Transverse flatfoot - causes, symptoms, diagnosis and treatment

Flat feet are an extremely common pathology among adults. It accounts for 25% of all visits to an orthopedic doctor. Among all foot deformities, flat feet account for 80% of cases. The disease progresses slowly but constantly without treatment. Over time, it leads to severe pain, limits a person's physical activity and leads to complications in the foot, spine and large joints of the lower limb. Let's talk about whether it is possible to cure flat feet in adults without surgery and when there is a need for surgical treatment.

Causes and symptoms

All children have flat feet at birth. Typically, by the age of 5, arches are formed: longitudinal and transverse. In childhood, flat feet are considered normal. It does not require correction with insoles or orthopedic shoes.

But as an adult, the foot should not be flat. However, flat feet develop in at least 15% of the adult population. It can be congenital or acquired. Congenital is extremely rare. Acquired by origin can be:

flat foot

static – due to prolonged standing;
rachitic – a consequence of previous rickets (develops due to a disorder of calcium metabolism, mainly caused by a lack of vitamin D);
paralytic - the result of damage to peripheral nerves or diseases of the central nervous system;
traumatic – the result of a foot injury (damage to bones, joints, muscles, tendons).

The most common type is static flatfoot. Its symptoms depend on the stage of the pathology:

Stage 1 – patients complain of pain and fatigue of the calf muscles of the legs, which appear only after a long walk;
2nd degree – pain with minimal loads, the first signs of foot deformation;
3rd degree – severe deformation of the foot and its expansion.

Static flat feet are the result of constant overload of the feet. It leads to weakened muscles and sprained ligaments. It usually develops in people who stand for a long time, lift and carry heavy objects.

Combined type treatment

Transverse longitudinal flatfoot is the most severe form of the disease. In a person, both arches are deformed at once, and the foot becomes completely flat. Treating the pathology is quite difficult.

Goals of operations for combined flatfoot:

restoration of the arches of the feet;
reliable fixed fixation of bones;
correction of deformities of the first finger;
removal of exostoses;
correction of hammertoe deformity.

Operation of longitudinal-transverse deformation.

With transverse-longitudinal flatfoot, a person undergoes several interventions at once. For example, a patient simultaneously undergoes a Schede operation, a Scarf osteotomy, and arthrodesis of some metatarsal joints. As a rule, doctors try to do everything in one surgical procedure.

The recovery period after such operations lasts longer than in other cases. Fortunately, patients do not require a cast or crutches. In the worst case, they will have to wear fixation needles, which will be removed along with the stitches in 2 weeks.

In cases of severe longitudinal flatfoot, a person requires posterior tibialis tendon repair and marginal subcutaneous tenotomy of the Achilles tendon. After such a surgical intervention, the patient is put in a plaster cast, and is allowed to walk only with crutches.

flat feet

flat feet
Flat feet reduce the spring (shock-absorbing) function of the foot. As a result, the vibration load on the spine increases and joints suffer. Patients with flat feet have a higher risk of scoliosis, osteochondrosis, and deforming osteoarthritis of large joints of the lower limb.

Thus, if signs of foot deformation appear, you should consult a doctor immediately, since flat feet need to be cured as quickly as possible. The disease is prone to progression. In addition, it causes many complications that are difficult to treat.

Hallux valgus becomes a frequent complication of transverse flatfoot. This is a deformity of the first (big) toe, which is popularly called a “bunion.” The disease is 20 times more likely to develop in women than in men. A predisposing factor is considered to be congenital weakness of the ligamentous apparatus of the foot. The situation is aggravated by wearing tight high-heeled shoes. Severe deformities may require surgical treatment.

How to treat flat feet?

There are conservative and surgical treatment methods. In the vast majority of cases, conservative methods are used.

How flat feet are treated depends on the stage of the pathology and the presence of concomitant foot deformities. Typically, at stage 1, massage, gymnastics, and arch supports in shoes are used. At stage 2, individual insoles, physical therapy, and myostimulation are required to strengthen muscles. At stage 3, conservative treatment can be the same as at stage 2. But sometimes they resort to surgical intervention if a radical improvement cannot be achieved without surgery.

Before treating flat feet in adults, the doctor must conduct an examination. Basic diagnostic methods:

How much does the operation cost?

In Russia, prices for surgical treatment of flat feet start at 30,000 rubles. Please note that the amount does not include the cost of preoperative examination, anesthesia, consumables and implants. If during the operation doctors perform several manipulations at once, the treatment will cost even more. For example, the minimum cost of SCARF osteotomy in combination with subtalar arthrodesis is 35,000 rubles.

If you do the math, in total treatment abroad is not much more expensive than in Russia. In the Czech Republic, you will pay euros for surgery and rehabilitation. In Germany – from 7 thousand euros, in Israel from 7 thousand dollars (without rehabilitation). So if you want to have surgery in Europe, go to the Czech Republic.

treat flat feet

plantography - obtaining foot prints with subsequent decoding;
radiography – to visualize the bones of the foot;
podometry – change in the nature of walking;
computer pedobarometry is the most accurate method that measures pressure during standing and walking on different parts of the foot (allows you to ideally select orthopedic insoles).

In conservative treatment, the most important role is played by the use of orthopedic insoles or shoes. At stage 1 of flat feet, patients can buy ready-made insoles. However, they do not take into account the individual configuration of the foot, and therefore have only a symptomatic and not a corrective effect. Pre-made insoles relieve pain, but over time they can further weaken the muscles. Therefore, the disease can progress with their use.

The best option is individually selected and custom-made insoles. They not only reduce symptoms, but also help eliminate foot deformities.

Drug therapy

Medicines are used to relieve unpleasant symptoms. They cannot cure the disease.

A doctor should prescribe medications, as they may have contraindications. In addition, prescription medications may be prescribed if necessary. The doctor may prescribe:

non-steroidal anti-inflammatory drugs (Diclofenac, Ibuprofen) – relieve pain;
muscle relaxants (“Mydocalm”, “Sirdalud”, “Tolisor”) – relieve muscle spasms and eliminate cramps.

Can flat feet be treated with insoles?

Flat feet in the initial stages, without accompanying foot deformities and without arthrosis of the joints, can be cured with the help of insoles or orthopedic shoes. Insoles should only be made to order for a specific person. They are worn at least 5-6 hours a day. The course of treatment lasts from 2 to 4 years or more. The desired result is achieved in 60% of patients. The rest show improvement, but the disease is not completely cured.

Important conditions for the effectiveness of insoles:

ideal conformity to the topography of the plantar surface of the foot;
the absence of areas of increased pressure on the foot, which over time can lead to structural changes in soft tissue structures;
creating conditions for training the muscles of the arch when walking.

Custom insoles affect the degree of muscle tension, joint position, and tendon tension. They also have an effect on proprioceptive sensitivity and contribute to better control of the dynamics of the human body. Good insoles not only relieve symptoms and correct foot deformities, but also improve posture and form a correct gait.

Making insoles

custom size;
reconstruction of the arch of the foot;
energy-saving depreciation;
optimal thermoregulation.

Methods for planning the production of insoles are mechanical and computer. Although mechanical methods were historically the first, today the computer method is increasingly used in modern clinics.

The mechanical method involves obtaining a cast of the foot. In the future, orthoses are made on its basis. However, the technique has one huge drawback: it does not take into account the load on the foot when walking. The impression is taken in a static body position. However, when walking, areas of overload shift, and in different ways for different people. The cut is adjusted subjectively, based on the patient’s feelings, not on objective measurements.

The computer method is more accurate. Pedobarography is performed using a special apparatus. Many parameters are assessed: the position of the direction of the patient’s center of body mass, his movement when walking. There are 5 zones of greatest load on the plantar surface:

finger;
metatarsal (metatarsophalangeal joints, rollover axis);
medial middle region;
lateral medial region;
the heel area, which is the axial support.

Based on the results, the structure of the integral load graphs is assessed. A model of the insole for manufacturing is formed. After its production, the orthosis is adjusted to the patient, based not on his sensations, but on the data of pedobarography and photoplantometry.

The use of individual insoles allows obtaining positive treatment results after 1.5 years in 85% of patients. Their pain and muscle fatigue when walking decrease or disappear. Measurements show an increase in arch height. Further treatment can be carried out using other insoles. The examination and orthoses are made again, as the configuration of the foot changes. In a few years, in this way, a person can completely recover from flat feet, after which the need for further use of insoles will disappear.

Diagnostics

If you suspect that you have flat feet, you should consult an orthopedist. Initially, the doctor will definitely conduct a survey of the patient and find out what complaints he has about the condition of the feet and health in general, clarify the features of work and rest, etc. After this, he conducts an examination, during which he will evaluate not only the condition of the foot, but also the shoes. In doing so, he will pay attention to:

the nature of the wear of the sole (normally the outer part should wear out more);
the color of the skin of the feet (normally it should be pale pink, pallor and, conversely, a rich red color of the skin indicates circulatory problems);
coarsening of the skin of the feet, the presence of corns, calluses;
features of foot placement, when a person stands straight with his feet close to each other;
the presence of deviations of the feet inward or outward;
the presence of hallux valgus, i.e. the formation of a so-called lump at its base, which can be swollen and painful;
flat feet;
difficulty maintaining balance when squatting;
gait changes.

Based on these data, the orthopedist can already diagnose flat feet and determine its type. But to determine the degree of deformation, obtain initial data for the manufacture of individual orthopedic devices and determine the most effective treatment tactics, additional examinations are required. Therefore, all patients, including children, who have signs of combined flatfoot, are prescribed:

Computer plantography is a modern diagnostic method that allows you to obtain images of the plantar part of the foot under load. It means that the patient stands on a special instrument panel in a position that is comfortable for him. At the same time, he should evenly distribute the load on both feet. The results are assessed in accordance with the norms characteristic of each age. Children have physiological flat feet, which goes away as they grow older and develop the musculo-ligamentous system.
Podometry is a method for diagnosing flat feet, in which the Friedland index of the longitudinal and transverse arches of the feet is determined. Normally, the longitudinal arch index is 29-31%. Lower scores indicate flat feet. The transverse index of the arch is normally no more than 40%.
Podography is a diagnostic method that makes it possible to study the biomechanics of walking and movement patterns. To carry it out, special equipment is required, which is not available in all medical institutions. But with its help you can accurately determine all the features of gait. It allows you to study the phases of the heel roll, as well as obtain an accurate coefficient of gait rhythm.
X-ray method gives an accurate understanding of the peculiarities of the position of the bones of the foot. This allows you to determine the degree of flatfoot, and subsequently monitor the dynamics of changes. It is from X-rays that you can accurately determine the height of the arch of the foot, intermetatarsal angles, the angle of the longitudinal arch of the foot, etc.

Sometimes electromyography is additionally performed, with the help of which the condition of the muscles of the lower extremities is assessed.

treat flat feet

treat flat feet
You can often find orthopedic insoles and shoes on the Internet, orthopedic salons, pharmacies and medical equipment stores. They are much cheaper than those performed individually and do not require preliminary diagnostics. You can start using these insoles immediately after purchase. Sellers help you choose them, taking into account the degree and type of flat feet.

The only problem is that such insoles do not treat flat feet. In them, a person can feel more comfortable, pain and fatigue in the leg muscles are reduced. But such treatment is only symptomatic. Purchasing ready-made insoles always creates areas of increased pressure on the foot. In addition, the arch muscles are not trained. On the contrary, they are unloaded and gradually atrophy.

The relief of the vast majority of mass-produced insoles does not at all correspond to the relief of the foot of an individual person. It does not take into account the characteristics of walking.

Thus, store-bought insoles are unlikely to be a good treatment, since flat feet in adults cannot be cured with their help. Even minor positive changes are unlikely. The disease will progress more quickly with regular use of these medical products.