The procedure for examining a child and prescribing exercises for the feet.

Buy anti-virus shoes

Varus is a general term for all deformities that cause the foot to move inward, appearing like a clubfoot.

Varus deformity usually affects several joints: from the hip to the foot. The femur develops unevenly: the outer part is too enlarged. The shin forms a convexity outward, and the heels curve inward. In young children with severe varus deformity, it is noticeable that the knees do not fully extend. This makes it difficult for the child to walk and he gets tired quickly. In adults, progressive varus deformity leads to significant limitation of mobility, even disability.

What is hallux valgus?

Hallux valgus is a pathological curvature of the metatarsophalangeal joint of the first toe, which leads to further deformation of the other toes. In this case, the head of the metatarsal bone deviates greatly, and a protruding lump forms in the area of ​​the lateral surface of the foot near the big toe.

Such a growth, without timely treatment, can be accompanied by pain and inflammation of the surrounding tissues, causes rapid fatigue of the legs, disrupts gait and provokes severe curvature of the spine.

Main symptoms

Symptoms are not as varied as they might seem. By checking, by external signs, even on your own, it is quite possible to determine not only the nature, but even the degree of the disease. But to make a correct diagnosis, you will still have to contact a medical specialist.

The main symptoms are:

• Lack of proportional movement. That is, the patient cannot move his legs one distance relative to the central axis. One leg will lag at least to some extent behind its fellow.
• Incorrect bending of the contact surface. We have already clarified that the inner side rises up, a person moves only on the outer side. This is easily determined visually, just look closely. Of course, the degree may vary; with small deviations, the bend is not too great. But still noticeable.
• Feet do not bend completely. For example, equinovarus deformity of the right foot is characterized by the fact that this particular foot cannot bend completely. And this mostly manifests itself while driving.
• Definite lameness. This cannot be said to be an accurate symptom for making a diagnosis. But it often complements other obvious and unambiguous manifestations.

Causes of hallux valgus

Doctors identify several possible causes for the development of hallux valgus:

• hereditary predisposition;
• high load on the foot structures due to the patient’s excess weight;
• arthrosis of the joints;
• hormonal changes in the body due to menopause, pregnancy and endocrine diseases (for example, diabetes);
• long-term wearing of narrow, uncomfortable high-heeled shoes;
• high professional loads on the feet – professional sports, ballet, etc.);
• injuries and mechanical damage to the foot.

Sometimes pathology develops against the background of a combination of several of the reasons listed above.

In children, hallux valgus deformity develops due to imperfections of the tendon-ligament system and pathologies of the musculoskeletal system. The first manifestations of the pathology become noticeable to parents already by 10-12 months, when the baby tries to take his first steps. Another provoking factor may be muscle hypotension in a child.

Foot exercises

Figure 8-16 shows simple and accessible exercises for independent development of your own foot muscles and the muscles that come to the foot with their tendons from the lower leg.

Symptoms of hallux valgus

The most obvious symptom of the development of hallux valgus is the formation of a protruding bone on the side of the foot near the big toe. In addition to this manifestation, the patient has the following symptoms:

• strong deviation of the thumb from the axis outward;
• hammertoe deformity of other toes;
• pronounced flat feet;
• severe pain in the foot, first when walking, and later at rest;
• fast fatiguability;
• inability to wear usual shoes;
• development of inflammatory processes of soft tissues and pustular skin lesions in the bone area.

Most often, patients ignore the symptoms of hallux valgus for a long time and consult a doctor only when it becomes impossible to choose suitable shoes due to a protruding bunion. At this stage of deformation, treatment with conservative methods is no longer effective. Only surgery will help eliminate the pathology.

Severity and types of disease

Hallux valgus develops gradually, going through four stages of development:

1. First degree. The deviation from the vertical axis is no more than 15 degrees. Timely correction leads to complete cure.
2. Second degree. The lower part of the legs is turned out 15-20 degrees. Complex conservative treatment gives a good result, completely eliminating the defect.
3. Third degree. The deviation from the axis is 20-30 degrees. Therapy includes a number of activities and lasts several months and even years.
4. Fourth degree. The deformation angle exceeds 30 degrees. Conservative treatment does not always give a positive result, so in approximately 7% of cases surgical correction is performed.

Varus curvature has three degrees of severity:

Diagnosis of hallux valgus

An experienced orthopedic traumatologist can make a diagnosis simply by examining the foot with pathology and palpating the tissues. The joint tissue is dense, and any touch can cause pain to the patient. To confirm the diagnosis and determine the severity of hallux valgus, radiography of the feet is performed in 3 projections. Sometimes magnetic resonance imaging and plantography (footprints to identify flat feet) are used as additional diagnostic techniques.

Surgical technique

Indication for surgery is the absence of positive dynamics from conservative therapy. In most cases, surgical intervention is resorted to in adult patients, when the bone tissue and muscle corset are fully formed, and the pathology cannot be corrected with the help of exercise therapy and massage. During the operation, the length of the muscles and tendons is adjusted, and excess fascia is removed. The surgical method allows you to bring the arch of the foot to the middle position. After the operation, the leg is fixed in a cast for 1 month, for a child – for 3 weeks.

The operation can be performed in 2 ways - open surgery using the Zatsepin technique and laparoscopic method. Advantage is given to laparoscopy, during which several small punctures are made in the skin, and the absence of abdominal incisions shortens the rehabilitation period. The disadvantage of laparoscopy is the high price. The cost of surgery using the Zatsepin technique is much lower, but due to the abdominal incisions, the rehabilitation period takes longer.

How to prevent the appearance of a bulging bunion?

Prevention of pathology involves following simple rules:

• Attentive attention to the condition of the feet - when the first signs of increased fatigue, discomfort and inflammation of the feet appear, you must immediately contact an orthopedic traumatologist. By diagnosing the disease in the early stages, you can avoid surgery and restore the health of your feet using conservative treatment methods.
• Wearing comfortable shoes - experts recommend choosing shoes very carefully, in strict accordance with your foot size. It is also important to avoid prolonged wearing of uncomfortable shoes with pointed narrow toes and high thin heels (above 7 cm). Wearing shoes made of non-breathable synthetic materials can also accelerate the development of various foot pathologies.
• The use of orthopedic insoles - special insoles help reduce the load on the forefoot, evenly distribute the person’s weight and soften mechanical shocks.
• Regular rest - if the patient’s professional activity involves long periods of standing, it is very important to provide the feet with proper rest.

Prevention

With a varus foot, it is extremely difficult to get rid of this defect, and you can struggle with the curvature for years. However, doctors do not always guarantee success for patients. Therefore, disease prevention is of particular relevance. Among preventive measures, doctors point out the following points:

• You should not skimp on choosing shoes - your baby should use only high-quality shoes with foot support and proper supination. As a rule, in cheap shoe options these features are not taken into account, so after wearing, parents encounter similar problems in their child, and it is good if the pathology is diagnosed at an early stage;
• Regular examination by an orthopedist is an opportunity to make a timely diagnosis and begin treatment. Not all adults pay attention to problems with walking, and only when there are noticeable problems do parents turn to the doctor. As a rule, this is already the second or third stage of pathology development, and it is much more difficult to help;
• Leading a healthy lifestyle is not an empty phrase. It is especially relevant for pregnant women. To prevent the newborn from developing signs of pes varus, it is necessary to eat well, get plenty of rest, and monitor all possible complications during pregnancy. Only responsible motherhood produces healthy offspring.

What is varus deformity of the foot in a child?

Varus deformity is a pathology of the foot that causes deformation of the middle part of the legs with outward deviation. In this case, the patient has a characteristic O-shape of the legs. This pathology develops against the background of improper distribution of loads on the joints of the body - knee, hip, etc. The main factor provoking the pathology is compression of the internal meniscus.

This, in turn, reduces the internal condyle of the femoral bones, but enlarges the external one, which increases the load on the knee joint. With varus deformity of the foot, its outer part is in an overloaded state, which leads to further distortion of other parts of the body and curvature of the spine.

The pathology usually develops in childhood. The O-shaped shins are also popularly called clubfoot. In the absence of timely treatment, varus deformity of the foot can lead not only to severe diseases of the musculoskeletal system, but also to psychological problems in the child.

How dangerous is the development of the disease?

Varus deformity of the lower extremities requires immediate treatment, because pathology can cause the development of severe complications in the condition and functioning of the lower extremities. The consequences of varus pathology include:

• blood stagnation in the legs due to poor circulation and compression of blood vessels;
• edema syndrome with an intense symptomatic picture;
• phlebeurysm;
• pinching of the roots of the nerve endings: sciatic, tibial or fibular;
• development of muscular dystrophy;
• frequent sprains.

With this pathology, the heel is constantly in the wrong position, as a result of which the gait is disrupted and the person becomes susceptible to frequent dislocations of the leg.

A frequent complication that occurs against the background of varus deformity is the development of osteoarthritis, a disease characterized by the gradual destruction of cartilage and bone structures.

In children (due to a congenital foot deformity or one that appears in the first years of life), delays in mental or mental development may occur due to the fact that there is no effect on the biologically active points located on the foot.

During preschool and school, children with varus deformity may experience difficulties with social life and communication with peers. A child who develops a deformity of the lower leg is deprived of the physical opportunity to participate in outdoor games with other children, which can lead to isolation and complexes.

Causes of development of varus foot deformity

The pathology may be congenital or acquired. The cause of acquired varus deformity of the foot in adulthood is usually Paget's disease, accompanied by damage to the tibia and femur. Prolonged immobilization of the limbs after severe injuries can also lead to the formation of pathology.

Most often, varus deformity is congenital and manifests itself in early childhood. The following additional factors lead to aggravation of the condition:

• the child wearing uncomfortable shoes that compress the foot;
• transmission of severe infectious diseases, including influenza;
• severe forms of vitamin deficiency, primarily associated with a lack of vitamin D and calcium in the body;
• pathologies of bones and joints;
• severe endocrine diseases;
• excessive stress on the legs;
• injuries and mechanical damage to leg tissue.

How to recognize in a newborn?

Foot pathology in an infant manifests itself in too wide placement of the legs in the hip joint. If you take the legs of a child with a deformed foot and try to bring them together at the knees, one shin will overlap the other - this is a sign of varus curvature.

Other signs by which varus can be identified in newborns are the inability to bring the heels together if the child is lying on his back, the placement of the feet has an atypical position - the toes are brought together, the heels are apart.

Symptoms of foot varus deformity

Symptoms of varus deformity can develop very slowly, which leads to a long, uncontrolled course of the disease. Due to improper distribution of the load on the spine and joints, this can lead to severe pathologies of the musculoskeletal system.

Symptoms of varus deformity that can be seen visually:

• external changes in the shape of the legs - O-shaped shin;
• the formation of a characteristic varus foot - the inner arch is high, and the heel of the foot is deviated inward;
• changes in gait, frequent loss of balance and falls;
• foot fatigue syndrome;
• discomfort when putting on and wearing shoes.

If such symptoms appear in a child, you should consult an orthopedic traumatologist as soon as possible.

Dislocation in the knee joint

Congenital pathology of dislocation in the knee joint and, as a consequence, varus deformity of the tibia in children is a rather rare orthopedic disease.

According to statistics, pathology is 3 times more likely to be detected with unilateral deformation than with bilateral O-shaped curvature of the lower extremities.

In girls, orthopedic congenital manifestations also occur 3 times more often than in boys. Varus deformity of the tibia is observed when the proximal end of the tibia is displaced forward.

The causes of the clinical condition are considered to be congenital dystrophy or a disorder of cellular metabolism in the quadriceps femoris muscle as a result of intrauterine damage to the osteoarticular structure of the fetus.

According to some medical experts, this intrauterine situation occurs due to the incorrect position of the fetus in the mother's womb, when the hip joints are bent and the knee joints, on the contrary, are straightened.

Diagnosis and prevention of varus foot deformity

Usually a visual examination is sufficient to make a diagnosis. If the specialist needs additional information, an x-ray examination of the lower extremities is prescribed. Another informative study for varus foot deformity is magnetic resonance imaging.

The following rules help prevent the development of varus deformity:

• wearing comfortable shoes that match your foot size;
• complete nutrition containing all the vitamins and microelements the body needs;
• preventing overwork of the lower extremities;
• timely visit to an orthopedist for preventive purposes.

Diagnosis

To make an accurate diagnosis and determine varus deformity, it is necessary to consult an orthopedic doctor, who identifies the pathology during an examination of the patient’s lower extremities and conducting stress tests.

To clarify the primary diagnosis, determine the causes of the development of pathology and identify possible complications, an x-ray is taken. An instrumental diagnostic method such as computed tomography is less commonly used.

Treatment and rehabilitation of hallux valgus

Treatment of hallux valgus in the initial stages of bunion formation can be carried out using conservative methods - therapeutic exercises, physiotherapy, wearing orthopedic shoes, adherence to a work-rest regime. If the pathology develops in adulthood, treatment involves surgery.

Surgery to remove a bunion can be performed in two ways:

Classic surgical technique

In this case, the operation is performed under general anesthesia or under epidural anesthesia. The specialist cuts through the soft tissue, gains access to bone and joint structures and removes the growth on the bone. In some cases, the surgeon has to partially remove the phalanx of the big toe or even perform prosthetics of the foot joints. In this case, the patient's own joints are excised and replaced with prostheses.

Rehabilitation after surgery is complex and lengthy. The patient cannot walk for the first days after surgery. Then, for several months, the patient cannot lean on the operated leg. The patient moves only with the help of crutches or a stick.

To speed up the recovery of motor activity, therapeutic exercises, physiotherapy and massage are used. Only after a few months (4-6) the patient can return to normal life and wear familiar shoes. At the same time, experts recommend that such patients give preference to orthopedic shoes and avoid heels and models with narrow toes.

Laser technique for removing a bunion on the leg

Experts consider the laser method of treating hallux valgus to be the most gentle and minimally invasive. The operation can be performed under spinal and intravenous anesthesia, which reduces the overall burden on the body.

The surgeon makes a small tissue incision in the area where the protruding bone forms and removes the growth using a directed laser beam. The laser evaporates cells layer by layer, forming a healthy shape of bone and joint structures. After the operation, several small cosmetic sutures are placed at the incision site, which are removed 10-12 days after the operation.

An important advantage of the laser method for removing hallux valgus is the absence of the risk of bleeding due to coagulation of blood vessels under the influence of the laser beam. In addition, the laser has bactericidal activity, which prevents infection of the wound surface.

Recovery after laser treatment of a bunion on the leg is much easier and faster than after classical surgery. Already on the second day the patient can walk without crutches and additional support.

After 2-3 weeks, wearing shoes without heels is allowed, and after 2 months the patient can return to normal physical activity. Moreover, due to the low invasiveness of the surgical method, the tissues quickly heal and are restored, excluding relapse of the pathology.

, , . . . .

We can talk about valgus curvature of the legs when the distance between the inner ankles with tightly compressed and straightened knees exceeds 4-5 centimeters; contrary to popular belief, this is not a congenital defect, not a hereditary quality, but an acquired defect.

Curvature of the legs most often appears a few months after the child got to his feet and began to walk; this is explained by excessive load on the lower limbs during the period of rapid growth and a still weak muscular-ligamentous system.

The main cause of leg deformity is rickets suffered in infancy, especially its low-symptomatic and untreated form; in severe cases, the lower leg bones may become convex inwards. More rare causes include some foot defects, congenital dislocation of the hip, diseases and injuries of the knee joints, and excess weight of the baby adversely affects the formation of the legs. However, in children with a stocky build, the predisposition to this defect is less than in asthenics; girls get sick more often, which is due to their wider pelvis.

With valgus deformity, the main changes occur in the knee joint: uneven development of the femoral condyles (faster growth of the internal condyles than the external ones leads to the fact that the joint space becomes wider inside and narrower outside). The ligaments that strengthen the joint are stretched, especially on the inside, the knee loses its stability; if you look at such a child from the side, you will notice hyperextension of the legs in the knee joints. The feet gradually become deformed and acquire a stable flat-valgus position (the heels are deviated outward), and flat feet develop. In advanced cases, the gait suffers - the child walks uncertainly, awkwardly, gets tired quickly, complains of pain in the legs, if one leg is more curved than the other - spinal curvature and scoliosis often develop.

Treatment of hallux valgus is a difficult and lengthy task; it requires constant attention and perseverance from parents. Try to convince the child of the need for therapeutic measures, giving them the appearance of an exciting game, and create a stable habit.

Firstly, the child should avoid prolonged standing, especially with legs wide apart; standing in this way is harmful, since this increases the inward deviation of the knees and the abduction of the feet outward, but with closed legs, the weight of the body falls through the middle of the knee joint to the outer edge of the foot, purpose which is to bear the weight of the body.

Secondly, it is necessary to periodically rest your legs and refrain from long walks and prolonged games while standing.

Thirdly, the child needs to choose games and exercises that would eliminate the harmful effects of body weight on the knee and ankle joints, while simultaneously promoting the development and strengthening of the muscular-ligamentous system.

Exercises for the legs should be done daily, gradually increasing the load; exercises for other muscle groups should, if possible, be performed from the starting positions while sitting, sitting cross-legged. Exercises on gymnastic apparatus (wall bars, trapeze, ladder), swimming, and cycling are very useful for such children. Losing excess weight also reduces the load on your legs and has a beneficial effect on the condition of your knees and feet. When walking, you should wear specially selected orthopedic shoes with heels slanted outward or corrective insoles, but the issue of wearing such shoes should be decided by an orthopedic doctor. In any case, shoes should be comfortable, new (you can’t wear someone else’s) and always have a hard back. At home, if there is no need to wear orthopedic shoes all the time, it’s better to walk barefoot to train the muscles of the foot; in the summer it’s also very useful to walk barefoot on sand and pebbles , grass, giving your feet and toes freedom of movement.

In case of significant deformities of the legs, treatment with orthopedic splints, corrective placement, and surgical treatment is used. Therapeutic gymnastics and massage - stability and normal functioning of the knee and ankle joints depends on the condition of the surrounding muscles; with the help of massage and specially selected exercises, weakened and stretched muscles are strengthened, and overly tense ones are relaxed.

The massage is carried out in courses of 12-20 procedures daily or every other day, with breaks between courses of two to four weeks, the intensity of the massage gradually increases towards the middle of the course. It is necessary to avoid sudden, painful movements; the child should have a pleasant feeling after the massage. Starting position - the child lies on his stomach, a small roller is placed under the ankle joint - back massage - stroking, rubbing (with fingertips, sawing, comb-shaped), kneading, stroking again, do not forget - stroking is carried out several times on each massaged area, after each reception , stroking the whole body - at the beginning and at the end of the session. Lumbar-sacral area - stroking, intensive rubbing, kneading by pressing or sliding, stroking in the direction from the spine to the sides and slightly down. Gluteal area - stroking in a circular or X-shaped direction, intensive rubbing (with the back of bent fingers), kneading with two or one hand, tonic percussive techniques (effleurage, patting, chopping), stroking. The back of the thigh - stroking in the direction from the popliteal fossa upwards and outwards, intensive rubbing, kneading with one or two hands, light striking techniques (patting, chopping with one or two fingers), stroking. The back surface of the shin - general stroking from the heel up to the popliteal fossa, differentiated rubbing - the outer part of the shin (outer head of the calf muscle) is rubbed gently, the inner surface (inner head) - more intensively, kneading with one or two hands throughout the entire muscle group, along the inner on the surface - light striking techniques, on the outside - vibration, stretching, at the end - obligatory stroking. Knee joint area (correction) - stroking the lateral surfaces of the joint, rubbing them, pressing on the inner surface (inner femoral condyle), while pressing on the inner femoral condyle with one hand, hold the shin in the lower third with the other and try to bring it to the midline. Achilles tendon - stroking and rubbing (pincer-shaped). Starting position: the child lies on his back, under the knees - a cushion - the front surface of the thigh - stroking, soft but thorough rubbing, gentle kneading, stroking in the direction from the kneecap up and out. The anterolateral surface of the lower leg - stroking from the foot up to the knee, light rubbing, stroking. Knee joint (correction) - circular stroking of the joint area, rubbing the lateral surfaces (femoral condyles), pressing on the inner condyle with adduction of the tibia. Foot - stroking along the back surface from the toes to the ankle joint, rake-shaped or transverse rubbing, stroking and rubbing around the ankles, intensively around the inner ankle, rubbing the inner edge of the foot, stroking.

After the massage, be sure to do several exercises - flexion and extension of the feet at the ankle joints is carried out alternately for one leg, then for the other, you can help the baby by bending his foot with one hand, fixing the shin with the other. Rotation of the feet, first one foot rotates in both directions, then the other, if necessary, help the baby, only the rotation should be soft and painless. Grabbing a toy with your feet, invite the child to grab and hold a comfortable toy (skittle, small ball, etc.) with his feet for a while. Therapeutic gymnastics exercises are best done several times a day, once after a massage, the other during daily activities, including them in a regular complex, some exercises should become familiar, for example, sitting cross-legged, so the child should be seated in this way as much as possible more often. Rising from a pose while sitting cross-legged, the baby sits cross-legged, invite him to stand, leaning on the outer edges of his feet, help the child by supporting him by the arms, when repeating the exercise, you should change the position of the legs so that in the initial position, sitting on top, the left one is alternately , then the right leg. Squatting with the knees spread, supporting the child under the arms or hands, teach him to squat with the knees wide apart, squatting in the same way is useful, you just need to monitor the position of the feet (they should rest completely on the floor and stand parallel). Standing on toes, invite the child to stand on his toes and stretch up, then lower himself onto his full foot. Walking on the outer edges of the feet, ask the baby to walk a little, leaning on the outer edges of the feet (a clumsy bear walks through the forest, collects cones, sings a song). Walking on a gable ribbed board, along a narrow path, teach your baby to walk and stand with his feet placed close to each other, for this purpose you can use any narrow (10-15 centimeters) board, a strip on the carpet, you can draw a narrow path with chalk, mark with its ropes, make sure you walk correctly during a walk, guide your child along a log on the playground, a sidewalk curb, and the like. Exercises in water - all of the above (except the last two) can be done while swimming, warm water relieves excess muscle tension and facilitates movement, it is also useful to walk on a corrugated mat and bounce on it.