Equinovalgus deformity and foot alignment in children - treatment

ICD code

In the Russian Federation, the International Classification of Diseases 10 has been adopted as a single document for monitoring and recording the morbidity of patients. According to ICD-10, the pathology has code Q66 (congenital deformities of the vault). Another name for the defect is ballerina syndrome, or tiptoeing. They are additionally subdivided into Q66.0 (calcaneal-varus clubfoot), Q66.1 (calcaneal-varus), Q66.2 (varus), Q66.3 (other congenital pathologies), Q66.4 (calcaneal-valgus), Q66. 5 (congenital flat), Q66.7 (hollow), Q66.9 (unspecified).

You can see what ICD 10 number for equinovalgus foot disease your doctor will give you on your sick leave certificate or patient card.

Causes of abducted finger

Depending on the severity of the disease, the big toe can be deviated at different angles - less than 20°, 25-35°, more than 35°. Factors that provoke the development of hallux valgus with abducted finger:

• Hereditary predisposition, hormonal changes.
• Wearing the wrong shoes (narrow, high heels).
• Excess weight with increased load on the foot.
• Osteoporosis, characterized by calcium deficiency.
• Injuries and past infectious diseases.
• Transverse and complex flatfoot.

Causes and symptoms

Let's consider what provokes and stimulates the development of this problem.

Root causes of deformation

• Injuries and damage to the cervical spine and vertebrae.
• Shortened lower limbs.
• Past polio and paralysis.
• Rupture of muscles, tendons, joints.
• Consequences of a stroke.
• Developing flat feet.
• Poor metabolism.
• Obesity.
• Incorrectly selected shoes.
• Genetic congenital predisposition.
• Weak immunity after infection.
• Incorrect application of plaster.
• Rickets.
• Cerebral palsy.
• Other serious illnesses.

These manifestations are easily diagnosed with due attention from the attending physician. They can be corrected, especially if the problem arose before the year. The treating orthopedic surgeon will recognize the problem using ultrasound, MRI, or visual examination.

How should a parent identify the problem? Let's look further.

Symptoms

• Uncertain, shaky gait. The child steps slowly, incompletely, and tries to lean only on his toes.
• Crying and unwillingness to continue walking.
• The baby begins to limp on one leg.
• Does not want to run, only walks or crawls.
• Bends the inside of the arch under itself.

If you notice any of these, see a podiatrist at your clinic to prevent further consequences.

Causes

Congenital flat feet are caused by genetic factors, as well as a violation of the correct formation of the foot ligaments in the prenatal period.

The following reasons influence the change in the shape of the foot and the progressive development of deformity:

• wearing low-quality or old shoes;
• standing on your feet for a long time;
• obesity, leading to significant stress on the entire musculoskeletal system, especially on the foot;
• traumatic injuries causing deformation of the bone elements of the foot;
• a disorder of vitamin D metabolism that causes rickets;
• complete or partial paralysis of the muscles of the foot (develops as a result of poliomyelitis, cerebrovascular accident or polyneuropathy of an infectious or toxic nature).

The cause of flat feet is determined only after a diagnostic examination by a specialized specialist. Parents should seek help from an orthopedist if they suspect improper development of the foot: early treatment increases the baby’s chances of restoring the shape of the foot.

Adducted foot in a child

This is a congenital equino deformity, which is considered a type of clubfoot. It manifests itself already in the first year of life, when the baby is taught to walk. In half of the cases it goes away on its own within three years. However, this is not a reason not to see a doctor.

Symptoms

Here the body weight presses unevenly, the arches do not absorb the baby’s weight. To determine this defect, the doctor looks at the following signs:

• turn the heel outward;
• inward deviation of the metatarsal bone;
• increasing the distance between fingers;
• the appearance of calluses;
• swelling, redness;
• discomfort when walking;
• the thumb is turned inward.

Parents are not recommended to conduct research on their own. It is better to diagnose in a hospital. The disease manifests itself as follows:

• the vaults are deepened;
• the outer side is rounded;
• there is no equinus setting.

In this case, the child stands on his heel, but crookedly, leaning on the outer part. The baby will begin to walk from the inner edge, moving down to the outer edge. The steps will be uncertain and small.

What is metatarsus adduction

In most cases, it occurs in infants and goes away within a year. The anterior section of the arch is directed inward. Moreover, the middle and rear ones remain in the same position, the baby is not yet fully trying to walk on his toes.

But the disease will not go away on its own. To prevent it from developing into a plano-equino-valgus deformity of the foot, you need to consult a doctor.

Norm or pathology

When making a diagnosis, remember that this can happen to anyone. And this is considered the norm. But lack of treatment will deprive your children of normal functioning and a long healthy life. Therefore, do not refuse therapy. Orthopedic shoes, which you will find in our catalog, can further prevent the development of the disease.

Symptoms

The first signs of the disease cannot be ignored, as they indicate progressive deformation. You should pay attention to the following body signals:

• unpleasant sensations after walking, which gradually become intense;
• fatigue and lack of endurance;
• swelling of the ankle and shins, most pronounced on the outer side;
• pain in the head and lower back;
• soreness of points located in the central part of the foot and along the inside of the heel area;
• the depressions between the tarsal bones on the dorsal surface are characterized by increased sensitivity.

Treatment methods for equinovalgus foot deformity in children

Therapy is determined by the attending physician. At the initial examination, he must prescribe the necessary tests, conduct tests and send for examinations. If he does not do this, consult another physician. You should not carry out unfounded self-medication (without a conclusion after further examination).

Therapy can be aimed at both initial correction, when only initial symptoms exist, and at thorough correction in advanced cases. It should be started at one year old and continued until the age of seven, when the muscular system has already strengthened and will not be subject to increased exposure.

The treatment method includes physical therapy, which can be carried out both in special centers and at home. The effect is strengthened by massages and physiotherapy. You can do several courses at a clinic, but more often you will have to ask a doctor to teach you how to do it yourself at home.

You can’t do without purchasing orthopedic shoes, which you will find in our Ortopanda online store. We know how important it is to keep your baby healthy, so we offer products made from natural materials, tested by orthopedists.

If the initial treatment does not help, the traumatologist should prescribe physical therapy, orthoses, plaster casts, and additionally use a distraction-compression device. As a last resort, they resort to surgical intervention when it is necessary to bend or file the bones. The operation is performed on both legs at intervals of one to six months.

If you ignore the doctor's recommendations, your child may remain disabled.

What complications can there be?

Improper development of the lower extremities will provoke a general lag in physical growth. After diagnosis without treatment, flat feet are guaranteed. With age, knee joints will not be able to withstand human height, and as a result, arthritis and arthrosis will develop.

Sometimes it is possible to get a disability when the baby cannot move independently. Due to all external defects, the child will experience difficulties communicating with children and will not be able to socialize and find friends.

During adolescence, without therapy, limbs will be frequently injured and frequent bone fractures will occur. Due to an unformed gait, curvature of the spine, scoliosis, and, in the future, osteochondrosis are guaranteed. Any abnormal bone formation will lead to disruptions in the functioning of internal organs.

To prevent all this from happening, early diagnosis of the disease is needed. It is mandatory to undergo full therapy under the supervision of a doctor. Do not diagnose yourself and do not self-medicate so as not to harm your child.

Physiotherapy

All exercises should be combined with massage to relax muscles and maintain tone. Without it, exercise therapy can cause pain. It is especially important to warm up your feet.

If the baby is still a newborn, you will need to do the exercises yourself. For those who can walk, the following methods are suitable:

• ballet step;
• walking on heels;
• lifting pebbles and toys with your fingers;
• walking backwards;
• wall squats.

Useful exercises

• Warm up, lifting each finger.
• Rolling feet. Repeat for 5-10 minutes.
• Marching or raising your knees high. We alternate the soldier's step, 6 minutes.
• Walking across and along a gymnastic stick.
• Squats with the foot completely on the floor.
• Raising your knees to your nose, 20 times.

The physiotherapist will suggest additional exercises.

Diagnostics

Diagnosis of flattened foot in children and adults is possible using the following methods:

1. Plantography is the making of a foot print using watercolor paint or liquid oil.
2. Podometry, showing the percentage of the length of the foot to the height of its arch.
3. X-ray examination of the feet with a load (standing), carried out in frontal and lateral projections.
4. Examination of feet using ultrasound.

Research allows us to determine the degree of deformation. Factors taken into account include the angle and height of the longitudinal arch, as well as the degree of outward deviation of the thumb.

Diagnosis of the disease in children under three years of age can be difficult due to the physiological flattening of the foot at this age.

A few more recommendations

When carrying out therapeutic measures, follow the advice:

• do not stop training until complete recovery;
• exercise every day;
• exercises should not be painful;
• Everything should be done in socks or barefoot;
• secure everything by swimming.

And be sure to consult your doctor.

Orthopedic devices

Fasteners made of fabric, silicone or hinges are considered popular. Doctors recommend interdigital cushions and foot pads with or without partitions. At later stages of the disease, correctors are used that fix in one position, silicone and fabric bandages.

Hard options are used at night, when the baby does not need to move, or in very rare cases.

The selection is made individually by a doctor. Self-medication is not recommended, so as not to make it worse.

Physiotherapy

Experts recommend salt baths, electrophoresis, and magnetic therapy. You cannot prescribe them for yourself; the doctor will select everything.

Massage

Since they are often treated with plastering, the massage therapist works on unused areas with his hands. It all starts with the back and lower back, then the hips, knees, legs and feet. Pressing, pinching, rubbing is used.

The procedure is carried out by specialists in a physiotherapy room or by parents themselves, but only after consultation and diagnosis.

The importance of therapeutic massage

It is needed to relax muscles and ligaments and strengthen unused ones. Increased attention is paid to the interior because it bears the heaviest load.

Kinesio taping for equinovalgus feet (ICD 10)

This method of treatment involves the application of a special elastic patch, which improves blood circulation and reduces pain. At the same time, the ligaments and muscles have constant support and are not hurt by movement, so there is no need to take pills or use ointments.

The patch stays in place for 3 to 5 days and contains a special, odorless, hypoallergenic adhesive. Moreover, you can stick it on yourself without visiting a doctor. Contraindications are only open wounds, ulcers, hypersensitivity of the skin and allergies to acrylic.

Medicines

Doctors prescribe medications that relieve pain and promote blood microcirculation. The drug Neovit, which removes inflammation, is suitable. In severe cases, Ketonal and Ibuprofen are prescribed to relieve pain on the skin.

Additionally, Dolgit, Chondroxide and Diclofenac act against inflammation and swelling. Voltaren gel and indomethacin help with blood circulation. However, you should not choose your own ointment; everything should be advised by a doctor, taking into account contraindications and age.

Laser treatment

Low-intensity laser radiation is used in the treatment of the lower extremities. It has anti-inflammatory, anti-edematous properties. Due to its characteristics, it can penetrate into affected tissues to reduce swelling and heal wounds.

Surgical correction

It is carried out in extreme cases, and the type is selected individually depending on the stage of the disease. More often, part of the joint is removed and a wire and screws are attached to the bone. During the operation, the Ilizarov apparatus is used, for which the surgeon makes incisions on the bone. Therapy lasts up to a year.

The bone is sometimes corrected without an incision using pins and miniplates.

Equius is most common in cerebral palsy. Due to the insufficient effectiveness of standard procedures, doctors have proposed many operations. The most popular lengthening procedures are the gastrocnemius triceps muscle and the Achilles tendon. After surgery, rehabilitation and orthoses and orthopedic shoes are often required.

Traditional methods of treatment

Remember that such methods are used in addition to the main corrections and are considered only auxiliary. If you experience a negative reaction, be sure to refuse and stop.

• A bath of raw potato peelings. Add water to the remaining potatoes in a ratio of 2 to 3. Boil a little and strain the broth so that your feet do not get hot. Steam your feet in it, and then apply the cleansing to the bone and keep for a couple of hours.
• Add boiling water to the lingonberry leaves - a spoonful per glass of water. Let it brew for 12 hours. Give your child it instead of tea. However, remember that lingonberries are a very strong diuretic, and the child must receive enough fluids so as not to become dehydrated.
• Soften the propolis and apply it to the bone, securing it with a cloth. Put a wool sock over it and leave it overnight.
• Take jacket potatoes and grind them to a paste. Apply to your foot and leave for two hours, after putting on a warm sock and a bag.
• Dissolve 500 g of salt in ten liters of hot water and warm the legs. Repeat for two weeks.
• Take ammonia and powder from 7 leaves of dry bay leaf. Combine the ingredients and leave for 2 weeks. The tincture can be used as a compress.

It is important to remember that traditional methods do not help in advanced cases and cannot be used alone without conservative treatment. Additionally, consult a doctor so as not to make things worse.

Treatment

Since flat feet with foot deformation lead to problems in the functioning of the entire musculoskeletal system, treatment measures should be started as early as possible. In most cases, conservative methods are used, the effectiveness of which depends on the timing of the start of corrective procedures.

Conservative treatment

To correct flat feet, you must use the following remedies:

• medications;
• orthopedic correction using special shoes and devices;
• massage;
• physiotherapy;
• physiotherapeutic treatment.

Treatment of severe congenital planovalgus deformity must begin as early as possible, since this disorder requires surgical intervention.

Exercise therapy

The use of therapeutic exercises is the most effective method of treatment in adults and children. The first sessions are carried out under the supervision of an instructor, later you can study independently. The following exercises are most effective:

• grasping small objects with your toes;
• alternate walking on the toes, the outer edge of the foot and the heels;
• extension and flexion of the foot;
• rolling the foot in the direction from the toes to the heel area;
• rolling your feet on a cylindrical object (you can use a rolling pin).

Classes must be conducted regularly. A positive result can be seen if you devote 10-12 minutes to exercise 3-4 times during the day.

Treatment with medications

Drug therapy is necessary for adults whose pathological condition is accompanied by persistent pain. In this situation, it is necessary to take non-steroidal anti-inflammatory drugs in tablets or injections. The most popular products from this group:

• Ibuprofen;
• Diclofenac;
• Arcoxia;
• Movalis.

Prescription of therapy requires strict monitoring by the attending physician, taking into account contraindications and side effects.

To obtain a more pronounced effect, in some cases they resort to intra-articular injection of corticosteroid drugs (Diprospan, Dexamethasone).

Diet for hallux valgus

To begin with, you should remove from your diet all harmful foods that contribute to blood stagnation and prevent bone growth. We exclude flour, fried and fatty foods, fast food, teas and coffee, seasonings, mushrooms and fast carbohydrates. We also refuse fatty meats, onions, butter, plums, grapes, and chocolate.

They do not provide the necessary vitamins A, E, C, which would help capillary permeability and strengthen tissues. They also slow down metabolism.

It is advisable to provide your baby with fractional proper meals - 6-7 times a day, but in small amounts. Sometimes you will have to additionally agree on this at the kindergarten or school.

Also make sure your child drinks enough water.

What is recommended to eat when treating equinoplanovalgus deformity of the feet?

Focus on grain crops - porridges and soups, pasta and durum noodles, chickpeas, vegetables, black grain bread, dairy and fermented milk products. Also pay attention to seafood (except smoked), white and red meat (stewed, boiled, in salads), fruits, eggs, compotes, juices and kvass.

Causes

Flat feet in children is a natural physiology. In childhood, it is formed due to the “cushion” on the foot. As the musculoskeletal system develops and bones grow, the pillow goes away and the arch takes its place. True congenital flatfoot is rarely detected and can be seen on x-rays. The basis of heredity is the peculiarity of elasticity of the ligamentous-capsular apparatus.

The main reasons for the formation of hallux valgus include:

• Flat feet in children whose weight exceeds the norm. Excess weight contributes to improper load distribution;
• Violation of calcium and phosphorus metabolism, rickets. When the bones soften, they cannot support the body, it “sags”, literally falls on the feet with all its weight;
• Paralytic diseases – polio, encephalitis;
• Neurology. For example, fetal hypoxia at birth;
• Wearing uncomfortable shoes for a long time;
• Injuries and fractures of the heel bones and ankle.

What shoes should you wear if you have equinus valgus?

Let's decide which one is worth giving up.

• Don't choose soft soles, especially if they are high. The foot should not sink into the base, because the load will not be uniform.
• Throw away or sell small and already tight models - calluses and abrasions will only add pain and inconvenience.
• Synthetic materials - the skin does not breathe in it and sweats. Hence the additional discomfort. And also the possibility of getting fungus.
• Low and flat soles will provide increased load on the heel; the central part will not receive support. It is better not to buy soft flat sneakers or ballet flats for your health.
• Flip flops, slides and other options without a strap when the foot will not be secured. In order not to aggravate the situation, refuse them.

Truly orthopedic shoes should be made from high-quality natural materials, as in our Ortopanda online store. They will not cause allergies, and the skin will breathe in them.

What shoes should be like?

The sole is needed up to three centimeters, but not flat. The heel is rigid, fixed in place by the sides. Choose options with a wide toe, in which the toes will be slightly raised. The ankle is supported by Velcro, lacing, and straps.

Models must be equipped with shock-absorbing instep supports. Sometimes it is better to make to order.

Insoles can be inserted into both orthopedic shoes and regular ones to slow down the progression of deformation and eliminate discomfort when moving. They can be:

• preventive - for everyday wear to maintain muscle strength of the arch;
• therapeutic and prophylactic for initial symptoms;
• therapeutic - rigid for the correction of pathology, used together with orthopedic models. Additionally, they are recommended by surgeons after surgery.

We recommend breathable cotton socks or socks made from other natural materials that do not absorb moisture and allow air to pass through easily. Sometimes there are special socks-fixators for gentle correction of the course of the disease. However, they will help only in the very early stages; in other cases, it is better not to overpay for them.

Prevention of flat feet - does it exist?

My deep conviction is that yes, it exists. If the feet were not deformed in early childhood, then most likely there is no deep programmed pathology that will inevitably lead to disorders. Accordingly, if you managed to survive without flat feet at least until adolescence, then you should follow very simple rules :

• give your legs adequate exercise (swimming, walking, exercise bike, jogging, jumping rope and much more),
• avoid overload (excess weight, lifting and carrying heavy objects, prolonged standing),
• wear orthopedic insoles in all types of shoes,
• if you are forced to walk and stand for long periods of time at work, take breaks as often as possible and use appropriate shoes (ideally MBT type),
• If the deformation has begun and is progressing, visit an orthopedist. Surgery may already be required.

As for children, this is discussed above. Let them run and jump, skip and tumble, and the more barefoot the better. In summer - on the sand, in winter - on a skipping rope. An excellent workout for the muscles of both feet and legs. A bicycle, a scooter, a skateboard - yes, it is dangerous, but it perfectly keeps the muscles that “tighten” our arches in tone.