Development of the foot in a child. Formation of a children's foot - an orthopedist answers questions

X-shaped legs or wheeled legs, although not as common, can be seen in some children under the age of 2-3 years. In any case, it is clear that this is not the norm. Some of the parents take this calmly, thinking that this is temporary and will fix itself, someone immediately sounds the alarm.

To understand how serious the problem is, you need to understand its nature and causes of occurrence, as well as find out what consequences it is fraught with. After that, it is already possible to decide whether it is worth exposing the child to any procedures and additional loads, or, indeed, there is nothing wrong with crooked legs and over time they will straighten naturally.

This is the scientific name for the deformation of the knee joint, as a result of which the legs of a child of 2 years old do not become straight and even, but acquire the shape of the letter X. Any mother can independently diagnose such a pathology. It is enough to put the baby straight and connecting the heels.

If there are no deviations, then the legs will touch each other at three points: at the knees, mid-calf and ankles. With hallux valgus, the child will not be able to connect the ankles - there will be a gap of 4-5 cm (or even more) between them, while the knees will be tightly closed. If the baby still manages to put the ankles together, then his knees will go behind each other.

Why does this disease appear?

There may be several reasons:

• rickets;
• congenital deformity of the pelvic ring;
• flat feet;
• past trauma;
• infections;
• inflammatory process;
• too early attempts of the baby to move in an upright position.

Rickets is the most common cause of curvature of the legs (and any) in children of the first years of life. It is caused by a lack of vitamin D in the body, so do not think that this disease is a thing of the past. Today it is just as relevant, especially in the autumn-winter period.

The fact is that we get vitamin D directly from sunlight. And if a child is born in autumn or winter, it is not surprising that he is deprived of the most valuable substance. With a lack of vitamin D, the bones become soft and the knee joints are deformed.

Children who tend to get up and walk on their own too early are at risk of forming x-shaped legs. In this case, the rule “the sooner the better” is inappropriate. There is a time for everything, and when the baby starts walking too early (even in a walker), the fragile legs become deformed. If at the same time the child is overweight, the problem is exacerbated.

It is widely believed that curvature of the legs is a purely hereditary disease and therefore not treatable. Yes, with a hereditary predisposition, it is very difficult to correct the curvature of the legs and most often it is possible only by surgery. But such a cause is rare, and most cases still do not have a hereditary factor.

The various diseases listed in the list are also individual and single. These are the least likely causes of curvature of the legs in children.

Consequences

Not all parents are wondering what complications the x-shaped legs of a child are fraught with. And if it is also a boy, many believe that, unlike a girl, beauty is not necessary for him. However, if you look, the matter turns out to be much more serious than an unaesthetic appearance.

With hallux valgus, the load is incorrectly distributed to all joints of the lower extremities. This leads to the occurrence of flat-valgus deformity of the feet, when the correct setting of the foot is also violated. In the future - curvature of the spine and other diseases of the musculoskeletal system.

Moreover, pain in the legs will make itself felt not in old age, but much earlier - already in senior school age. Therefore, the question of whether any action should be taken becomes irrelevant. We need it, and as soon as possible!

Early age is a definite advantage. The younger the child, the easier it will be to correct the situation. While the body is only being formed, it is easier to help it.

An adult person has to rely only on surgical intervention. Surgery is rarely prescribed for children, in those extreme cases when complex treatment does not work and when the child has reached the age of 7 years.

How to straighten your legs

You can fix the situation, but you will have to make an effort. The timing of treatment plays an important role. As we have said, if you deal with the problem before 3 years, when the child’s bones are just being formed, the chances of success are greatest. 7 years is the last age when you can still bring the legs back to normal by conservative methods.

Treatment for hallux valgus should be comprehensive and versatile. Parents first of all need to contact a doctor who will give a referral for an examination. Based on the results of the tests, the doctor prescribes a solution of vitamin D (water or oil). When the disease is already developing, an increased dosage is prescribed.

In addition to the drug taken orally, plaster casts on the knee joints are used up to 2.5-3 years. The essence of this method is to reduce the load on the bones, which will grow faster, and gradually the legs will align. In the case of using plaster casts, you should tune in to the duration of treatment - at least 1.5-2 years.

A good aid is orthopedic shoes. It clearly fixes the foot and ankle joint, thus ensuring the correct position of the foot.

An appointment for massage and physiotherapy is necessarily made, recommendations are given on special physical exercises and diet, as well as advice on what parents can additionally do at home. After all, in order to fight the disease, you even have to change your lifestyle.

Massotherapy

It is recommended to take it for 4 or more courses a year and trust only a specialist, since we are talking about treatment, not prevention. However, there are techniques that parents can learn on their own and do in addition to therapeutic massage.

The main task is to strengthen the muscles of the thighs and lower legs from the inside, and relax the muscles from the outside. In addition, you also need to work on the muscles of the back, lower back and buttocks.

The first sessions should last 15-20 minutes. Gradually, the duration can be increased to 30 minutes, but no more.

The main technique is stroking:

• lower back - from the spine to the sides and down;
• buttocks - in a circular motion;
• the back of the thighs - from the popliteal fossa outward and upward;
• back surface of the lower leg - from the ankle joint to the popliteal fossa;
• patella - round;
• anterior lateral surface of the lower leg - from the feet to the knees;
• stop - on the back side from the fingers to the ankle joint.

Light pats, kneading, rubbing, tingling are also allowed.

Gymnastics

It is desirable to perform exercises after the massage, but if you return to them several times during the day, the benefits will be obvious. Exercises will help to correct the irregular shape of the child's legs, in which the load on the outer edge of the foot increases, and on the knee and ankle joints it decreases.

So that the baby does not refuse therapeutic exercises, you can interest him by turning classes into a game:

1. "Turkish Sultan" This is an ordinary “lotus” pose or its simplified version - spreading the knees and connecting the feet.
2. "Crow's feet". Simultaneous or alternate flexion and extension of the ankle joints.
3. "Bike". A well-known exercise when, lying on your back, you need to rotate your legs, simulating cycling.
4. "Clumsy Bear". Walk, waddling, with a preponderance on the outer side of the feet.
5. "Monkey". With the help of the toes, you need to grab some objects. If you perform the exercise while sitting on the floor, you can do grabs with two feet.
6. "Heron". Tiptoe walking.
7. "Circus Acrobat" You need to walk straight along a narrow path, a curb or just a drawn line. The main thing is that at the same time the child puts his feet as close to each other as possible.
8. "Horse". If the child does not have a toy horse on which he can ride and swing, you can imitate riding, for example, on an adult's knee.

Even if you devote a little time to the exercises, in combination with other types of treatment, they will give a good result. And the game moment will give the child a lot of pleasure and make you want to return to fun activities again and again.

Physiotherapy

Electrical stimulation is prescribed when valgus deformity of the knee joints is complicated by planovalgus deformity of the feet. Electrical impulses of different durations stimulate the motor activity of the muscles and improve blood circulation in the lower extremities. Muscle contraction alternates with small pauses during which the muscles relax.

This type of treatment is contraindicated if the child has open wounds or colds.

Proper nutrition

It should be noted that the child's diet should be given great attention in any case, since nutrition is the basis of health. If the curvature of the legs is already observed, then it is necessary to draw up a special diet.

The most important elements for proper bone formation are calcium and phosphorus. It is their lack that leads to deformation of bones and joints.

Calcium is found in all natural dairy products, eggs and fish. Phosphorus - in meat food, milk, nuts and legumes. And vitamin D, about which we have already written so much above, just helps to assimilate these two beneficial substances.

It is necessary to ensure that the baby's diet is enriched with calcium and phosphorus. All of the listed products should be present in the children's menu every day. And so that the child does not get bored with monotonous food, you can make many variations. For example, add honey, berries or dried fruits to kefir and cottage cheese, and for hot fish and meat dishes, take turns using different cooking methods (stewing, baking, steaming, boiling).

Prevention

Experts say that up to 2 years, a slight curvature of the legs is observed in many children and is not a pathology. However, even if the child's legs are even, it's a good idea to think about prevention, which at the same time will strengthen the whole body.

In addition to a balanced diet, it is necessary to ensure that the weight of the baby is normal. Extra pounds can cause not only problems with the musculoskeletal system, but also have a bad effect on overall development.

When a child begins to walk, you need to take care of good shoes. The heel should be high and sufficiently rigid, fixing the foot, a slight elevation is required on the insole to prevent flat feet.

It will not be useful for a child to stand motionless for a long time, especially with legs wide apart. But to move actively - on the contrary. Wall bars, running, jumping, cycling and especially swimming are the only sports that harmoniously develop all muscle groups and normalize the work of all internal organs.

It is better to beware of skates, roller skates and jumping on trampolines and other soft surfaces. Such types of physical activity are not very useful. But you can walk barefoot on grass, pebbles, a massage mat and any other uneven surface as much as you like.

And of course, sunbathing is good for saturating the body with vitamin D. Starting from 15 minutes a day and gradually increasing the time, avoiding drafts and overheating, in the spring you can accustom your child to the sun. Such prevention will be not only useful for physiology, but also guarantees the baby a lot of positive emotions.

Parents perceive the first steps of a child as a very joyful family event. But it can be overshadowed by the identification of such an orthopedic pathology as valgus deformity of the feet. This disturbance usually becomes apparent just in time for the start of walking and after some time. Yevgeny Komarovsky, a well-known pediatrician and author of books on children's health, tells about the causes of the problem and what to do in this situation.

About the disease

Valgus in medicine is such a deformity of the feet, in which they are in a cruciform position with respect to each other, reminiscent of the Latin X. Most often, the pathology becomes noticeable when the child tries to step on the legs and take the first steps - the pathology is expressed in the fact that when walking, the baby rests on the inside of the foot.

It is extremely difficult for such a baby to take steps - he quickly gets tired, sometimes he experiences pain, the steps themselves are shaky and uncertain. Orthopedists describe this condition in terms of the processes occurring in the feet - the toes and heels are turned outward, the middle part of the foot is somewhat lowered. If the legs are straightened and pressed against each other in the knee region, the distance between the bones of the ankles will be more than 3-4 centimeters. If at the same time the height of the arch of the foot is significantly reduced, then orthopedists will already say that the child has flat-valgus feet. Valgus flatfoot is considered the most common diagnosis in pediatric orthopedics.

This curvature of the feet, there are two types: congenital and physiological (acquired). In the first case, the legs are bent even during the period of intrauterine development of the fetus under the influence of certain factors that medicine does not yet know much about. Congenital pathologies of the foot are usually quite severe, and it is possible to see them in the first 2-3 months of the child's independent life.

Acquired deformity is often associated with errors in the development and functioning of the musculoskeletal system, ligaments, tendons. It is these violations that become apparent closer to the age of one. At risk are crumbs with weakened muscles, premature babies suffering from rickets, who have had frequent and severe viral infections in the first year of life. The legs are at risk of bending in obese children, since the load on the lower limbs with excess weight is very significant.

Sometimes parents themselves are to blame for the occurrence of pathology. So, too early setting the baby on his feet may well “start” the mechanism of foot deformity, and insufficient load on the foot, walking exclusively on a flat floor can cause acquired flat feet or flat-valgus foot.

Flat feet scare parents no less. However, Komarovsky advises not to panic, because absolutely all children have flat feet from birth, this is a feature of babies. The arch of the foot will form gradually, as the load on the legs grows, and everything is in the hands of the parents, with the exception of congenital flat feet, which can only be corrected surgically.

Degrees of pathology

There are four main degrees of valgus disease according to the severity of the defect and the severity of the course:

• First degree. The angle of deviation from the norm does not exceed 15 degrees. Pathology lends itself well to correction by conservative methods.
• Second degree. Deviation angle - no more than 20 degrees. This condition is also successfully treated with exercises, massage and physiotherapy.
• Third degree. Deviation angle - no more than 30 degrees. The pathology is difficult to correct, the treatment is long, but with due patience and perseverance on the part of parents and doctors, the prognosis is very favorable.
• Fourth degree. The angle of deviation from normal values ​​is more than 30 degrees. With the ineffectiveness of conservative treatment, a surgical operation is prescribed.

Flat feet also have several degrees, which are similarly classified according to the degree of deviation of the arch of the foot from the norm. As in the case of hallux valgus, the first and second degrees of ordinary flat feet are treated quite simply and quickly enough. The third and fourth will be more difficult.

Diagnostics

The diagnosis is made by an orthopedic doctor. This is done on the basis of a visual examination and additional studies assigned, which include radiography of the feet, computer plantography, podometry. If such studies are not prescribed, and the doctor makes an appropriate diagnosis for you, you should consult another doctor. Quite often, small patients with confirmed valgus pathology are advised to visit a neurologist to rule out problems with the peripheral and central nervous systems.

As soon as the causes that underlie the modification of the feet are identified, the doctor will establish the type of lesion by etiology:

• Static deformation. Such a problem is detected if incorrect posture is involved in the curvature.
• Structural deformation. Curvature of the feet, which has congenital causes. As a rule, the talus with such a deformity is located incorrectly with a deviation in one direction or another.
• compensatory deformation. If a child has a shortened Achilles tendon, beveled legs, the foot will deform functionally when walking.
• corrective deformation. Such a curvature occurs if the child was treated completely incorrectly or was not treated at all with the usual clubfoot.
• Spastic nerve deformity. The reason for this curvature is the malfunctioning of the cerebral cortex, which often results in spasms of the limbs.
• paralytic deformity. Usually it is a consequence of encephalitis transferred at an early age or complicated poliomyelitis.
• Rachitic deformity. Occurs with rickets.
• Consequences of trauma. Ligament ruptures, fractures of the bones of the foot, ankle, injuries of the hip and hip joint can lead to pathology.

When diagnosing flat feet, the same techniques and research methods are used.

Treatment

Finally, the child's foot is formed only by the age of 12, so many problems found by specialists and the parents themselves at a more tender age can and should be corrected right up to this moment, says Dr. Komarovsky.

Usually, the treatment of both flat feet and valgus curvature is aimed at strengthening the ligamentous apparatus, the muscles of the foot, and forming an arch. For this, foot baths, therapeutic massage, magnetotherapy, electrophoresis, swimming, and physiotherapy exercises are prescribed. In case of congenital pathology, the lower limbs are immobilized with the help of plaster. In the absence of the desired effect of all these measures, the child may be recommended surgical intervention.

If the defect is not treated and corrected, in the case of severe deformity, the child is threatened with subsequent disability, since the increased load on the knee and hip joints causes deformation and destruction of them, which leads to irreversible changes in the functions of the musculoskeletal system.

Forecasts

The sooner the pathology is detected, the easier it will be to correct it. Medical statistics show that valgus curvature of the feet and legs, detected at the age of one and a little older with appropriate therapy, has very favorable prognosis - the probability of eliminating the problem completely and permanently approaches one hundred percent.

If the disease is detected late or the child has not been provided with the necessary medical care for a number of reasons and the disease is advanced, in adolescence, the likelihood of developing problems with the spine is very high. The more time has passed since the onset of the curvature before the start of treatment, the less likely it is for a complete successful recovery.

Shoes

Quite often, parents tend to blame themselves for problems with the child's foot. Moms feel guilty that they may have chosen the wrong shoes for their child, which caused a violation of the anatomy of the foot . Evgeny Komarovsky reassures parents - the deformation of the legs does not in any way depend on shoes. Since a person initially appeared in the next world without shoes, it is not so necessary for him from a biological and physiological point of view.

However, with the help of special, orthopedic shoes, some pathological changes in the foot can be corrected. Although Komarovsky does not recommend relying entirely on the healing properties of expensive orthopedic shoes. They can have an auxiliary effect, but they need to be treated in other ways, and prevented through an active lifestyle, walking barefoot on uneven surfaces, running and jumping. The more active the child, the less likely the acquired curvature of the feet or flat feet.

Most parents are interested in when it is possible to start putting on shoes for a child. Komarovsky says that there is no point in doing this immediately after the first steps. Let the baby walk barefoot as long as possible - around the house, on the street, if possible. Naturally, in kindergarten or for a walk in the park, you need to put on a child.

With severe valgus symptoms, it is often recommended to buy insoles with insoles that prevent the foot from “falling” inward. These shoes usually have hard sidewalls that fix the foot in the correct position, a solid heel lock. Most often, such shoes have to be made to order, taking into account the degree of deviation from the norm, which is measured and described by the orthopedist.

You should not buy orthopedic shoes for a baby just like that, for prevention, just because it seemed to the mother that the legs of the crumbs were not located in the right way.

When choosing ordinary casual shoes, Komarovsky advises to follow the basic rules:

• Shoes should be in size, not small and not large, the child should be comfortable and comfortable.
• Buying shoes "for growth" does not make sense, since the geometry of the foot changes during the growth of the leg.
• It is desirable that the shoes are not sewn from synthetic materials, the leg should "breathe".
• Pointed toes and heels are not allowed in children's shoes.

How can children's foot development be promoted?

infant

The joints of a very young child are still very soft. Of course, many have had to watch how an infant, without any effort, puts the fingers of his lower limb into his mouth. Try to do something like this at an older age! It will not work: not only because the more proportional and longer lower limbs make such an action difficult, but also because their mobility is lost over time.

Soft and tender joints do not interfere with a small child at all, he instinctively trains his mobility, which is why babies jerk and dangle their legs so nimbly. The infant should be given the opportunity to satisfy his need for movement in order to strengthen the muscles. It is impossible to constrain his movements due to tight swaddling, since the optimal position of the hip joints of an infant is their elevated position: bent knees and divorced hips - a position instinctively correctly preferred by the infant himself.

It is necessary to give the child the opportunity to move more! Thus, it will be possible to prevent the occurrence of pain in his legs in the future.

The little man does not load his joints yet. And they cannot be forced to load until the child himself decides for the first time to sit down, stand up or walk. Each premature load damages the still fragile soft tissues of the joints and bones. They are deformed and bent, thus there is a curvature of the lower extremities in the form of the letter "o" and "x". An impatient mother can inadvertently harm her child's health for life if she begins to sit or stand too early.

Also, the children's spine is often damaged due to too early static load, for example, due to giving the child a specific position in the so-called "kenguryatnik". A child whose back muscles have not yet grown stronger in order to carry and support their own weight should lie down until he himself can use his muscles to hold his head and a straight back, that is, until he sits on his own and can not sit without support, otherwise, already at this age, the cornerstone of later diseases of the spine and vertebral discs will be laid. The reference to such customs among uncivilized peoples is not justified, since the later workload at school and work in our civilized society cannot be compared with the living conditions of these peoples.

young child

So, he is already striving and trying, still clumsily and uncertainly, to take his first steps. With enthusiasm and diligence, a young mother buys her child "lovely, hard shoes" that will, she thinks, "provide her baby with better stability." And thus she lays the second cornerstone in the future possible deformation of her child's foot. As soon as the baby begins to train his muscles by jerking and dangling legs, he immediately learns to keep balance, trains muscle coherence and the ability to transfer stress on the joints.

It is enough to look once at a one-year-old child who has had his shoes taken off when he is playing and does not notice that he is being watched. In this case, you can see how even sitting he moves his legs up and down, stretches and bends them. The tiny fingers also wiggle, contract, and rotate. If he then runs, none of his movements will repeat the previous one. He walks on the balls of his fingers, dances, tries to get up on tiptoe, on the very toes, in order to immediately squat down again or dangle his legs. This is a long gymnastics for the lower extremities. Tissue blood supply and growth are constantly stimulated in this way. Mobility, not limited by anything, trains. Muscles with such training receive excellent nutrition.

But as soon as the child puts on hard shoes, with soles that he still cannot bend because of his too small weight, his leg seems to be squeezed by a plaster bandage or a splint. With bent knees, hips, and immobile ankle joints, the little creature begins to mince helplessly. All the grace and plasticity of dance steps are replaced by heavy clumsy waddle. As soon as the muscles of the foot are deprived of freedom of movement, mobility as a whole is immediately limited.

The consequence of this is not only incomplete muscle development, but also the loss of most of the muscle strength. Articular ligaments and tendons can no longer support the joint with the same force, since this function is performed by the boot. Thus, they detrain and weaken. That which does not train, begins to wither! This is a very old observation. Thus, one can observe exactly what is called a child's weakened foot: the arch of the foot, which should be supported by strong muscles, drops. Normal, healthy ankle and knee joints can only be maintained by elastic strong muscles and strong tendons and ligaments in a straight state. When the foot is weak, the articular ligaments weaken, the ankle joint loses its balance, and external clubfoot develops, in which the ankles move inward and the knee warps, in most cases, forming an X-shaped lower limb.

The development of foot weakness is quite common. It can be overcome by giving the legs of young children full freedom of movement, and such a violation can be corrected in a natural way. The best way to train the leg is on an uneven surface with natural vegetation, for example, in a meadow, in a forest and in a field or on the shore of a reservoir. If this is not possible, the child is happy to train in the apartment, in the yard and on the street, strengthening the muscles of the lower extremities during outdoor games, of which those that provide freedom of movement are most preferable. If weather and hygienic conditions allow, the child should wear shoes that do not restrict the roll of the foot, that is, with very soft soles, and the toes of the lower extremities should be able to move freely inside the shoe.

So, whenever possible, children should be allowed to walk barefoot!

If a child with flat feet and external clubfoot rises on his toes, the deformity of the foot does not progress. If he does this during the game 100 times during the first half of the day, preferably arbitrarily, after a few months you can see the restoration of a normal arch of the foot. This is best done if his favorite toys are placed or hung up high.

Against the X-shaped position of the lower extremities in the knee joints, for prevention during games, you can put the child in the tailor's position (or "in Turkish", with crossed legs). The back should be straight.

Suitable shoes are knitted sock slippers with soles made of very soft leather. You can also sew soles cut from soft glove leather onto ordinary woolen socks. By the way, socks with rubber "bumps" on the sole, resistant to abrasion, are the best option. In summer, there is nothing better than sandals, because they have an easily bendable sole. In them, the movement of the fingers and the rolling movement (rolling the foot from heel to toe) is minimally limited. But even shoes for bad weather should have a flexible sole and a wide toe in which the toes are free to move. The health of the feet is so precious that you should not sacrifice the health of your children for the sake of fashion.

Just look at the normal shape of a child's lower limb and toes and match it with the shape of the shoe! Squeezing the toes of the lower extremities with tight shoes leads to the fact that the muscles of the arch of the foot weaken. A young child who wears narrow-toed shoes will already have a flat transverse arch foot at a very young age, and "bumps" at the base of the big toes of the lower extremities in middle age. If a young girl also walks in high heels, her knee and hip joints will begin to deform when walking. Finally, a concave loin (literally: a hollow sacrum) is formed on the back, with all the ensuing harmful effects on the intervertebral discs and abdominal organs.

School children

As the child grows older, it will become less and less possible for him to walk around barefoot. Now he can, however, systematically train the muscles of the foot through gymnastic exercises. Also in childhood and adolescence, it is necessary to train the entire muscular system as a whole, performing jumps and jumps, exercising, as well as hiking and swimming. Children must necessarily spend most of their free time playing outdoor games and balls.

It is completely different to behave if, due to a weakened foot, an incorrect position of the joints has already developed. This requires the intervention of a physician. It can be limited to correcting the foot with the help of special arch supports for flat feet. Sometimes, in severe cases, even surgery may be required. The arch support only supports the foot. It cannot cure flat feet, but it can eliminate the harmful effects on the joints by balancing the distribution of stress on them.

It is at a young age that only barefoot walking and gymnastics can have a therapeutic effect.

WHAT IS ORTHOPEDICS

Orthopedics is a medical discipline that studies the prevention, recognition and treatment of diseases, deformities and consequences of damage to the human musculoskeletal system.

Orthopedics has deep roots. There is no doubt that even before our era, the treatment of dislocations of the joints, bone fractures and congenital deformities of the skeleton was carried out. The date of birth of orthopedics as a science is considered to be 1741, when the French physician Nicolas Andry (1658-1742) published his two-volume work under this title. Translated from Greek, orthos means straight, paedos means child, and orthopedics is characterized by the author as "... the art of preventing and treating body deformities in children", and the child's parents should play the main role in this. It is for this purpose that a variety of simple and fairly effective methods of non-surgical treatment, available to everyone, have been proposed. Later on they
improved, improved and formed the foundation on which modern pediatric orthopedics stands.

Despite the fact that at present, orthopedics and traumatology are combined into one specialty of the surgical profile, prevention, detection and bloodless treatment of deformities are the main tasks of a pediatric orthopedist.

Symbol of orthopedics from the book by N. Andry

The symbol of this medical discipline is a tied up twisted tree. Such a simple measure allows the tree to improve over time.

In childhood, a similar approach is used. The basis of treatment is the natural growth and development of the child, it is only necessary to create conditions for the correct formation of his musculoskeletal system and make the necessary adjustments to this process in a timely manner. They say about a boy: “Slender as a cypress”, about a girl: “Slender as a birch”. A crooked tree is usually pitiful, as is a crooked child. I would like to straighten it, and it is easier to do this while the child is small and the formation of his skeleton has not been completed.

The child must be built even after his birth. The growth and development of the child is stimulated by the love of parents, good nutrition, exercise and adequate sleep.

Orthopedic pathology in children is divided into two approximately equal groups in number. One is congenital skeletal deformities and hereditary diseases leading to systemic disorders, the other is an acquired pathology. In addition, deviations from normal development may be the result of a combination of individual characteristics that parents pass on to the child. These include the constitution, tissue structure, metabolism, etc. For example, a child is born with a large weight and height, which in itself is not a pathology, but in combination with a certain shape of the lower extremities, the overweight factor can lead to foot deformity at the stage of standing up baby on his feet and start walking.

Groups of orthopedic pathology in children

It is possible to identify and eliminate emerging disorders of the musculoskeletal system in a timely manner. To do this, it is necessary to know the main features of the normal anatomical structure of the child's skeleton, trends and key age periods of its formation.
Severe congenital deformities are more often detected immediately after birth, but often they appear later, in the process of growth. Already in the first weeks of a child's life, acquired deviations of the musculoskeletal system are possible: the consequences of birth trauma, inflammatory diseases, altered metabolism and dysfunction of internal organs. Therefore, it is very useful for the child to be examined by an orthopedic doctor at the age of one month. By this time, parents should have a certain impression about the musculoskeletal sphere of the baby. They will share their observations with the doctor at the first visit, which will help to identify the pathology and determine the correct tactics for its elimination. In cases where violations that are obvious to parents appear earlier, you should immediately contact a pediatrician or specialist.

CHILD IN THE FIRST MONTH OF LIFE

The structure of the upper part of the femur

A newborn baby is characterized by tenderness, slight vulnerability and high sensitivity of the skin. His muscles are underdeveloped. Bones are represented mainly by cartilaginous tissue, although there is already a "pro-Newborn 6 years 10 years _
image of a skeleton" - its reduced exact model. Ossification or replacement of cartilage tissue with bone takes a long time, gradually. For each bone, nature determines certain age limits.

In some cases, these data are used to determine the final maturation, the biological age of the child.

Children have their own proportions of the skeleton. A child of the first weeks of life has a relatively large head, a long torso and short limbs. Unbent and pressed to the body, the arms reach only the upper third of the thighs with the fingers. The middle point of the body is located in the navel. These ratios will gradually change in the process of growth and development. Over the entire period of growth of the child, the height of his head doubles, the torso - three times, the length of the arms - four, and the length of the legs - five times.

The arms and legs of the newborn are bent, due to the increased tone of the flexor muscles, their intrauterine position is maintained. The spine is almost straight, no bends or lateral deviations are yet observed. A child of this age is characterized by a symmetrical build, which is important to consider when identifying pathological disorders. This refers to the size, shape of individual parts of the body and their position, to skin folds and soft tissues in general.

The shape of the legs of a healthy child of the first year is not quite straight, but O-shaped with a slight curvature at the top at the level of the knee joints, and this is already noted in the first weeks. The feet are slightly "clubbed", facing the plantar surfaces to each other, but they are easily "brought out" and set in the middle correct position. The shape of the feet themselves does not differ from that of an adult, however, the child does not have the lift characteristic of adults.

The shape of the legs of a child of the first year of life

The newborn does not hold his head on his own, and it is uncomfortable for him to lie on his stomach due to bent legs. The baby's head is relatively heavy, and the torso is not a worthy counterweight, so the baby cannot lift its head yet. The muscles of the neck are weak, which makes it difficult to actively move in the cervical region. Nevertheless, parents The shape of the child's legs need to have an idea of ​​​​what the usual position of the first year of life is the head of the newborn, whether the mobility of his neck is impaired. To do this, pay attention to the distance between the auricles and shoulder girdle on both sides - both in front and behind. They should be the same, which indicates the absence of a lateral tilt of the head and neck. The constant inclined position of the head is called torticollis.

Right torticollis

A healthy newborn baby does not have a pronounced tilting of the head back, as happens after a trauma to the cervical spine during childbirth. On the contrary, the normal head is slightly tilted forward, so the neck seems short. The height of the neck is considered normal if it corresponds to the width of the child's palm. They check it this way: slightly raise the child's chin and put his palm across the neck.

Movements in the cervical region are usually free and do not cause concern to the baby. Such movements include: bending or tilting the head forward when the chin touches the chest; extension, when the back of the head is in contact with the back; lateral tilts to the right and left with the ear reaching the shoulder of the same name; turns to the right and left to the line connecting the shoulders. The child performs these movements easily. Rotational movements in children of the first year, as a rule, are not determined. Movements can be assessed while caring for the baby: when feeding, laying on one side and the other, while bathing, etc.

Despite the fact that the child's arms and legs are in a bent state, mobility in the main joints can be easily determined by the hands of the parents. In this case, we are talking about passive movements.

A person performs active movements in the joints himself. Passive movements are performed with outside help.

The strongest in the first weeks of life are the flexors of the hip joints, then - the knee, somewhat weaker - the adductor muscles. Therefore, passively in a child, to a greater extent, almost up to 180 degrees, it is possible to spread bent legs than to straighten them. By the end of the first month of life, the ratio between the strength of individual muscle groups is gradually changing, the tone of the flexors is weakening. Active movements are usually symmetrical: the baby moves both arms and legs equally.

If you notice that the child's muscles are very weak, there is a forced and unusual position of the limbs, impaired mobility in the joints and the child is worried, you should consult a doctor. Mobility disorders in the hip joints, especially dilution, as well as any clicks in this case, can be a sign of a violation of the structure of the hip joints from the mildest - dysplasia, to severe - congenital dislocation
Restriction of hip abduction. It is necessary to pay special attention to this, the right hip is currently the most common orthopedic pathology. In girls, it is observed 5-7 times more often than in boys.

Right hip abduction restriction

Hip dysplasia is a developmental disorder. Almost always, the development of the fetus and the birth of a child in the breech (foot, pelvic) presentation lead to the fact that the newborn's hip joints are not well formed. This is not accompanied by any pain or anxiety, so it is not always easy and quickly determined.

The formation of any joints can be disturbed even after birth, for example, with rickets, endocrine disorders, and hereditary systemic diseases. The hip joints after birth are formed under the influence of active movements.

Limitation of movements is often due not only to changes in the osteochondral elements of the joint, but also to the high tone of individual muscle groups due to neurological disorders. This applies to both the upper and lower limbs.

The musculoskeletal system of a newborn develops in parallel with the formation of the nervous system and with general physical development, an important criterion for which is the weight-to-height ratio.

In the first month of life, the main task of parents is not only proper breastfeeding, hygienic care of the skin and navel, but also the creation of conditions for the development of the musculoskeletal system.

Motor activity is an indispensable condition for the growth of the child, the normal formation of joints and ossification of the skeleton.

It is necessary to lay the baby alternately on each side. The pillow under the head is used very flat, it should lift the neck only to a horizontal position. The legs should be swaddled widely and freely so that they occupy the breeding position and are not constrained in movements.

Already in the first month of life with a child, it is necessary to engage in physical therapy, which consists in daily simple, smooth, natural movements of the arms and legs.
An orthopedic doctor examines a healthy child at 3 months, 6 months and 1 year.

First examination by an orthopedic doctor

At the age of one month of a child's life, it is necessary to show an orthopedic doctor. The doctor evaluates the development of the baby, compliance with his age, determines the correctness, proportionality, symmetry of his physique. At the same time, the range of motion in all joints is checked. Signs of congenital or acquired disorders of the musculoskeletal system, not previously noted by doctors and parents, are revealed.
What can an orthopedic surgeon reveal?

Child Development Disorders

Torticollis

There are various forms of torticollis - a persistent tilted position of the child's head.

Neurogenic torticollis

Currently, the so-called neurogenic torticollis is observed more often than others. It is a consequence of various disorders of the central nervous system and changes in muscle tone. In such cases, not only the muscles of the neck suffer, but other general functional disorders also occur. As a rule, the behavior of the child changes. He can be lethargic, inactive, with low muscle tone, or, conversely, noisy, restless, constrained in movements. In addition to general manifestations, various disorders of the trunk, limbs and feet are observed. Neurogenic torticollis at this age is not accompanied by impaired passive mobility in the cervical region, but the tone of the neck muscles is asymmetric, which is determined by their palpation. Such children are observed by a neuropathologist, and in most cases, treatment is successfully completed in the first year of life: torticollis disappears along with neurological disorders.

In such children, another pathology of an orthopedic nature is often detected. Disorders of the musculoskeletal system in them may appear in the process of further growth: in the form of changes in gait, posture disorders, joint function, and position of the feet.

All children with disorders of the central nervous system should be observed by an orthopedic doctor for a long time.

Injury to the cervical spine of a child at birth is so common today that in some maternity hospitals, all newborns wear fixation collars. This is not entirely correct, since even a good collar prevents children from sucking, swallowing, breathing and should only be used when really needed. In difficult childbirth, small displacements of the cervical vertebrae in the newborn sometimes occur. In such cases, a picture of neurogenic torticollis develops in combination with impaired mobility in the cervical region. The child is worried when changing the position of the head, throws the head back and thereby reduces the tension of the vertebral ligaments and spinal cord. The neck muscles tense up and protect the neck from further tilting. There is always a danger of damage or compression of the cervical spinal cord, which contains the nerve pathways to the arms and legs.
Only on the basis of external data and the behavior of the child it is impossible to reliably judge the nature of the existing injuries. In such cases, fixation of the neck with a collar and an ultrasound examination of the cervical spine, brain are indicated, and some children are prescribed an X-ray examination of the neck and dopplerography of the cerebral vessels, which shows an objective picture of the blood supply to the brain and spinal cord.

Any bone-traumatic changes in the cervical spine must be confirmed by additional objective research methods.

In case of a neck injury with obvious neurological manifestations, not to mention traumatic displacements of the vertebrae, fixation of the cervical region with a collar is absolutely necessary and is carried out during the first months in combination with neurological treatment. During this time, the ratio of bone structures in the cervical region gradually stabilizes, and neurological disorders disappear.

Congenital muscular torticollis

Congenital muscular torticollis can also be the result of a traumatic effect on the baby's neck during childbirth. In such cases, its initial signs appear in the second week of life. Much less often, a child is born with such a deformation, that is, torticollis is formed in the prenatal period. Then it is more pronounced and manifests itself already in the hospital.

Congenital muscular torticollis is the result of changes in the largest and working muscle of the lateral surface of the neck. It is called the sternocleidomastoid, and we will designate it sternocleidomastoid, since it is involved in the lateral tilt and rotation of the human head.

Location of the sternocleidomastoid muscle on the neck

Violation of the processes of blood supply in the muscle leads to a specific reaction, which manifests itself in the form of a tumor-like thickening ranging in size from a pea to a walnut. This formation is painless and does not bother the baby, it can be determined both during examination and when feeling the neck. Up to 2-3 months of life, a "muscle tumor" can increase in size, and then gradually disappears. The sternocleidomastoid muscle itself shortens, loses its elastic properties and turns into a dense cord. The latter is not the location of the sternocleidomastoid and only leads to a tilt of the head in the direction of muscle change on the neck of the muscle and a turn in the opposite direction, but also impairs mobility in the cervical region: the tilt of the head to the healthy side and turn to the sick side are limited.

The inclined position of the head in young children often leads to an increase in skin folds in the neck and the appearance of diaper rash in them. In cases where the tumor-like formation in the muscle is large, then, on the contrary, there are fewer skin folds on the side of the slope. Sometimes there is some retraction between the thickened sternocleidomastoid muscle and the angle of the lower jaw. In order to examine the entire neck well and see the main violations, you need to put the child on his back, slightly raise his shoulders, placing his hand under them, and turn the child’s head first in one direction, then in the other.

All newborns need to carry out a thorough comparative palpation of the sternocleidomastoid muscles.

If a child has torticollis from birth, then by the month he develops a typical asymmetry of the face: its height on the side of the inclination decreases, and the sloping of the occiput indicates a habitual turn of the head. In young children, the main part of the face is the cheeks, and therefore it is on them that asymmetry is determined. This component of torticollis is of particular concern to parents. With a quick correction of the neck deformity by conservative methods, the asymmetry of the face disappears without a trace during the subsequent growth of the child. In cases where torticollis is eliminated over the age of three years, facial asymmetry remains.

When a child has different cheeks, you need to think about a possible torticollis.

Deformity treatment is carried out for several months. First of all, at home, the child must be properly laid in the crib, constantly giving the head a tilt position in the healthy direction. When he lies on the side of the torticollis, that is, on the side of the head tilt, a large pillow is used, and if on the other side, the pillow is removed, and a thick diaper folded four times is placed under the shoulder. When laying the child on his back, a cotton-gauze roller is placed between the shoulder and the head, which prevents the tilt, and toys are hung from the side of the torticollis so that the baby independently corrects the vicious turn of the head. After the child starts le-. press on the stomach, that is, from 4-5 months of life, for
neck fixation used asymmetrical collar-fixation neck nicks. They prevent the head from tilting and are put on with an asymmetrical collar only at daytime.
Already from the age of one month, such children are shown physiotherapy exercises, which are carried out at home. After briefly warming up the neck with a blue lamp or a warm diaper ironed with an iron, gently tilt the child's head to the healthy side with a slight turn in the opposite direction at the same time. The correct position must be held for a few seconds. Such movements should be done 15-20 twice or thrice during the day before feeding.

Neck fixation with asymmetrical collar

From the arsenal of traditional medicine, one can advise compresses with cakes of steamed oats and honey, especially in the presence of a tumor-like formation in the sternocleidomastoid muscle.
Children are shown massage of the neck and shoulders. It is carried out by a competent massage therapist in courses every 2-3 months. Physiotherapy courses in the clinic are carried out with the same frequency. As a rule, electrophoresis (phonophoresis) is used with absorbable agents: lidase, hydrocortisone, potassium iodide, as well as dry heat in the form of paraffin applications. It is advisable to combine neck warming with massage sessions.

In cases of early initiation of therapy, most children are cured during the first year of life. An orthopedic doctor controls the effectiveness of treatment after each comprehensive course, which includes massage, physiotherapy exercises and physiotherapy.

With late detection or irregular treatment of torticollis, conservative measures are not enough. Then, at the age of two years, the child undergoes surgery to lengthen the sternocleidomastoid muscle or cut it along with other shortened soft tissues. After the operation, a long-term rehabilitation is carried out, which includes fixing the neck with a collar, massage, physiotherapy exercises, physiotherapy, since only the operation cannot solve all the problems in the treatment of such children.
Children with this form of torticollis are observed by an orthopedist not only during treatment, but also after the deformity has been eliminated. It is obligatory for them to have an examination before school, when after the second period of stretching there may be some return of violations and especially the curvature of the spinal column. This is because the altered muscles on one side do not stretch as fast as the cervical spine grows.

Congenital torticollis

Congenital bone torticollis is a malformation of the cervical spine, a gross anatomical and functional defect with lateral curvature, that is, congenital scoliosis of the cervical spine. In most cases, it has pronounced external manifestations: shortening and expansion of the neck, a change in its configuration. Movements in the cervical region are limited in different ways, but the muscles are not changed. The presence of a defect is confirmed by x-ray in children over the age of three months. The question of the treatment of such patients is decided in each case individually, since the type and severity of the defect is always varied.
Of course, when examining a small child for the first time, it is necessary to evaluate his musculoskeletal system from all sides, but special attention is paid to the hip joints - as the largest, most complex in structure and development.

Hip dysplasia, congenital subluxation and congenital dislocation of the hip

These conditions differ from each other in the degree of underdevelopment of the articular elements and in the location of the femoral head relative to the acetabulum. In any case, the joint is not well developed at the time of birth. In a child of one month, it is possible to reliably determine their anatomical and functional failure only with congenital dislocation of the hip, when the articular surfaces are completely disconnected. In less severe cases, pathology is only assumed, and an accurate diagnosis is established when the child is 3 months old.

Pathology of the development of the hip joint

Fold asymmetry and external rotation of the right lower limb at rest

Different leg lengths in a child according to the level of the knee joints

In such children, after birth, you can notice the asymmetry of the folds on the legs, special importance should be given to the inguinal and femoral front, buttock and popliteal rear. In this case, the folds can vary both in number and in severity. The leg of a child with an underdeveloped hip joint is turned outward, as evidenced by the position of the knee and foot. This is especially noticeable when the baby is sleeping, in a relaxed state of the muscles.

In some cases, there is a slight shortening of one limb. This is primarily due to the incorrect position of the pelvis and legs - the so-called "apparent shortening". Subsequently, shortening during dislocation increases due to the displacement of the femur upward from the acetabulum.

Abduction in the hip joint is difficult, which is also a presumptive sign, but a click during abduction is a reliable symptom of pathology. Unfortunately, in most patients, the structure and function of both joints are disturbed, which makes it difficult to identify dysplasia by comparison. Such a child can be examined using ultrasound, but a large number of variants of the normal structure of the hip joint makes this method very indicative at present.

If there is a suspicion of underdevelopment of the joints in a child, constant wide swaddling, special physiotherapy exercises and massage with an emphasis on the hip joints are recommended. In such cases, a second examination by an orthopedic doctor is mandatory when the child is 3 months old.

At this age, an X-ray examination of the hip joints is performed, and thus the results of the earlier suspicions are summed up. Girls who were born in breech presentation with a burdened hereditary background, when the mother of the child or other children in the family had a pathology of the hip joints, are subject to mandatory examination. Those children who have neurological disorders of the lower extremities, especially the feet, or pronounced orthopedic defects of the legs, also need an X-ray examination.

X-ray examination is the most informative method for the pathology of bones and joints. It makes it possible to assess the shape, size of bone structures, their density, correct development and relationship with each other. A dose of a single irradiation of a segment of the body does not have any harmful effect on the body and does not have negative consequences in the future. Therefore, you should not be afraid of this examination, but it should be carried out strictly according to indications.

Hip dysplasia, confirmed by X-ray, requires a long, thorough functional treatment. The child is placed in the Frejka pillow, which keeps the legs in the flexed position and the maximum extension. This position contributes to the best centering of the femoral head in the acetabulum (in case of congenital dislocation - reduction of the latter) and allows bone and cartilage structures to develop over time.

A pillow should be used most of the day, during sleep - a must. The child very quickly understands that it is better without a pillow, so you need to persevere in order to accustom the baby to it. The first time the pillow is put on after a warm bath only for a few hours, and at night it is removed. The next day - leave for a night's sleep.

In order to speed up the process of joint formation and avoid possible complications, physiotherapy treatment is mandatory in the clinic: electrophoresis with calcium and phosphorus on the joints, with aminophylline or nicotinic acid on the lumbar spine, and at home - dry heat, 10 procedures per month per joint area, as well as coniferous or salt baths.

Massage of the legs and back is carried out in courses every 1.5-2 months, and physiotherapy exercises - constantly, but only with joint dysplasia or subluxations in them. In cases of congenital dislocation, motor activity using massage and physical education is possible only two months after the reduction and fixation of the joint with the femoral head set into the acetabulum.

The child should be regularly observed by an orthopedic doctor. One stage of such treatment is 3-4 months, and its effectiveness is controlled by X-ray of the hip joints in direct projection at the end of each stage.

To correct dysplasia, 1-2 stages are usually sufficient; with congenital hip dislocation, a child can be treated conservatively for much longer, up to 2-2.5 years of age.
The Frejka pillow, or one of the many splints that fix the child's legs in the position of greatest flexion and dilution, can only be used for 6 months - this is the longest period. If it is necessary to continue treatment, they switch to other orthopedic devices that keep the legs in a position of moderate abduction and inward rotation.

Frejka pillow

In most cases, dysplasia and congenital dislocation of the hip are completely cured, but with a late start of therapy, non-compliance with the orthopedic regimen, complications in treatment or metabolic disorders that lead to a slowdown in bone development, the child develops subluxation of the joint, which requires surgical correction.

Surgical treatment of children with congenital dislocation of the hip is carried out for children older than two years of age, and surgical interventions for subluxations - over the age of 3 years. These complex traumatic operations are the only and last opportunity to cure a child, to save him from disability.

The final results of treatment, taking into account the growth and development of the child, are summed up at the age of 5-6, that is, before school. In case of any dysfunction of the hip joints in combination with different lengths of the lower extremities, their X-ray examination is carried out. In such cases, it is necessary to determine whether the child needs further observation and treatment, whether he can go in for physical education and sports at school, and make a certain prognosis for the future.

Foot deformities

Heel planting

Heel planting of the feet is one of the most frequent and mild forms of pathology in young children and occurs as a result of their special fixed position during fetal development. With this pathology, the feet are in the position of dorsiflexion in the ankle joints, sometimes in combination with both adduction and abduction. This condition of the feet is detected already in the maternity hospital and by the first month of life can be corrected by physiotherapy exercises. For this, it is necessary to perform 15-20 extension exercises 2-3 times a day. In cases where the incorrect installation persists after 3 weeks of training, the doctor makes plaster splints - removable splints to fix the feet in the correct position. It is undesirable to use any products made of cardboard, wood or plastic in young children.

Heel setting of the foot

Holding the feet with a plaster splint in the middle position, continuing the treatment with physical education and massage for the next few weeks allows you to completely eliminate the vicious heel installation.

Neurological abnormalities in the lower extremities associated with a birth injury in the lumbar region or with impaired development of the spinal cord in the lumbosacral region are manifested by asymmetric muscle tone and various functional disorders of the position of the feet: they deviate outward from the middle position, occupy the heel position or the reverse of it, when the feet are lowered to the plantar side. Gradually join violations of passive movements in the ankle joints.

Calcaneal feet may be the result of neurological disorders of the lower extremities.
Such children are carefully examined for bone deformities of the spine and consulted by a neuropathologist. In this case, orthopedic treatment should be combined with neurological treatment aimed at correcting the functioning of the spinal cord.

Adducted feet

Adducted feet often appear only by one month of age, and parents learn about it from an orthopedic doctor at the first examination. The essence of the deformation is the deviation inward of the anterior section in relation to the heel and the rounding of the outer edge of the foot. This is clearly visible from the side of the sole. The first interdigital gap is widened, and the first finger "looks" inward. Some take this deformity for clubfoot, but this is not the case, since in this case there are no violations of the ratio of the bones of the foot, there is no limitation of mobility in the ankle joints, etc.

Adducted feet are successfully treated non-surgically in children under 3 years of age. The pathology is eliminated by the doctor gradually by manual corrections and fixation of each achieved position with non-removable plaster splints. Corrections are made once a week. It takes from several weeks to several months to correct the deformity - even with the timely early start of therapy.

adducted foot print

After elimination of the deformity of the foot, they are fixed for 1-3 months in the middle position in order to exclude the return of the adduction of the anterior section. Only after this is functional treatment carried out in the form of physiotherapy, massage and physical education. During sleep, the child's feet are held in the corrected position with removable plaster splints. The issue of assigning orthopedic shoes to a baby is decided individually at the age of 10 months.
Late detection of such a pathology not only makes it difficult to correct it, but also significantly lengthens the treatment time. Children over the age of 3 years are indicated for surgical intervention.
reduced foot stop.

congenital clubfoot

Congenital clubfoot is a more severe deformity of the feet with a change in the shape and position of the bones, shortening of all soft tissues along the back and inner surfaces of the lower leg and foot (typical cases). It is more common in boys than in girls. In some cases, clubfoot is inherited. Such a vicious position of the foot is either not eliminated at once, or is eliminated with great difficulty. It is this fact that makes it possible to distinguish mild clubfoot from functional disorders associated with the predominance of the tone of individual muscles.

With congenital clubfoot, the foot is somewhat reduced in size, since the processes of its blood supply and ossification have been changed. Movement in the ankle joint is always disturbed.
Clubfoot may be the result of abnormal development of the spinal cord at the level of the lumbosacral region. In such cases, paradoxical work of muscle groups is noted, their atrophy gradually develops, and by school age the entire limb is shortened by 1-2 cm as a whole.

Active treatment of congenital clubfoot should begin at one month of age. It consists in staged corrections of the position of the foot and simultaneous fixation of each achieved state with plaster splints. Manual correction of foot deformity is performed once a week in the first stages and every 10-14 days thereafter. It is advisable to combine this with physiotherapy in the clinic. Conducting electrophoresis with vasodilators on the lumbar region improves blood circulation and the function of the nerves of the lower extremities.

From three months of life, the feet are already held by circular plaster bandages. The treatment is carried out in stages, for a long time and persistently until the complete elimination of all components of the deformity, and then the child is provided with orthopedic shoes and removable splints for the feet during sleep. Active rehabilitation of the patient and monitoring of the correct growth of the foot are carried out for at least

Congenital clubfoot (back view)

five years. In those cases where there is a partial return of individual signs of deformity, they are corrected conservatively or promptly, and the observation of the child continues until the end of the growth of his feet.

A large number of variants of deformity with varying degrees of severity of its individual components, a variety of nuances when applying fixing bandages require a sufficiently high qualification and experience of the doctor to cope with the task of conservative treatment of clubfoot.

Typical congenital clubfoot in most cases is completely cured in the first year of life without any surgical intervention.

Conservative treatment of clubfoot is longer and more difficult than surgical correction, but gives better results. Therefore, in the first year of life, conservative, proven, classical methods of treatment are indicated. In cases where individual elements of the clubfoot cannot be eliminated conservatively, at the age of over one year, minor surgical interventions are performed on the soft tissues of the foot.

With a late start of treatment, the effectiveness of conservative measures is less high, and after the preparation of the altered foot, children older than one year undergo extensive surgical interventions followed by long-term rehabilitation treatment.

Pathology of the fingers

six-fingered

Six-fingered - this word refers to an increase in the number of fingers or toes (polydactyly). This defect can be inherited and combined with other congenital skeletal disorders. Additional fingers are usually represented by insufficiently well developed little fingers or additional first fingers. They can either be located in isolation or be connected to the main fingers. This is primarily a cosmetic defect, which can only be removed surgically. In cases where the fingers hang on a thin skin stalk, removal is performed in the first weeks of a child's life. But if the additional fingers have pronounced bone structures or they are tightly fused with the main fingers, one should not rush to remove them. It is more correct to carry out surgical treatment closer to the age of one: firstly, the hand and fingers increase in size, and secondly, those anatomical structures that need to be removed are clearly defined. In some cases, only time allows you to determine which of the two fingers is the main one and which is the additional one, so they are the same in the first weeks of life.

Fusion, fingers

Finger fusion (syndactyly) is the joining of two or more fingers by skin, soft tissue, or even bone. Fingers can be fused at the base, all over or at the tips. More often than others, there is a connection of the third or fourth fingers, which is inherited through the male line. With skin and soft tissue adhesions, the function of the fingers and their shape may not be disturbed. When bone structures are involved in the deformity, the changes are more severe.

This defect is easily detected after the birth of a child, with the exception of those cases when the fingers are not connected all over, but only at the base. It is desirable to separate the fingers at the age of 4-5 years, that is, before school. Only with terminal fusion, surgical treatment is performed earlier, starting from the first year of life, since this type of disorder interferes with the normal growth and development of the child's fingers.

Plastic separation of the fingers is a complex jewelry operation. The resulting skin defect is closed either by surrounding tissues or by a flap taken from another part of the body. Soft tissue fusion of the toes, when their shape and function are not disturbed, is better not to be eliminated, since the scars formed after the operation bother the person more in the future than the fused fingers themselves.

CHILD IN THE FIRST YEAR OF LIFE

In the first year of life, the processes of growth and development of the musculoskeletal system occur most intensively. This is primarily evidenced by an increase in the weight and height of the child. The length of the body by the year increases by half, the limbs lengthen, the circumference of the chest increases. Muscle tone gradually normalizes, and movements in the joints of the limbs become smooth, with greater amplitude than in a newborn. At the same time, the symmetry of the shape, length and circumference of the arms and legs should be maintained.

The length of the upper limbs is indirectly determined by the level of the fingers pressed against the body. Tentatively, the equality of the length of the lower limbs can be judged by the level of the location of the heels, inner ankles, knee joints with full extension of the legs or by the level of the knee joints of bent legs. This period is very important for creating the correct shape of the spinal column.

By 1.5-2 months of life, the child begins to raise and hold his head, lying on his stomach. In this regard, moderately pronounced cervical and thoracolumbar lordosis of the spine appear, that is, its anterior bends. By 5-6 months, when the child begins to sit, a thoracic kyphosis is formed - a posterior bend of the spine.

Normal axis of the upper limb

Formation of physiological curvature of the spine during the first year of life

The severity of these bends is subject to significant fluctuations depending on individual structural features, nutritional conditions, physical activity, diseases, etc. The shape of the spine is the basis of the future posture of a person. Posture is the usual vertical position of the body in space without active tension of individual muscle groups.

In the first year, the muscles of the trunk develop, the stereotypes of holding the body in an upright position are formed with the active participation of the central nervous system, and the processes of ossification proceed rapidly. By the end of the first year of life, the child begins to walk independently. At the same time, he bends his legs somewhat, puts them wide and slightly turns inward, increasing the area of ​​\u200b\u200bsupport. He takes small steps, which is associated with a small amplitude of active movements in the ankle joints.

A child of this age has the so-called physiological flat feet due to soft tissues that fill and smooth the entire plantar surface. However, the load on the feet is correct if it lies on the outer edge. The child should not “fill up the feet inward”, crushing their inner part, so that the formation of the bony arches of the foot is not disturbed. To avoid this, it is necessary to teach the child to walk in hard shoes, not to allow the house to constantly run barefoot or in socks. It is necessary to keep the foot within the shoes and always with a hard heel.

Every healthy baby in the first year of life needs to receive courses in general massage and physiotherapy exercises.

In the first year of life, the orthopedic and neurological treatment of the patient, begun in the neonatal period, continues. But other congenital disorders may appear, skeletal deformities associated with various diseases may occur.

More often than others, rachitic curvatures of the limbs and spine are observed. They are associated with a load on the bones softened by rickets. At the same time, first of all, their physiological curves increase, less often, new curvatures appear.

Proper feeding of the child, prevention and treatment of rickets is the basis for preventing skeletal deformities.

Most of the curvatures acquired as a result of rickets disappear without a trace on their own in the process of growth, subject to the early normalization of the exchange of calcium and phosphorus in the body and the use of other therapeutic measures: therapeutic massage, special physical exercises, salt or coniferous baths. A significant decrease in O-shaped curvature or their complete correction occurs by 5-6 years of a child's life.

Incorrect stop setting

Violation of the axis of the limbs

The situation is more complicated only with the X-shaped legs. On the one hand, it disrupts the proper development of the feet, since the center of gravity falls medially from their inner edge, and on the other hand, it corrects itself worse. In order to support the feet and contribute to the normalization of the axis of the limbs, children need to wear hard shoes for a long time and orthopedic arch support insoles that raise the inner edges of the feet.

CHILD BEFORE SCHOOL

By the age of 5-6, the ratio of the length of the limbs and torso changes in the child. Hands reach the border of the upper and middle thirds of the thigh. The middle point of the body is located below the navel. The axis of the lower extremities can be straight or deviate in the area of ​​the knee joint both inwards (more often in boys) and outwards (in girls) by 10 degrees. The curvature of the legs associated with rickets suffered in the first year of life is reduced or completely disappears. The child ceases to overextend his knee joints, he more effectively uses the capabilities of the bone-articular and muscular apparatus due to the improvement of the nervous regulation of movements.

Very often, the growth of the lower extremities proceeds unevenly, asymmetrically. So, by the end of the second stretching period, that is, by the age of 6, more than half of the children have a difference in the length of the right and left legs by 0.5-1 cm. Even such a small difference often affects the location of the child's pelvis and leads to lateral deviation spine in the thoracolumbar region. This allows the child to maintain the balance of the torso in an upright position.
By school age, the longitudinal and transverse arches of the feet are normally formed. An unloaded subaerial space appears on the inside, as in an adult, which indicates the formation of a longitudinal arch of the foot, and roundness at the base of the toes characterizes the presence of a transverse arch of the foot. Children at this age should wear stiff, preferably leather shoes with a medium (2-3 cm) heel and a loose toe. Factory insoles in shoes lighten the load on the feet and contribute to their proper development.
By the age of 6-7, constitutional features of the development of the musculoskeletal system begin to appear, although they are especially clearly expressed in adolescence. Most often, doctors designate the following types of addition: asthenic, normosthenic, hypersthenic. A predetermined division is certain features of physiological processes in the body, a tendency to a particular pathology.

The asthenic type of constitution is distinguished by a narrow, flat chest with an acute angle of attachment of the ribs to the sternum, a long neck, thin and long limbs, narrow shoulders, an oblong face, poor muscle development, pale and thin skin.
The hypersteppe type is characterized by a broad, stocky figure with a short neck, a round head, a broad chest, and a protruding belly.

The normostepic type of constitution is a good development of the bone and muscle systems, a proportional build, a wide shoulder girdle, and a convex chest.
During this period, the future shape of the human spine is also determined.

The normal form is moderately pronounced and of a certain length physiological curves: cervical and lumbar lordosis, thoracic and sacral kyphosis, the absence of lateral curvature of the spine and any other disorders of its bone structures and soft tissues of the body. Reducing the correct bends or strengthening them determine other forms of the spine, which develop by 5-6 years.

The posture of a person depends on the shape of the spine. At an early age, there is no specific posture worked out for the vertical position, and the posture is often called unstable. The body in an upright position is supported by bones, ligaments, muscles and tensions in the chest and abdominal cavities. Normal posture in children under 5-6 years old: lordotic, kyphotic, balanced, which is determined by the ratio of the thoracic and lumbar curves of the spinal column in a standing position. Over 6 years of age, posture may be correct, incorrect or pathological.
Posture depends not only on the anatomical structure of the musculoskeletal system, but also on the somatic health of a person, the psycho-emotional factor, and the development of the central nervous system. Posture changes naturally, as does the shape of the spine, due to the growth and lengthening of the limbs, with a shift in the center of gravity of the body. Incorrect posture can be with any form of the spinal column. A physically tired child, even with a well-formed spine, begins to poorly hold the body in an upright position, for example, stoops, breaking his posture.

Forms of the spinal column

Correct posture and older children is a condition in which the existing shape of the spine in an upright position does not change.

Even the posture of a person that has developed by the end of puberty is also not some kind of invariable life stereotype of keeping the body in an upright position. It is modified both due to a gradual age-related decrease in muscle strength, degenerative disorders of the spine, changes in body weight, and under the influence of environmental factors, in particular social and living conditions, labor activity.

Scoliotic posture disorder

Scoliotic posture disorder, or frontal posture disorder, is a lateral deviation of a large part of the spine without any bony changes, unlike scoliosis. The reason for this may be the different length of the legs of the child. This static factor can lead not only to a scoliotic posture, but also to the development of a complex progressive deformity of the spinal column, which is called scoliosis.

Children before school need to measure, compare and equalize the functional length of the lower extremities.

In such cases, you should compensate for the decrease in leg length with an additional insole. The amount of shortening of the limb and the required thickness of the insole will be determined by the orthopedist. Such a simple action, performed before the age of 10 years, allows you to equalize the length of the legs, normalize the ratio of the pelvis to the spinal column and contributes to the formation of the correct shape of the back and normal posture. In older children, length compensation no longer allows changing the ratio of bones and joints, causes inconvenience and is performed only in cases of shortening of more than 2 cm.

As the child grows, the length of the lower extremities, as a rule, equalizes on its own, so the compensating insole must be removed in a timely manner. But even the preservation of such a minimal difference in the future is not visible to the eye, it does not affect the gait and should not disturb the child and parents.

Insufficient development of the trunk muscles, which must involuntarily return the spinal column to its original correct position, also serves as the basis for scoliotic curvature. With scoliotic posture, a child can correct the axis of the spine on their own, both actively tensing the muscles and completely relaxing them in the prone position, so an important task of treatment is the formation of a muscular corset that holds the spine in the correct position.

A set of social measures allows you to form the correct posture: good nutrition, outdoor games, hardening, a long sleep period, the use of furniture appropriate for growth and a moderately hard bed with a small pillow. An obligatory element is the purposeful development of the muscular apparatus: gymnastics at home, classes in sports circles, visiting the pool, etc.
Children with scoliotic posture disorders are shown therapeutic back massage, compensation for limb shortening with orthopedic insoles or shoes, physiotherapy exercises in a polyclinic (rehabilitation center), including the use of biofeedback techniques. Such children should be examined annually by an orthopedic doctor.

Chest deformities

In the process of growth, the existing congenital disorders of the structure of the chest and ribs intensify. These include, first of all, funnel-shaped deformity - when the sternum is pressed inward, and when inhaled, its retraction increases. "Shoemaker's chest", as it is sometimes called, is always accompanied by a violation of the function of the lungs and heart, a decrease in the body's resistance to overload. Severe deformity requires surgical repair as early as the age of 4-6 years, but in some cases, treatment is delayed until adolescence. With small changes in the shape of the chest, physical education is shown to children to increase the mass of the muscles of the anterior surface of the chest and shoulders, which will correct the external manifestations of the defect.

Keeled deformity is a consequence of a violation of the correct growth of the ribs and sternum and manifests itself in adolescence. It does not affect the functioning of internal organs and is only a cosmetic defect. In severe cases, if the child wishes, plastic surgery is performed.

Static flat feet

Static flat feet are most often caused by weakness of the capsular-ligamentous and muscular apparatus of the feet and a large load on them (with an overweight child). The decrease in arches gradually increases and leads to fatigue of the legs after a long load, pain in the calf muscles. The child's gait becomes heavy, he does not keep up with his peers in speed, turns into a "lump" and "clumsiness". A decrease in the spring function of the feet affects the state of the entire skeleton, especially the spine, and existing disorders are intensified.

The presence of flat feet can be confirmed not only by a careful examination of the child's legs, but also by a plantographic study of footprints. The most reliable method for determining the size of the arches is the X-ray of the feet standing under load.

The beginning of the treatment of flat feet from preschool age allows not only to preserve the arches, but even increase them, saving a person from such an unpleasant defect. Currently, almost half of preschool children need orthopedic foot treatment.

It is too late to start correcting feet in adolescence, and the goal of treatment in this period is to stabilize flat feet, improve the functional state of the child's legs and spine, and prevent deformities of the toes.

Children with flat feet need to wear orthopedic arch support insoles or insoles that form arches. In cases where not only the height of the arches is reduced, but there is also an incorrect installation of the feet, orthopedic shoes are prescribed.

A prerequisite for treatment is training the muscles of the legs and feet, strengthening the capsular-ligamentous apparatus, and improving blood supply. For this purpose, various simulators, massagers, physiotherapy exercises, including the use of biofeedback techniques, contrast (alternating warm and cool) baths, Kuznetsov applicators or corrugated insoles, physiotherapy procedures are used. In severe cases, surgical treatment of flat feet is possible.

The formation of the child's musculoskeletal system does not end at the age of 5-6 years, and the disorders we have described are only a small fraction of those deviations that occur in children and require treatment. Already schoolchildren develop conditions associated with the wear of individual bone and cartilage structures, their aging. Numerous diseases of an inflammatory nature, the consequences of injuries complement congenital and dysplastic skeletal disorders in children.

I would like to remind you that human health is formed in childhood. The child's skeleton is a soft, pliable and grateful material that lends itself well to correction in the treatment of disorders. By joining your efforts with doctors, you can achieve the desired results in building the child's musculoskeletal system.

INJURY

Features of injuries in children

Who hasn't been injured in their life? Children are no exception, but fractures of bones and dislocations of joints in a child have their own characteristics.

As you know, trauma is any damage to the body caused by mechanical, thermal, chemical or other environmental factors. More often than others, mechanical damage is observed, which leads to fractures and dislocations of bones.

For each age period of childhood, certain injuries are characteristic, which is associated with the peculiarities of the psychophysical development of a child of this age group. In the first years of life, domestic injuries predominate, of which one third are burns and only a fifth are bone fractures. At school age, the frequency increases in personal, (transport and non-transport) injuries.

In children, trauma differs not only in the mechanism of occurrence, which is due to the unusual mobility and curiosity of the child, but also in the manifestations of the disorders that have arisen, the healing time, and outcomes. This is primarily due to the anatomical and physiological characteristics of the child's body, very intensive recovery processes. Methods of treatment of fractures and dislocations in children and adults differ significantly.

In the musculoskeletal system of a child, there are much more soft tissues (muscles, fat, cartilage) than bones, they soften the direct traumatic effect on the bones, which are more difficult to break than in adults. Fractures of the bones of the upper limb in children occur much more often than other bones. The same structural features, combined with the elasticity of the capsule and ligaments, protect the child from dislocations, which are practically not observed in children under 5 years old: there is only one dislocation for 10 fractures. However, the total number of fractures in children is higher than in adults, and this is a retribution for the extraordinary mobility and inexperience of the child. The most common in children are fractures of the forearm and elbow joint, among dislocations - dislocations of the bones of the forearm, subluxation or dislocation of the head of the radius. There are also so-called fracture-dislocations, that is, a combination of fracture and dislocation. These include dislocations of the bones of the forearm with a detachment of a section of the humerus or a fracture of the ulna in the lower part with a dislocation of the head of the radius in the elbow joint.

The bones of children are thin, but contain more organic substances, which makes them elastic and flexible. The articular sections of the bones of the extremities consist mainly of cartilaginous tissue, which serves as a material for subsequent bone formation. In an adult, only rubbing surfaces are covered with a thin cartilaginous layer. The transformation of cartilage into bone tissue occurs gradually during the growth of the child - throughout childhood.

Between the articular part of the bone, which is located in the joint cavity, and the bone itself, there is a so-called growth zone. It is also present near various bone outgrowths, to which ligaments, tendons, etc. are attached. These cartilage layers ensure the growth of bones in length and exist until the end of human growth.

Cartilaginous structures are not subject to fractures due to their high elasticity, shock-absorbing capacity and homogeneous structure. But fractures - separation of bones along the growth zone - are quite common, and only in children. These fractures are difficult to detect because the cartilage is not visible on x-rays, and they require precise alignment or the function of the nearest joint is compromised. Breaks of bones along the growth zone “replace” dislocations of the joints in children. However, this does not mean that the cartilaginous tissue itself is not damaged by mechanical action. As a result of an injury, cartilage can move, dissolve, change its content and properties. The consequences of such disorders are very sensitive for the body: these are shortening of the limbs, and violations of the shape of the bones, and limited mobility in the joints. Osteochondrosis, arthrosis, osteochondropathy - all these conditions are based on pathological changes in cartilage tissue.

Knee-joint

Types of fractures:
a - a fracture of the "willow rod" type; b - impacted fracture

The bones of children are covered with a relatively thick and dense a) / /5) membrane - the periosteum, which also serves as a source of bone formation and is very well supplied with blood. In case of a fracture, the periosteum easily exfoliates, and when it is damaged, its parts may be between the fragments and become an obstacle to the exact comparison of the fragments.

Due to the special elasticity of the periosteum, the form of bone fracture in children is different than in an adult. There are longitudinal splits of the bone, small fractures without displacement and impacted fractures are characteristic, when one part of the bone is introduced into another. The dense elastic periosteum often keeps fragments from moving, and such fractures resemble a broken green wicker. Doctors sometimes refer to such fractures as “greenstick” fractures.

The bone is able to regenerate completely through the stage of callus formation without any scarring. The impetus for the formation of callus is the products of tissue destruction at the site of the fracture. The severity of callus depends on the accuracy of comparison of fragments and the rigidity of their retention. The high regenerative capacity of bone and cartilage tissue in children and the subsequent growth of bones in length and width make it possible to leave the so-called "permissible displacements" that are self-correcting over time.

The obligatory task of a traumatologist is to eliminate the displacement of the articular parts of the bones along the line of growth zones, the displacement of fragments and around their own axis, as well as unacceptably large angular displacements. This procedure is painful and is performed under anesthesia.

In children, open fractures rarely occur when the skin over the fracture site is damaged and there is a threat of infection in the bone, followed by the development of osteomyelitis (inflammation of the bone tissue). Gunshot (always infected) wounds to bones and joints are even less common. Inflammation in fractures is more often a complication of treatment and develops 5-7 days after infection. In the treatment of such infected fractures, antibiotics are mandatory.

Any injury is a damage to the whole organism as a single integral system, for the restoration of which absolutely all protective forces are turned on. Therefore, bone damage is accompanied by local and general symptoms that differ from those in an adult. In most cases, the condition of the child with fractures and dislocations of the bones is satisfactory. A severe or extremely severe condition with manifestations of traumatic shock occurs with multiple fractures or when they are combined with trauma to internal organs, the brain.

Particular attention should be paid to the conditions under which the injury occurred, as well as the child's complaints, the position and shape of the injured limb, its mobility. It should be remembered that children, especially younger ones, cannot always clearly tell what happened to them, they are not able to accurately localize pain. Communication with the child is even more difficult due to the general reaction: screaming, crying, anxiety, fever. An injured child seeks protection, so an adult should control himself, look confident and calm, not panic, and calm the child if possible. You should not immediately try to examine, touch the affected limb. With all your appearance and behavior, you need to show the child that he will soon be helped and everything will end well.

It is necessary to try to determine the accompanying disorders and the amount of local damage - abrasions, wounds, bleeding, to assess the adequacy of the child's response to damage, including by feeling a healthy limb.

Clinical signs of fractures and dislocations of bones can be divided into probable and reliable. The first include pain, swelling, bruising, hematoma, deformity, dysfunction, the second - a feeling of crunching of bone fragments at the fracture site and the appearance of unusual mobility there, a violation of the normal ratio of bone landmarks of the joint.

Manifestations of fractures and dislocations of a specific localization have their own characteristics. In addition to inspection and palpation, in order to establish a diagnosis, tapping is sometimes used, especially for fractures of the spine, measuring the length and circumference of the damaged area of ​​\u200b\u200bthe limb, etc.

You should always pay attention to the color of the skin on the periphery of the injury, in the area of ​​the hand and foot, check the mobility of the fingers. Pronounced blanching, “marbling” of the pattern, stagnant-cyanotic skin tone, combined with the absence of any movements, may be due to damage to large vessels or nerves. Serious damage is also indicated by the absence of a pulse on the upper limb in a typical place, on the radial artery, the disappearance of the pulse on the back of the foot or in the popliteal region, as well as a violation of skin sensitivity or a feeling of "goosebumps", unpleasant burning, tingling. In such cases, you should seek medical help as soon as possible and do everything possible to quickly deliver the child to the doctor of the trauma department of the surgical hospital. This also applies to injuries that are accompanied by profuse external bleeding or a violation of the vital functions of the body.

It is always necessary to determine whether the blood supply to the peripheral parts of the limb is not disturbed.
In typical cases, the diagnosis of fractures or dislocations is not difficult, since there is an indication of trauma and all signs of a fracture or dislocation are present. A feature of diagnosing injuries in young children is that they have a large amount of soft tissues and they often have no displacement of fragments in subperiosteal or impacted fractures. All this makes it difficult to identify a fracture by inspection and palpation, and it can be very difficult to obtain accurate information about what happened. It is possible to reliably determine damage to bones and joints only with an x-ray examination of the affected limb in two projections with the capture of the nearest joint. In particularly difficult, doubtful cases, an x-ray is taken of a healthy limb to compare individual sizes and ratios of bone landmarks. On the basis of radiographs, one can judge the nature of the fracture and the displacement of bone fragments, the presence of one or more fragments, concomitant disorders. Only taking into account the data of radiographs, it is possible to build a correct treatment plan for a sick child.

First aid

First aid for a child in case of injury is carried out according to the general rules of traumatology.
The first thing to do with a fracture is to anesthetize and immobilize the injury site. Immobilization is immobilization of the damaged area, which significantly reduces pain. Temporary immobilization of the limb can be carried out by bandaging the hands to the body, the injured leg to the healthy leg, or using such improvised means that will ensure the immobility of the fracture site and allow the patient to be transported. It can be boards, sticks, skis, etc.

When fixing a fracture, two joints adjacent to the fracture must be immobilized.

In case of a serious general condition of the child, it is necessary to leave him in a lying position until the arrival of a doctor or, with a motionless position of the limbs and torso, transport the victim to the nearest medical facility.

Even the suspicion of shock requires warming the patient and effective anesthesia. Before the doctor arrives, the child should be given some kind of analgesic - baralgin, analgin, pentalgin, etc. The doctor can inject pain medication directly into the fracture area - a hematoma. Good anesthesia is achieved in such cases with a 1% solution of novocaine with the addition of 70-degree alcohol. For the purpose of analgesia, injections of a 1% solution of promedol, tramal, baralgin or a 50% solution of analgin are used. Preference is given to the first two. To enhance pain relief, doctors sometimes inject a solution of diphenhydramine or suprastin in a dosage corresponding to the age of the victim.

In most cases, children with a fracture are not only able to move independently, but they do not require special emergency assistance, especially if it is an upper limb. You don't have to put off going to the doctor.

With fractures, most often there is no need for hospitalization, most patients are successfully treated on an outpatient basis. The child must be admitted to the hospital in cases where a fracture reposition is required, that is, a comparison of fragments, when there is damage to internal organs or a combined (fracture and burn) injury, as well as when the injury is complicated by an infection. Reposition of fractures in children is performed under general anesthesia (anesthesia) as soon as possible after the injury.

Treatment of fractures and dislocations

Conservative treatment

Therapeutic tactics for fractures in childhood can be conservative, that is, without surgical intervention, active-surgical, when the fracture line is not exposed during treatment, and operational - with an open comparison of fragments. The main method of treating fractures in children is conservative. The principles of treating patients with fractures and dislocations are as follows.

Provision of emergency care - anesthesia, immobilization, X-ray examination, selection of the optimal method of treatment.
Mandatory anesthesia before starting treatment.
The most accurate comparison of fragments.
Ensuring the stability of holding bone fragments until the end of the union of the fracture.
Early start of functional treatment - massage, exercise therapy, physiotherapy in order to restore movement in the joints.

Three laws of the German orthopedist Beller remain immutable in the treatment of any patients with bone fractures.A. Good comparison. B. Complete immobilization. B. Restoration of full range of motion.

In pediatric practice, the main methods of conservative treatment are: fixation, functional (traction) or combinations thereof.

The fixation method of treatment consists in applying bandages that hold the fragments until the fracture is completely healed or immobilizes the joint after the reduction of the dislocation of the bones for the period of edema resorption and restoration of the damaged capsular-ligamentous apparatus. The fixing bandage should capture two joints adjacent to the fracture, be comfortable, not disturb the blood supply and function of the nerves of the limb, and be aesthetic. Circular plaster bandages are not applied to children immediately after an injury, since fractures and dislocations in them are accompanied by significant edema from the soft tissues, which creates a high risk of impaired blood supply in the peripheral areas. As a rule, in the acute period, plaster splints are used, covering 2/3 of the circumference of the limb, and only after a few days the splints can be replaced with circular bandages.

With conservative treatment of fractures, control X-rays are taken 4-5 days after the closed comparison of fragments. Find out if secondary displacements have occurred, associated with the disappearance of edema and the appearance of free space under the plaster cast. The following X-ray images are performed after the removal of the plaster cast: these images clearly show how the fragments have grown together. The period of wearing a plaster cast depends on the location of the fracture, its characteristics, severity and age of the child.

In children, the time for bone fusion is much shorter than in adults. The younger the child, the faster his bones grow together.

In some cases, in order to compare the fragments, extension is used. This primarily applies to fractures of the bones of the lower limb. Traction is either carried out until the fracture is completely healed, or is replaced by the fixation method after the formation of the callus begins.

Active-surgical or surgical treatment

The doctor has to resort to active-surgical, or surgical, treatment in the following cases:

Displaced fractures that cannot be compared and treated conservatively;
with the failure of conservative comparison of fragments, including when soft tissues get between the fragments, as well as when their displacements are unacceptable;
with fractures, the conservative treatment of which can lead to very poor results, for example, fractures along the growth zone with displacement;
in fractures with delayed consolidation affecting limb function;
in case of damage to the neurovascular bundle or the threat of its damage during conservative treatment of the patient;
with multiple fractures with difficult conservative treatment;
with fractures in children with malformations of the limb or its shortening. In this case, fracture treatment is combined with deformity correction or simultaneous lengthening of the limb;
with open fractures of bones;
with combined injuries, for example, with a combination of a fracture with a burn. In the process of treatment, it is necessary to constantly monitor the condition of the vessels and nerves of the affected limb. Already from the 2-3rd day, physiotherapy methods are used to reduce pain and swelling, as well as physiotherapy exercises free from fixation of the limbs. Currently, medications are widely used to improve the processes of fracture healing and restoration of blood microcirculation in the affected limb. Comprehensive rehabilitation treatment can be carried out in rehabilitation centers under the supervision of a rehabilitation physician.

Complications

Complications that are observed in children with fractures and dislocations of bones can be divided into early and late. They can be of a general order: suppuration of wounds, osteomyelitis, fat embolism, which is practically not observed in childhood, shock, vascular thrombosis and thromboembolism, anaerobic infection, and of a private order: damage to the neurovascular bundle, the formation of ossificates (formations bone density in soft tissues), etc.
Early complications most often develop at the time of injury, with fracture reposition, reduction of dislocation, or in the course of further treatment.

Late complications develop after the main period of treatment. This is a non-union of a fracture or a false joint between fragments, deformities and shortening of the limb due to improper standing of the fragments or a violation of the subsequent growth and development of the affected bone, contracture or impaired movement in the joint. Late complications often require repeated surgeries and longer rehabilitation treatment in rehabilitation centers.

Fractures of bones and dislocations of joints in childhood are a frequent and serious pathology, which is not only treated for a long time, but can have serious consequences - up to a person's disability. This is a serious test for the child and his parents. In this series, injuries of the spine and head stand in a special place.

Parents should pay special attention to the prevention of traumatic disorders in children. This does not mean that you need to constantly keep the child with you, on a “short leash”. Physical education, hardening, the correct daily routine and long sleep with good nutrition will not only protect the child from somatic diseases, but also prepare the body for a worthy experience of extreme situations. Then the very probability of a fracture or dislocation will be the smallest. The physical activity of the child should be comparable with the age capabilities of his body.

It is necessary to educate the child's safety skills on the street, during physical education and sports. Adults cannot remain indifferent when the threat of injury is obvious to strangers.

When an injury occurs, one should correctly navigate, be able to provide first aid and create conditions for the recovery of the child. Qualified specialists of children's trauma centers, hospitals, institutes of traumatology will always help you with this.

Increasingly, very young children, up to 5 years old, are diagnosed with flat feet. Deformation of the bony arches of the foot, may be congenital or acquired. In any case, if the child has flat feet, measures must be taken, since such a pathology can cause irreversible processes in the body of a little man. Let's talk about children's flat feet and methods of its prevention.

Norm or pathology? What is flat feet?

Initially, let's figure out what is considered to be the norm in the development of a child's foot? Immediately, we note that all babies are born "slightly clubfoot." In newborns, the foot is even, due to the fatty "cushion" that hides the bones of the foot. With age, up to 5-6 years, the correct foot is formed.

According to physiology, it is considered correct when the foot rests on 3 points:

• in the region of the little finger;
• in the area of ​​the thumb;
• on the heel.

These points are connected to each other with the help of ligaments, muscle tissue and tendons, which are connected to the vaults. With the development of flat feet, the arches are flattened, which makes the middle part of the sole area a fulcrum.

A child is diagnosed with flat feet, it is possible to make only after the age of three. Since before that, in children, the bone part of the foot is hidden under the fat layer, which visually does not allow you to see the pathology. The fact is that by the age of one year, this layer performs a "spring" function, since the still fragile bones of the foot are not yet ready for heavy loads. By the age of three, the process of formation of arches begins, it is then that possible signs of pathological abnormalities begin to be noticeable.

Why does the disease appear?

There are not so many reasons for the development of flat feet in children.

1. Heredity. The transferred genes are one of the main factors in the appearance of flat feet in children.
2. Rickets in the chest. Lack of vitamin D adversely affects the formation of the musculoskeletal system. About the symptoms and manifestation of rickets, read the article:.
3. Wrong shoes. This includes shoes that completely lack a heel. For children, it is necessary to choose shoes with an instep support.
4. Cerebral palsy and poliomyelitis. During their course, paralysis of the muscle tissues of the foot and lower leg develops. To reduce the risk of getting polio, your baby should be vaccinated. Read more about vaccination in the article:.
5. The child has hypermobility of the joints (joints are too flexible).
6. Injury to the lower limb.

Which children are at risk?

It should be noted that there is a certain percentage of young children who can automatically fall into the risk zone for developing flat feet. These include:

• a child who has at least one of the parents has flat feet;
• a child who started walking early (8-10 months);
• overweight baby;
• a child suffering from cerebral palsy or having had polio, leg injuries, rickets at an early age.

If your child is at risk, then you do not need to wait until the age of five to confirm the diagnosis. Take care of the prevention of the disease and then the chances for the full development of the foot to forget about flat feet.

What are the consequences of flat feet in a child?

Often, young parents do not pay attention to such a disease as flat feet. Attributing it to heredity, because almost half of humanity lives with such a diagnosis. Indeed, what is special about such a pathology? Flat feet negatively affects the development of the child and leads to sad consequences:

• deformations of not yet formed bones on the foot;
• rapid fatigue when walking, pain in the lower leg;
• bones stick out, more about this in the article:;
• posture is disturbed, which leads to the appearance of scoliosis, kyphosis and other pathologies of the back, irreversible changes in the structure of the pelvis and the musculoskeletal system occur;
• violation of the "spring" function, the shock load passes to the hip region, which leads to arthrosis.

How is the presence of flat feet in a child determined?

The optimal age for determining the presence of flat feet in a child is the age of five. The foot is fully formed and the fat layer is absorbed. For diagnostics, ordinary paints for drawing or vegetable oil are used.

Mom needs to lubricate the entire foot of the child with art paints or vegetable oil. After putting the crumbs on a blank sheet of paper and attracting his attention with something, so that the trace is fixed. They can help you.

The resulting print will tell if the child has a problem with flat feet.

A- everything is normal, since the narrowest part of the print has a ratio of 1:4 to the widest;

IN– there is a flattening development if the ratio is 2:4.

WITH- Pronounced flat feet with a ratio of 3:4.

You can measure the ratio using a regular ruler. In cases where you received a print similar to B and C, then immediately go to the orthopedist and start treatment.

What are the types of flat feet?

In medicine, it is customary to divide this pathology into types and degrees.

1. Transverse flat feet - the alignment of the transverse arch is in progress.

2. Longitudinal view of the disease - the longitudinal arch thickens, which leads to the contact of the entire sole area with the floor.

3. Combined flat feet, when the above two types are present

Prevention of flat feet in young children

As mentioned earlier, it is impossible to diagnose flat feet in the smallest children. Therefore, in order to prevent the development of pathology, it is necessary to carry out preventive actions and follow certain rules.

1. Prevent the development of rickets in children. Talk to your child's doctor about the need for vitamin D.

2. Do not put the child ahead of time on the legs. He must stand on his own. Don't encourage early walking.

3. Get a special orthopedic mat, with tubercles of different sizes. It is quite possible to make it yourself. To do this, sew buttons of different sizes onto the canvas. Carry out daily exercises or other activities with your child on bare feet on this rug.

4. After the child learns to walk, show him:

• how "a bear walks" - on the edge of the foot;
• like a "duck walks" - on the inside, bringing his knees together;
• how to collect different objects with your toes.

5. As for shoes, they should be tough. The back is tight and long. A small heel is a must. Say no flat shoes.

6. Let the child run barefoot around the apartment. If possible, then in the summer, let him walk around the sand, grass, pebbles.

7. Enrich your diet with calcium, phosphorus and vitamins. The bone tissue of the legs during formation should receive a full amount of trace elements.

What therapy will help get rid of flat feet in a child?

If, nevertheless, at the age of 5–6 you are faced with a diagnosis of flat feet in a child, then do not despair, because up to 16–18 years this pathology can be treated. For this, conservative methods of treatment are used, in the form of specially developed complexes of therapeutic measures. An orthopedist will help in developing individual therapy based on the age category and degree of flat feet. The main goal of such techniques is to improve blood circulation, organize blood flow in order to prevent bone deformity and strengthen ligaments.

Foot massage and gymnastics treatment

You need to massage all over the leg, as well as in the lumbar region. Do it twice a day for 15 minutes. For children up to a year old, the mother does a massage, kneading, stroking and tapping on the skin. After a year, you can additionally use special massagers. These can be special rugs, balls, rollers, etc. After the massage, it is advisable to do gymnastics for the legs.

Special orthopedic shoes

Children with flat feet need to walk in special orthopedic shoes. It is prescribed by a doctor. In specialized stores, according to a prescription given by a doctor, you can purchase orthopedic shoes that are suitable for your child. There are also special insoles that are suitable for ordinary, standard shoes.

Folk recipes

In addition to conservative methods of treatment, folk methods are often used in the complex:

1. Trays using:

• sea ​​salt;
• decoction of mint;
• decoctions of sage herb.

2. Hydromassage with a change in the intensity of pressure.

3. Contrast baths: keep the legs in hot water for 1–2 minutes, then lower the feet into cool water for 15–20 seconds.

4. Tie wormwood leaves to the sole of the foot with a bandage.

Author of the publication: Eduard Belousov