopedist for consultations and possible treatment. Even if the child does not complain, then at the age of five he must be shown to a doctor for examination. If the deformity is discovered in the maternity hospital and it is congenital, then from the first days of life the baby is prescribed specialized treatment, which involves correcting the arch of the foot.

The acquired disease cannot be determined immediately, only after 3-4 years, when the subcutaneous fat of the pad disappears. It is very important to conduct a full examination at an early age.

At the first visit, the doctor will definitely examine the legs, palpate them, measure the width and length, and see how the baby moves. Also examines shoes for worn-out heels.

Next, he will conduct an examination using special equipment and tests.

Plantography of the flat foot in a child

A few years ago, the usual classical method was used using paint and paper. But the results were not very true, since it was impossible to force the child to stand straight and not move. After all, it is difficult to give an assessment if the baby does not put the body load on both feet.

Today, many medical institutions are equipped with an electronic plantograph. With its help, it became possible to make a high-quality print of the foot, and images on the side and back of the sole. Thanks to this, doctors determine the degree of deformation. All information is stored in a computer, and upon repeated examination, the orthopedist has the opportunity to compare indications and prescribe effective treatment for any stage of flat feet in children.

Podometry

The method involves measuring the parameters of the foot in height and length. The results obtained are multiplied by 100, and the ratio is calculated according to Flindland. An index of 20 to 31 percent is considered the norm.

Podography

The method involves assessing the child’s rhythmic gait. At the same time, special boots are put on his feet. While walking on a metal walkway, the orthopedist watches how the movement occurs and how the heel rolls.

Electromyography

Using electrical currents (where electrodes are placed directly on the lower leg or needles are inserted subcutaneously directly into the muscles), the activity of the muscular system is measured. Typically the method is used for paralysis or leg injuries.

Ergo backpack, scooter, balance bike, snowboard

– Ergo backpacks – what are they? To what extent can they be used?

– There is no medical data that would indicate the benefits or harm of slings. In utero, the child is in a monstrously crooked position; at the moment of birth, he straightens his arms, legs and back, nothing happens to him, despite months of being in a curled position. From the point of view of common sense, it seems to me quite difficult to spoil something for a child with a sling. In the same way, our smaller brothers sleep curled up, this does not damage their spine and legs. From a biological point of view, the embryo's position is quite physiological.

- What about swaddling?

– This is a different story, there is just a nuance here. Man, unlike our tailed, hairy ancestors, was rewarded by nature with upright walking. In humans, the position of the hip joint in a standing position and when walking differs significantly from the position in quadripedals, i.e. four-legged animals. A person has a predisposition to hip dysplasia, which occurs with a frequency of about one case per hundred, this is not so small. The position in which the legs are tightly closed is an unfavorable position, which, if there is a predisposition, can contribute to either improper development of the joints, or even, in the case of severe anatomical disorders, hip dislocation.

This is well known from the history of orthopedics, on a cultural-ethnic basis. In Armenia, it is traditional to tightly swaddle children's legs, especially girls. In Africa, it is customary to carry a child on the hip or on the stomach with legs apart. Orthopedists 100 years ago knew for sure that in Armenia there is a very high incidence of congenital hip dislocation, and in African tribes there is practically no congenital hip dislocation.

That is, it is absolutely certain that tight swaddling of the legs in a contracted state contributes, statistically, to an increase in the incidence of hip dysplasia and hip dislocation.

This does not mean that this will happen in a particular child, but if the child has a predisposition, then tight swaddling will contribute to the implementation of this predisposition.

– Won’t your crooked legs get better?

– Crooked legs will never be corrected by swaddling, absolutely. This is another story, it has nothing to do with swaddling, but this is a long story, it is not for this conversation, because it needs to be drawn.

– Scooter, balance bike – is there any benefit? Is a trampoline fun without harm?

– Regarding scooters and balance bikes: children do not have any medical prejudice towards these types of activities. The only criterion is common sense and safety in terms of injury. They are no more dangerous than other devices that children ride on. It must be remembered that the likelihood of injury, direct damage, is higher on scooters and balance bikes than if the child was just walking along the path. You need to be aware that the faster the child moves, the harder his nose will hit the ground when, sooner or later, he will fall anyway. It's simple physics. A child should have things in life that bring him joy, but in everything there should be common sense and adult control.

As for the trampoline, everything is much worse here, from a medical point of view. 10 years ago it was almost impossible to buy a personal trampoline. Now they have become cheaper, more accessible, any family can afford to buy a home or outdoor trampoline. This led to the coining of the term “trampoline fracture” in Western medical literature. These are fractures of long tubular bones, usually the tibia, with virtually no displacement due to compression of weak bone tissue. Jumping on a trampoline, especially long ones, is potentially dangerous.

– What about jumping walkers?

– Walkers and jumpers are more of a kind of entertainment for a child. From a developmental point of view, they do not bring anything to the child. Their importance or danger for crooked legs has been greatly exaggerated. This is entertainment for the child, an opportunity, several months before he begins to walk on his own, to move in space without distracting the attention and time of the parents, nothing more.

But there are nuances. Several years ago, the German Association of Pediatric Traumatologists recommended extreme restraint in the use of runners and walkers for the reason that children in walkers can move quite quickly. Studies have shown that quite often children drive into tables, bedside tables, and fall down stairs.

– Even now they like to put a special circle around the child’s neck in the bathroom, is that okay?

- Also common sense. If everything happens under the control of the parents and in front of the parents, then, in my opinion, there is no likelihood of a negative effect from this circle. This is an exclusively utilitarian thing for solving a specific problem.

– Snowboarding is probably the same thing, let’s not dwell on that.

– Snowboarding is a highly traumatic sport. Whether or not to put a child on snowboarding and skiing should be a conscious decision of the parents with full understanding that this is a sport with a high risk of injury, although, of course, it gives a lot of positive emotions. Michael Schumacher, having overturned his car so many times, ruined his life and career just on some unfortunate skiing.

What treatment is needed

After the diagnosis has been made, you must immediately proceed to the prescribed procedures until complete ossification of the skeleton occurs. Then it is more difficult to correct the deformation of the feet. Therefore, the orthopedist prescribes a technique that helps strengthen muscles, ligaments and joints, and improves blood supply.

Massage and manual therapy

To achieve better results, not only the lower legs are massaged, but also the lumbar region, buttocks and calf muscles. A relaxing, stimulating and tonic procedure must be carried out for at least 10 days exclusively by a qualified employee of a medical institution (massage therapist or chiropractor).

Orthopedic shoes

Pay special attention to this section! For the slightest defects in the legs, the doctor recommends that parents purchase special insoles that are inserted into ordinary boots or shoes. They will help in shaping the arch of the foot.

If the symptoms are significant, you cannot do without specialized shoes. Buying an orthopedic pair is not possible if you decide on your own. Only a doctor can give you a written recommendation after all the required measurements, which include the parameters for height, width, angle of deflection and turn when walking.

Very strict requirements are imposed on such shoes. The boots are made with a high back that clearly fixes the ankle. The socks are wide and rounded so that the toes fit freely against each other. They are also equipped with a lightweight sole with a heel, arch supports and insoles.

Unfortunately, in small towns and villages it is not always possible to find specialized stores or pharmacies that sell orthopedic shoes. People have to go to the regional center to purchase. And this is a waste of time and money on the road. Therefore, the best option is to purchase goods online. For example, it presents a wide range of products for boys and girls of all sizes (up to 40). Boots, boots, felt boots, pumps and sandals will surprise you not only with their colorful colors, but also with their fashionable, modern design. All products are certified. The company provides a warranty of 30 days from the date of purchase.

Physiotherapy

It is necessary to do gymnastics every day for 15-30 minutes. The complex includes rotational movements of the feet, wiggling the fingers, walking on uneven surfaces of a special massage mat, and practicing on the wall bars.

Physiotherapy

Magnetic therapy, shock wave treatment, electrophoresis and applications using paraffin and ozokerite are prescribed for moderate foot deformities.

Kinesio taping

Adhesive tapes are applied and fixed, which distribute the load across different leg muscles. It is recommended to wear them for several days in a row without taking them off at night, since the therapeutic effect is also present in the resting position.

Operation

If after prolonged treatment there is no positive dynamics, then surgical intervention is resorted to. It is prescribed to children who have been diagnosed with grade 3-4.

What type of doctor is needed?

Infants and children up to three or four years old will receive help from an orthopedist, massage therapist, chiropractor and physiotherapist. In adulthood, if there is a suspicion of scoliosis and neurotic diseases, they turn to a neurologist.

Does the treatment of children 2-5 years old differ from the treatment of flat feet of a child 6-12 years old?

At different stages of the disease, regardless of age, doctors adhere to an already established methodology. In the nursery group, therapy is significantly different. Only qualified specialists can choose the right course.

What causes?

Foot deformities in children can be congenital or acquired.

At the stage of intrauterine development they are provoked by:

• abnormal location of the fetus in the uterus;
• prematurity;
• congenital pathologies of the musculoskeletal or nervous system (cerebral palsy, impaired innervation of muscles, connective tissue dysplasia);
• oligohydramnios, multiple pregnancies, small space for the fetus leads to mechanical pressure on the lower limbs, causing deviations in their development;
• intoxication, smoking, taking alcohol or drugs by a woman during pregnancy;
• intrauterine infections;
• hereditary factor.

Common causes of acquired foot deformities are lack of physical activity and improperly selected shoes.

With a lack of physical activity, the foot muscles weaken over time and are less able to hold the bones in the anatomically correct position.

Contributes to this:

• moving mainly on hard, flat surfaces: smooth floors in an apartment, tiles or asphalt outdoors;
• lack of exercise;
• refusal of preventive massage, exercises to maintain foot muscle tone.

Bad shoes have a detrimental effect on the formation of a child’s foot in the first years of life. Therefore, there are a number of requirements for its selection. It should ensure proper formation of the foot and distribution of the load, supporting the arches. For this purpose, shoes for small children are equipped with instep supports, a small heel, a flexible sole, and heel fixation.

Acquired foot alignment disorders also cause:

• increased load on the joints of the legs due to excess weight, early walking (in children they are very mobile and are easily displaced);
• diseases of the musculoskeletal system;
• birth injuries;
• fractures, bruises, sprains, deep cuts, burns in the foot area;
• long-term immobilization of the limb after injury (wearing a cast, orthosis);
• vitamin deficiency;
• past polio;
• suffered acute respiratory viral infections with complications in early childhood;
• metabolic disease;
• endocrine diseases (hypothyroidism, diabetes mellitus);
• advanced rickets, leading to disturbances in bone mineralization, muscle development, and ligaments;
• inflammatory processes in muscles, ligaments, joints.

After 17 years, flat feet can be successfully treated

In this case, the stage of the disease must be taken into account. If flat feet have just begun to form, then complex conservative treatment can overcome the disease and restore the function of the foot and its shape. But usually, at the age of 17 years and older, such measures are no longer relevant - after all, the foot is practically formed. In the most extreme cases, surgery can be performed on the foot, but even here there are no guarantees for the result. We are talking only about eliminating the symptoms, while the cause of the disease is not eliminated. So timely diagnosis of flat feet and its prevention already in childhood are really important - at an age it will be difficult to treat.

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.