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Flat-footedness – the change of a form of the arches of foot which is followed by loss of its shock-absorbing (spring) functions. Depending on what arch of foot is flattened allocate cross and longitudinal flat-footedness. Also distinguish the congenital and acquired flat-footedness. About 45% of all adults suffer from various forms of flat-footedness. Pathology comes to light at women more often. Flat-footedness is the reason of the pains in foot developing during walking. Often at flat-footedness on a sole callosities and natoptysh, Hallux valgus deformation are formed. Except a radiological research, diagnosis of flat-footedness includes a plantografiya and a podometriya. Treatment consists in constant carrying instep supports or orthopedic footwear, periodic passing of courses of massage, LFK and physiotherapy.

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    Flat-footedness

    Flat-footedness – the change of a form of the arches of foot which is followed by loss of its shock-absorbing (spring) functions. About 45% of all adults suffer from various forms of flat-footedness. Pathology comes to light at women more often.

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    Anatomy

    Foot keeps body weight, does not allow the person to fall during walking, plays a role of the shock-absorber and lifting mechanism. In performance of all these functions the foot arches – rigid and at the same time elastic educations which bones of foot, her ligament and a muscle enter are of great importance. Allocate two arches of foot: cross (an arch from I to the V pyastny bone which becomes visible if to take foot a hand from sides and to squeeze it in the cross direction) and longitudinal (an arch in the field of an inner edge of foot). Mission of the arches of foot – deduction of balance and protection of a body from concussions during walking.

    When weakening musculocopular structures of a muscle and a linking of foot cease to cope with high loading, foot is flattened, "settles". At the same time its shock-absorbing function decreases. Concussions during walking are transmitted to overlying departments (a backbone and joints of the lower extremities) in whom because of a constant overload degenerate changes develop (osteoarthroses, violations of a bearing, osteochondrosis).

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    Classification

    When flattening the cross arch of foot speak about cross flat-footedness, when flattening longitudinal – about longitudinal flat-footedness. In case both arches are flattened, the combined flat-footedness develops. Perhaps acquired and congenital flat-footedness. Congenital flat-footedness – the rare pathology (2-3%) caused by violation of development of foot in the pre-natal period. Congenital flat foot is usually diagnosed for children at the age of 5-6 years as at early age the arches of foot are not rather developed, and symptoms of flat-footedness come to light normal at all children. The acquired flat-footedness can arise at any age. Depending on the development reasons in traumatology and orthopedics it is subdivided on:

    • Static flat-footedness. Common form of flat-footedness (more than 80%). Weakness of bones, muscles and the copular device of foot and shin becomes the reason of development of pathology. There is a hereditary predisposition to development of flat-footedness caused by the descended weakness of sheaves. The risk of development of flat-footedness increases at increase in body weight, insufficient physical activity at people of sedentary professions, "standing work" (sellers, hairdressers, collectors on conveyors, weavers, etc.), wearing inconvenient footwear, aging. Static flat-footedness can develop also owing to constant wearing footwear on a high heel (owing to excess load of forward departments of foot).
    • Traumatic flat-footedness. Develops after a fracture of bones of foot, a calcaneal bone and anklebones.
    • Rachitic flat-footedness. Arises after rickets. Reduction of durability of bones and violation of process of formation of a skeleton of foot becomes the reason of development.
    • Paralytic flat-footedness. Develops after poliomyelitis. The cause of flat-footedness – paralysis of tibial muscles and plantar muscles of foot.
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    Cross flat-footedness

     . Hallux valgus III .  II  The share of cross flat-footedness according to various data makes from 55% to 80%. The disease usually develops at people of middle age (35-50 years). Women have cross flat-footedness 20 times more often than men.

    This type of flat-footedness is characterized by reduction of length of foot, a fanlike divergence of bones of an instep, deformation of the I finger (Hallux valgus) which in life is usually called "stone", and molotkoobrazny fingers of foot.

    The cross arch of foot formed by heads of plusnevy bones is normal, has the arch form. The main support when standing and walking lays down on heads V and I plusnevy bones. At development of flat-footedness the supporting structures of the arch of foot weaken: the plantar aponeurosis bearing the main loading on deduction of the arch, an interosseous fastion and muscles of foot.

    The support is redistributed on heads of all plusnevy bones, at the same time load of a head of the I plusnevy bone decreases, and load of heads of the II-IV plusnevy bones sharply increases. The I finger deviates knaruzh, the head of the I plusnevy bone and the I finger form a corner. In the I plusnefalangovy joint there is osteoarthrosis. There are pains, the volume of movements in a joint decreases.

    Elevated pressure of heads of plusnevy bones causes thinning of a layer of hypodermic fatty cellulose on a plantar surface of foot, causing further decrease in depreciation function of foot. On a sole in the field of heads of plusnevy bones natoptysh are formed.

    Depending on expressiveness of a corner between the I finger and the I plusnevy bone allocate the following degrees of cross flat-footedness:

    • I degree. Corner less than 20 degrees. Poorly expressed flat-footedness.
    • II degree. Corner from 20 to 35 degrees. Moderately expressed flat-footedness.
    • III degree. Corner more than 35 degrees. Sharply expressed flat-footedness.

    Symptoms of cross flat-footedness

    As a rule, patients with cross flat-footedness see a doctor concerning cosmetic defect of foot, is more rare – concerning pains during walking, natoptyshy on a sole, than rough skin growths or an inflammation in the area I of a plusnefalangovy joint (Hallux valgus).

    However, during the poll usually it becomes clear that the patient with flat-footedness for an appreciable length of time is disturbed by the burning or aching pains which are more or less expressed in foot during walking. At survey deformation of foot comes to light: flattening of its cross arch, characteristic deformation of the I plusnefalangovy joint, at the expressed flat-footedness – molotkoobrazny fingers of foot.

    Treatment of cross flat-footedness

    Conservative therapy is effective only at the I stage of flat-footedness. To the patient recommend to lose body weight, to select convenient footwear without heels, to reduce static loads of foot. Carrying special insoles and rollers is shown.

    At flat-footedness of II and III degrees surgical treatment is carried out. There is a set of techniques for correction of deformation of the I finger, however, any operation does not remove the cause of cross flat-footedness – weakness of sheaves and muscles of foot. Perhaps isolated surgical intervention (Hallux valgus resection - the acting site of a bone) and the expeditious treatment including a resection of the site of a bone in combination with plasticity of the capsule of joints and change of sinews. In the postoperative period recommend to the patient with flat-footedness constant carrying instep supports or footwear with special insoles.

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    Longitudinal flat-footedness

     This type of flat-footedness the longitudinal arch of foot is flattened. Foot is extended, spread and adjoins to a support practically all sole. The share of longitudinal flat-footedness makes from 20 to 29%. The disease develops at young patients (16-25 years) more often.

    Bones, muscles and a linking of foot and a shin are involved in process. Bones of foot move in such a way that the calcaneal bone is developed knutr, and forward departments of foot deviate knaruzh. The tension of sinews of low-tibial muscles increases, and sinews of a forward tibial muscle – decreases. The middle part of foot extends. Gait of the patient becomes clumsy, when walking he strongly parts socks in the parties.

    Allocate four stages of longitudinal flat-footedness:

    • predisease stage (prodromalny stage);
    • the alternating flat-footedness;
    • flat foot;
    • ploskovalgusny foot.

    At a stage of a predisease of the patient with flat-footedness bystry fatigue during the walking, pain in the top part of the arch of foot and muscles of a shin after long static loadings disturbs.

    In a stage of the alternating flat-footedness of pain appear not only by the end of the working day, but also after long standing or long walking. Tension of muscles of a shin comes to light, their temporary contractures sometimes develop. The longitudinal arch of foot has a normal form in the mornings, however by the evening becomes flattened. Apply special techniques (a podometriya, a plantografiya, a X-ray analysis) to assessment of expressiveness of flat-footedness.

    During development of flat foot of pain appear even after small static loadings. Foot extends and flattened, height of its arch decreases. Gradually gait begins to change.

    Allocate three degrees of flat foot:

    • I degree. The stage began formations. Foot arch height less than 35 mm;
    • II degree. Height of the arch is 25-17 mm. In joints of foot osteoarthrosis begins to develop;
    • III degree. Height of the arch is less than 17 mm. Forward departments of foot are developed and spread. The deviation of the I finger of a knaruzha comes to light. At the same time pains in foot on temporarily decrease.

    In the absence of treatment ploskovalgusny foot at which pains develop at the slightest static loading develops further. Valgusny deformation (a sharp turn of foot the plantar party of a knutra) and the expressed flattening of the arch of foot comes to light.

    Treatment of longitudinal flat-footedness

    In a predisease stage to the patient recommend to develop the correct gait (without cultivation of socks), to go barefoot on sand or an uneven surface and to regularly unload foot arch muscles, during standing periodically transferring load of external surfaces of feet. To the patient with flat-footedness appoint LFK, massage and physiotreatment: magnetotherapy, SMT, hydromassage, etc.

    The recommendation to change working conditions for reduction of static load of feet is added to stages of the alternating flat-footedness to the listed actions. At flat foot to a complex of therapeutic actions orthopedists appoint wearing orthopedic footwear and special insoles. At further progressing of flat-footedness expeditious treatment is shown. In a stage of ploskovalgusny foot conservative techniques are ineffective. Various plastic surgeries are performed: resection of sites of bones, change of sinews, etc.

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    Flat-footedness - treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!

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