Dr. Komarovsky about hallux valgus in children: treatment and prevention

Dear Doctor.
The well-known practicing doctor Komarovsky recommends that parents seek medical help at the first signs of hallux valgus in children. This defect is characterized by a decrease in the height of its arch and an X-shaped curvature of the axis. The baby's toes and heel turn outward, and the middle part drops slightly. The child's gait becomes clumsy, he complains of pain, and quickly gets tired during even a short walk.

The appearance of one of the symptoms should be an incentive to visit a pediatric orthopedist. The doctor will conduct an external examination of the child and prescribe a number of instrumental studies - x-ray of the foot, plantography, podometry. Hallux valgus deformity of mild severity responds well to treatment with conservative methods. Massage and physiotherapeutic measures are indicated, and the wearing of orthopedic devices is recommended. In severe cases of pathology, surgical correction of the feet is performed.

External manifestation.

Characteristic features of the disease

“An effective and affordable remedy for joint pain exists...” ...

With hallux valgus, the baby, trying to stabilize the position of the body in space, pathologically changes its gait. E. O. Komarovsky draws the attention of parents that this leads to the occurrence of severe diseases that are difficult to treat conservatively:

osteochondrosis of the lumbosacral spine;
deformation of the hip, knee, ankle joints;
arthrosis of the foot, occurring against the background of irreversible destruction of hyaline cartilage.

Such complications take years to develop and are diagnosed less and less frequently. In modern pediatrics, regular examination of patients is practiced. The difficulty lies in the different etiologies of hallux valgus. What pathology can be:

congenital, resulting from intrauterine anomalies in the formation of the foot;
acquired, developing during the child’s growth.

Congenital deformity is usually diagnosed before six months of life, and pediatric orthopedists immediately treat it. Timely detection of acquired pathology often depends on the attentiveness of mothers and fathers. Improper formation of the feet becomes noticeable by 11 months, when the child begins to move relatively confidently. Dr. Komarovsky warns that plano-valgus foot deformity is detected in a child with insufficient muscle tension. Pathology of skeletal muscles occurs for the following reasons:

prematurity;
improper biosynthesis of collagen, causing hypermobility of joints, increased elasticity of ligaments and tendons;
rickets is a disease characterized by a disorder of bone formation and insufficient bone mineralization;
low body resistance to viral and bacterial infectious agents, frequent bronchitis, tonsillitis, laryngitis, bronchiolitis.

Hallux valgus deformity develops if a child is diagnosed with a pathology in which static and dynamic relationships are disrupted - partially or completely. This disorder accompanies cerebral palsy, polyneuropathy, myodystrophy, and poliomyelitis. Incorrect rotation of the toes and heels can result from prolonged immobilization of the child after a fracture, dislocation, rupture of ligaments or tendons.

Clubfoot (intoeing), internal rotation of the legs

Clubfoot and adducted feet usually do not cause serious problems. This problem is temporary and in most cases does not require orthopedic correction and treatment. The biggest problem with clubfoot may be difficulties in choosing shoes or cosmetic deviations in adolescence.

It is important to distinguish clubfoot from clubfoot. Clubfoot (as opposed to clubfoot) is a serious orthopedic pathology (deformation of the foot as a result of a dysplastic process of connective tissue). Such children require orthopedic and/or surgical treatment

Clubfoot can result from:

metatarsal adduction
internal rotation of the tibia
anteversion of the femur

Dr. Komarovsky about hallux valgus

A well-known pediatrician draws the attention of parents to the fact that they themselves sometimes provoke the development of pathology. This is true for overweight babies. Their musculoskeletal system is just beginning to form, and the ligaments and tendons are too elastic, the muscular corset of the foot is not strong enough. When an obese child begins to walk, his soles experience stress, leading to hallux valgus. Events develop according to the same negative scenario if mothers and fathers are ahead of the natural course of events. They begin to put the baby on his feet prematurely, forcing him to take his first steps. The elastic ligaments are not yet able to support the weight of the baby, so they begin to stretch, destabilizing the joints of the legs.

Dr. Komarovsky often conducts conversations with parents, focusing their attention on the causes of the pathology, methods for its timely recognition, and methods of conservative treatment. Here are his recommendations:

When choosing shoes for children, you should not go to extremes - immediately purchase orthopedic boots that firmly fix the leg, or give preference to wide sandals with flat soles. The best option is shoes with a slight protrusion at the heel that fits well but does not restrict movement. It is sandals and boots that can become one of the criteria for diagnosing hallux valgus. The greatest wear of shoes occurs on the inside of the shoe;
To prevent rickets in the cold season, when the sun is hidden behind the clouds, pediatricians prescribe an oil solution of ergocalciferol to newborns and older children. Fat-soluble vitamin D promotes optimal absorption (assimilation) of the micronutrient calcium. This doctor’s recommendation should not be neglected, since a course of ergocalciferol helps the bones, cartilage of the leg, its supporting ligaments and tendons to form correctly;
If parents suspect that the child’s feet are developing incorrectly, then they can contact the pediatrician directly. A doctor of this specialization has all the skills to diagnose hallux valgus. Further treatment will be carried out by a pediatric orthopedist. If necessary, doctors of other narrow specializations - endocrinologist, neurologist, immunologist - are involved in therapy;
Treatment carried out at the initial stage of the disease makes it possible to avoid severe complications with a 100% chance. But Dr. Komarovsky advises parents not to panic if their child is indicated for surgery. The operation is performed by experienced orthopedic surgeons who regularly confirm their qualifications.

Video with doctor's comments:

Often in the video, Dr. Komarovsky demonstrates special mats, walking on which is an excellent prevention of hallux valgus in children. This orthopedic device consists of several segments. Each of them imitates some natural surface - coarse and fine sand, pebbles, grass. Walking on a bright multi-colored rug promotes the proper formation of joints, strengthens the ligamentous-tendon system, and helps build muscle.

Foot adduction (metatarsus adductus, metatarsus adduction)

Metatarsus adduction in children
Foot adduction is a common positional deformity that causes a child's feet to bend inward from the midfoot to the toes. In severe cases, it may resemble clubfoot. In most cases, the condition improves on its own.

In cases of severe impairment, treatment may be required, which includes exercises, plaster casts or special corrective shoes.

Doctor Komarovsky about treatment and prevention

The main goals of therapy for hallux valgus in children are restoration of their anatomically correct form and functioning, strengthening of muscles and ligamentous-tendon apparatus. Pharmacological drugs are used very rarely in treatment. Sometimes agents with an analgesic effect are used - ointments, gels, but only when complaining of severe pain. A course of taking balanced complexes of vitamins and microelements in the form of syrups, dragees, and chewing gummies is indicated:

Wearing orthopedic shoes

The use of special shoes helps to correct the correct position of the foot while walking. It is quite rigid, fixes the foot well, and the inner part of the bottom of the shoe, attached to the insole, is designed to reduce the load on the arch. What should be the correct orthopedic shoes:

exact fit to size;
the fabric in contact with the skin is made from natural materials;
no heel or pointed toe.

Dr. Komarovsky warns parents against the temptation to buy shoes to grow out of. This will be a waste of money from the family budget, since the foot in such shoes moves freely, and there will be no therapeutic effect. Orthopedic shoes are sold in specialized stores. But the best is considered to be custom-made. The master carefully measures the children’s feet, taking into account the peculiarities of their structure. Such boots or sandals are much more expensive, but the therapeutic effect of wearing them is very high.

For mild hallux valgus, it is sufficient to use orthopedic insoles - arch supports. They are smoothly curved, and on the inner surface there is a protrusion that does not allow the foot to move to the side. The insoles are simply inserted into regular shoes and are securely fastened.

A short and informative video from the doctor:

Physiotherapy

In addition to walking on an orthopedic mat, doctors advise parents to regularly exercise with their children and perform special exercises. Dr. Komarovsky advises turning therapeutic exercises into an exciting game, followed by distributing “rewards” to the winner - pencils, coloring books, small toys. You can quickly collect or roll balls and construction set parts with your feet. What exercises are most therapeutically effective:

sitting on a low chair, imitate walking;
standing, rise on your toes, and then smoothly roll onto your heels;
lying down, lift your legs one by one and pull your toes towards you.

When relaxing in the country or going out into nature, you should use this to improve your health. Walking barefoot on sand, small pebbles, and grass contributes to the proper formation of the feet.

Massage

Massage is an effective way to treat hallux valgus in children. Dr. Komarovsky also recommends massaging the child’s feet to prevent disease 1-2 times a day. The first procedures are carried out by a physical therapy specialist. He informs parents about the regime of health-improving activities and shows in practice how to massage the feet. Warm up the soles and ankles, shins, knees, hips.

Professional massage therapists place the child on the couch so that the feet hang slightly from it. A small, dense pad is placed under the shins. The massage therapist first performs a general kneading of the legs by stroking and rubbing. Then comes the time for more energetic movements - rolling, vibrations, pressing on certain points. At the end of the treatment procedure, the massage therapist strokes the child’s legs again. Gentle kneading improves blood circulation in the feet and eliminates excess muscle tension.

Dr. Komarovsky often informs fathers and mothers that hallux valgus is not an incurable pathology. But you cannot use traditional medicine. The time required for conservative therapy will be lost. Surgery is performed to restore the correct position of the foot.

Parents should take into account that in the absence of adequate therapy, severe complications develop, which also require long-term treatment. The child may develop flat feet, shortened legs, and scoliosis (curvature of the spine). Therefore, in the absence of external signs of hallux valgus, the child should be regularly shown to a pediatric orthopedist.

Tibial torsion

Internal (internal) torsion of the tibia and external (external) torsion of the tibia.
Tibial torsion is the inward or outward rotation of the lower leg. The condition usually improves without treatment, usually before the child is 4 years of age.

With internal tibial torsion, the child's feet point inward. With external torsion of the tibia, the child's feet are spread outward.

How to prevent pathology in a child?

To prevent the child from developing signs of planovalgus deformity, parents should, if possible, eliminate the causes of the pathology. You should start with paying attention to the pregnant woman, organizing her regimen, nutrition, and protection from infection.

Tips for parents:

A newborn baby needs a regular strengthening massage; mothers can give it 2-3 times a day.
You should not shy away from a preventive examination by a surgeon. Timely detection of deviations will allow for minimal treatment.
Do not rush your child to walk; you cannot put your baby on his feet until he is 8 months old; remember that Dr. Komarovsky is against walkers.
When the baby walks on his own, allow him to walk barefoot more.
Select shoes according to size; if necessary, an orthopedic model can be ordered only after the recommendation of an orthopedist.
Do not overfeed your child; excess weight is a significant burden.

The future health of his spine, knee and hip joints depends on the serious attitude of parents towards the curvature of the baby’s foot. Timely treatment helps to cope with the problem.

Anteversion (internal rotation) of the femur

Anteversion and retroversion of the femur
Anteversion (internal rotation) of the femur usually becomes noticeable between the ages of 2 and 4 years, when internal rotation of the femur tends to increase.

The condition usually improves without treatment

Retroversion (external rotation) of the femur is less common than anteversion. The condition also most often corrects itself

In some cases, surgical treatment may be required in case of anteversion or retroversion of the femur, if the child is over 9 years old and has a very serious condition, when the child often stumbles and has severe gait disturbances.