About the consequences of flat feet: what happens with flat feet, why flat feet occur ORTECA

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.

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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.

What protective measures can you take yourself?

Prevention and correction of flat feet is not only a set of therapeutic measures prescribed by a doctor. You can supplement them with simple and effective measures that will give positive results in just a few months.

To prevent flat feet you need to:

Walk barefoot as often as possible. In winter you can do this at home, and in summer you can do it outdoors.
Engage in sports such as skiing, skating (including roller skating), cycling, swimming. Such exercises perfectly strengthen the muscles of the foot and help neutralize the consequences of deformation.
One of the conditions for preventing flat feet is correct gait and impeccable posture. To do this, you should sign up for oriental dancing, yoga, and gymnastics, which will help you cope with the task.
Properly selected shoes are exactly what can prevent flat feet at the initial stage. It is important to remember that if transverse flatfoot is suspected, heels are completely excluded, and if there is a longitudinal type of pathology, on the contrary, it is forbidden to wear shoes with flat soles.

Thus, various methods can be used to prevent flat feet; combining them in most cases gives a positive result and helps restore health.

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:

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.

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.

Dysplasia, treatment by position

– There are a lot of questions about dysplasia.

– This is a much more serious topic, since undertreated or missed dysplasia can lead to disabling consequences. Here we need to be specific.

– Is it possible to carry a child in a sling or ergo-backpack with first-degree dysplasia, while the child is in a Freiki pillow.

– Firstly, it is no longer customary to talk about the degrees of dysplasia in children, but there is a classification of types of development of the hip joint according to Graf. These types are determined by ultrasound. Often, ultrasound doctors, especially those not directly involved in orthopedics, do not find the ossification nucleus of the femoral head in children during the first 6-8 months of life and make a diagnosis of dysplasia. This is a fundamentally wrong approach. Dysplasia may be accompanied by a delay in the appearance of ossification nuclei, but this delay in itself is not a basis for the diagnosis of dysplasia. For example, pneumonia is usually accompanied by a cough, but this does not mean that every child who coughs has pneumonia.

Once the diagnosis of hip dysplasia is established, the main treatment is positional treatment. Regardless of what gives the hips relative to the pelvis the correct position, with the femoral head centered in the acetabulum, this principle works if this position is respected. The Freiki pillow gives your legs this correct position. If you are a child with hip dysplasia, who is wearing a Freiki pillow, additionally place it in any position, in any condition, in any design, but at the same time the femur will maintain the correct position in relation to the pelvis, then you can wear it as you like and in anything. The principle of treating dysplasia is long-term centering of the femoral head in the acetabulum.

– So there could be tires, stirrups, and a Freika pillow?

– There are a lot of designs, most of their authors or organizations that sell each specific design claim that their model is the best. To date, there is no consensus regarding which design is better. Therefore, different clinics and different schools use different products with fairly comparable results. Of course, if the diagnosis is made correctly, if treatment is started on time and if the child’s legs occupy the optimal position in this structure, the legs will not dangle, if everything is selected according to size, according to age, if all the rules are followed. That is, this is all treatment by position. Neither the cushions nor the stirrups emit any healing rays that cure hip dysplasia. For hip dysplasia, the main treatment is the correct position of the hip in relation to the pelvis.

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.

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.

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.

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!