Problems with children's feet - hallux valgus. Flat feet in a child - where is the line between normal and pathological? What should be the prevention of the disease from a very early age?

Children are the most interesting patients, and not just because they say and do the most unexpected things when they are in my office. The point is also that caring for children’s feet requires a highly qualified doctor, but gives excellent results.

And the first difficulty that the doctor faces is the misconceptions of parents regarding children's shoes and the development of the lower extremities. The second difficulty is that many doctors do not have experience working with children's feet, and they sometimes cannot identify the problem until it becomes too obvious.

Newborn foot development

Before we begin discussing the specific problems of children's feet, it would be useful to draw a line between normal and abnormal foot development in the womb and after the baby is born. Thanks to the wonders of modern computer technology, we have learned that the rudiments of arms and legs begin to form in the 5th week of embryonic development. After a week you can already see the shape of the foot. By the 26th week, the fetal foot is fully formed. At birth, a normal baby's feet are fully developed. Everything - soft tissues, nerves, and blood vessels - is in its place. All the bones are already there, except for two - the distal phalanges of the little fingers. Naturally, each foot has 5 toes with tiny nails. All the bones in the foot will have to change size, shape and position to be able to support your baby's weight as he learns to walk.

When the doctor examines the legs of a newborn, he should perceive the lower limb as a whole. It is necessary to check the position of the foot relative to the leg and the position of the hips and knees.

Potentially problems already exist if the baby has clearly crooked or X-shaped legs. This will negatively affect the feet, especially when the baby begins to walk, and his legs are turned outward or turned inward.

After examining the legs as a whole, I focus on the feet. The movements of the foot and ankle are so intricate that it is difficult for a specialist to distinguish normal from abnormal. Therefore, I try to be as precise as possible in my manipulations. However, according to the latest statistics, only 1 in 100 full-term and normally born babies have foot problems that require immediate intervention.

What are the features of children's foot development?

Children's feet - I always repeat to parents of children with normal feet that they should not interfere with the development process. And I quote the words of my old professor, said many years ago: “If God in his infinite wisdom wanted babies to wear shoes, they would be born with shoes on.” Until the baby begins to learn to walk, the only function of shoes is to keep the feet warm. Yes, and only if necessary. After all, there are cheaper ways to warm them. However, there is one more thing that unsuitable shoes can do: harm your child. So unless you're planning on casting your first pair of shoes in bronze, don't spend the money until your baby actually needs shoes. You don’t put glasses on your child to make sure his vision is developing normally, so why does he need shoes?

I also advise parents not to joke with their children's feet. If they think that the baby has a deformity, they should contact a pediatric orthopedist or orthopedic surgeon. Conservative treatment of common foot diseases in children brings excellent results, unless, of course, time is lost and the diagnosis is correct.

Good feet for a child are ease, confidence, lightness. These qualities will be highly valued throughout his life.

Declare war on flat feet!

Flat feet terrify mothers. And they are right. Flat feet cause numerous spinal curvatures, pain, and ankle sprains. After ten years there are no spontaneous improvements.

But don't sound the alarm too early. Until two or three years of age, almost all children have flat feet, since the sole of their feet is covered with a fatty pad. As soon as the baby walks, the pad will “melt” and a notch will form on the sole.

The foot is considered flat when its arch is flattened.

How to prevent this?

From the very birth of a child, you can already strengthen the arch of his foot. It is enough to tickle the sole of your foot from time to time. The baby curls his toes, which forces the muscles to work and deepens the arch of the foot.

Later, when the child begins to take his first steps, teach him to walk on his toes.

Choose good shoes!

And especially the first shoes. It's the most important. While the baby is not yet walking, it is useless to put boots on him; it is quite enough if he wears booties or felt shoes with soft soles.

But for the first steps you need real boots. It is very important to be able to choose the right ones. They should fit the child's feet. The sole is made of leather, not very soft and not very hard, with a padded rubber heel from five to eight millimeters. Socks should not ride up. The boots should have a slight step in the back to easily support the heel bone.

Selection rules

Boots should be soft and spacious enough so that your fingers can move freely. But don't buy boots that are too big: they won't provide good support for your child's feet. Don't force your child to wear tight shoes. It's better to change them more often, although they certainly won't wear out.

Boots must have a sufficiently arched sole to support the arch of the foot.

All these rules apply to children's shoes. Don't skimp on quality: bad shoes can cause irreparable distortion.

Too heavy outsole tires and “gnaws” the foot very much; too light causes lateral twisting, too rough atrophies the muscles and stretches the plantar ligaments.

Boots that are too narrow squeeze your toes and interfere with the free movement of the foot; boots that are too wide cause calluses and blisters.

Narrow-toed boots deform the forefoot and contribute to the appearance of calluses.

Never force a child to wear shoes that belonged to another: every child tramples shoes on his own feet. If you wear shoes that have already been deformed by another child, you can develop serious distortions.

Ban “ballet flats”; they are disastrous: they make the foot flat and the gait bad.

Eliminate slippers at home: very often they are the cause of poor gait (the child drags his feet) due to the fact that they are very soft. It is better if children walk barefoot. Or buy lightweight shoes that support your feet.

Orthopedic shoes

Do not use the first corrective sole that comes to hand. You can only use one recommended by a doctor and made to measure by an orthopedist. Buy orthopedic shoes in Moscow It's not difficult now. The main issue is quality. Good manufacturers today are Woopy, Totto et al.

Exercises for prevention

All the exercises and tips we give here are for both flat feet and good feet. For the former they are corrective, for the latter they are warning.

The easiest exercise is to walk on the ground with bare feet: sand, gravel, and so on. Small roughness causes the muscles to naturally contract. Try to have your child go barefoot outside the home more often. To be safe, give him a tetanus shot. Don’t be afraid to injure children’s delicate feet: a stratum corneum will form on them very quickly.

It is very useful to run, jump with both feet together over a rope, and ride a bicycle. Classical dancing and sea baths are also recommended.

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An unsteady standing child aged 6-18 months usually has an O-shaped (varus) leg shape.

With the onset of upright walking, the child begins to spread his legs wide in an attempt to maintain balance. In this case, the knees, as a rule, shift inwards, towards the midline of the body, and gradually, by 2.5-3 years of life, an X-shaped (valgus) shape of the legs may appear.

On this occasion, one of the patriarchs of Russian orthopedics, M. O. Friedland, wrote that a child who begins to walk “must go through a complex school of balancing act.” With a very small supporting surface of the feet and a high center of gravity of the body, the child must, first of all, learn to maintain balance when standing and moving.

Arches of the feet

As the child grows, the position of the feet, the shape and individual curves of the arches of the feet change accordingly. The alignment of the feet undergoes natural physiological changes and by the age of 8-9 years the feet should take a neutral position when the midline of the heel bone lies close (+5°) to the vertical axis of the lower leg and the entire lower limb.

In the 60s, employees of the Leningrad Institute of Prosthetics, led by Professor S. F. Godunov, conducted a detailed study of the “maturation” of the arches of the feet of children of toddler and kindergarten age. A total of 4881 children from 2 to 18 years old were studied.

The results showed that 97.6% of 2-year-old children have flat feet, and 72% of them have grade III flatfoot. With age, the number of flat feet decreased sharply, reaching minimum numbers by 9 years. At this age, longitudinal flatfoot of degrees I and II was found only in 4.3%, degree III - in 0.8% of the examined children.

Judging by the results of this and numerous other studies, by the age of 7-9 years, the arches of the feet, the shape of the legs and posture should gradually align and acquire the shape characteristic of an adult.

Adolescence and the period of intense endocrine changes account for the next period of increased vulnerability. During this period, the musculoskeletal system of children is most prone to deformation. Gender, age, genetic characteristics and especially environmental factors can significantly influence the further formation of posture, the shape of the legs and arches of the feet.

Thus, natural, age-related alignment of the shape of the legs does not always occur. For example, girls are naturally more flexible, plastic (hypermobile), but if this flexibility is excessive, and the muscular-ligamentous “corset” of the body lags behind in development, the X-shaped shape of the legs and excessive deflection (hyperlordosis) of the lower back remain for a long time, perhaps all life.

Parents perceive the first steps of a child as a very joyful family event. But it can be overshadowed by the detection of such orthopedic pathology as hallux valgus. This violation usually becomes obvious just before the start of walking and after some time. The famous children's doctor and author of books on children's health, Evgeniy Komarovsky, talks about the causes of the problem and what to do in this situation.

About the disease

In medicine, valgus is a deformation of the feet in which they are in a cruciform position in relation to each other, reminiscent of the Latin X. Most often, the pathology becomes noticeable when the child tries to step on the feet and take the first steps - the pathology is expressed in the fact that when When walking, the baby rests on the inside of the foot.

Steps are extremely difficult for such a baby - he gets tired quickly, sometimes experiences pain, and 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 slightly lowered. If the legs are straightened and pressed against each other in the knee area, the distance between the ankle bones will be more than 3-4 centimeters. If the height of the arch of the foot is significantly reduced, then orthopedists will say that the child has planovalgus feet. Valgus flatfoot is considered the most common diagnosis in pediatric orthopedics.

There are two types of such curvature of the feet: 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 about which medicine still does not know much. Congenital foot pathologies are usually quite severe, and they can be seen in the first 2-3 months of a child’s independent life.

Acquired deformity is often associated with errors in the development and functioning of the musculoskeletal system, ligaments, and tendons. It is precisely such violations that become obvious closer to the age of one year. At risk are babies with weakened muscles, premature babies suffering from rickets, who have suffered frequent and severe viral infections in the first year of life. The legs are at risk of becoming bent 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. Thus, putting the baby on his feet too early may well “trigger” the mechanism of foot deformation, and insufficient load on the foot, walking exclusively on a flat floor can cause acquired flat feet or planovalgus foot.

Flat feet scare parents no less. However, Komarovsky advises not to panic, because from birth absolutely all children have flat feet, this is a feature of babies. The arch of the foot will form gradually as the load on the legs increases, and here 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 hallux valgus according to the severity of the defect and the severity of its course:

First degree. The angle of deviation from the norm does not exceed 15 degrees. The pathology can be easily corrected using conservative methods.
Second degree. The deviation angle is no more than 20 degrees. This condition can also be successfully treated with exercise, massage and physiotherapy.
Third degree. Deflection angle - no more than 30 degrees. The pathology is difficult to correct, 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. If conservative treatment is ineffective, surgery 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. The third and fourth will be more difficult.

Diagnostics

The child is diagnosed by an orthopedic surgeon. This is done on the basis of a visual examination and prescribed additional studies, which include radiography of the feet, computer plantography, and podometry. If such studies are not prescribed, and the doctor diagnoses you accordingly, you should consult another doctor. Quite often, young patients with confirmed hallux valgus pathology are recommended to visit a neurologist to rule out problems with the peripheral and central nervous systems.

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

Static deformation. This problem occurs if incorrect posture is involved in the curvature.
Structural deformation. Curvature of the feet, which has congenital causes. As a rule, the talus bone with such a deformity is positioned incorrectly with a deviation in one direction or another.
Compensatory deformation. If a child has a shortened Achilles tendon, sloping shins, the foot will be functionally deformed when walking.
Corrective deformity. Such a curvature occurs if the child was treated completely incorrectly or was not treated at all for ordinary clubfoot.
Spastic nervous deformation. The reason for this curvature is the improper functioning of the cerebral cortex, which often results in spasms of the limbs.
Paralytic deformity. Usually it is a consequence of encephalitis or complicated poliomyelitis suffered at an early age.
Rickets deformity. Occurs with rickets.
Consequences of injury. Pathology can result from ligament ruptures, fractures of the bones of the foot, ankle, hip and hip joint injuries.

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

Treatment

The child’s foot is finally formed only by the age of 12, so many problems found by specialists and parents themselves at a more tender age can and should be corrected before this moment, says Dr. Komarovsky.

Typically, treatment for both flat feet and hallux valgus is aimed at strengthening the ligaments, foot muscles, and forming the arch. For this purpose, foot baths, therapeutic massage, magnetic therapy, electrophoresis, swimming, and physical therapy are prescribed. In case of congenital pathology, the lower limbs are immobilized using plaster. If all these measures do not achieve the desired effect, the child may be recommended surgery.

If the defect is not treated and corrected, in the case of severe deformation, the child faces 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 earlier the pathology is identified, the easier it will be to correct it. Medical statistics show that valgus curvature of the feet and legs, detected at one year of age and a little older, with appropriate therapy, has very favorable prognoses - the probability of eliminating the problem completely and forever is close to one hundred percent.

If the disease is detected late or the child, for a number of reasons, was not provided with the necessary medical care and the disease is advanced, in adolescence there is a very high probability of developing problems with the spine. The more time passes from the onset of the curvature to the start of treatment, the less chance of a complete successful recovery.

Shoes

Quite often, parents tend to blame themselves for their child’s foot problems. Mothers 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 - deformation of the legs in no way depends on shoes. Since a person was originally born into the next world without shoes, they are 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 advise 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 it is to have acquired bowed feet or flat feet.

Most parents are interested in when they can start putting shoes on their child. Komarovsky says that there is no point in doing this immediately after the first steps. Let the baby walk barefoot for as long as possible - around the house, outside, if possible. Naturally, your child needs to wear shoes when going to kindergarten or for a walk in the park.

In case of severe hallux valgus symptoms, it is often recommended to buy insoles with arch supports, which prevent the foot from “falling” inward. These boots usually have rigid sidewalls that fix the foot in the correct position and 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 an orthopedist.

You should not buy orthopedic shoes for your baby just like that, for prevention, just because the mother thought that the baby’s feet were positioned incorrectly.

When choosing ordinary everyday shoes, Komarovsky advises adhering to the basic rules:

The shoes should be the right size, neither too small nor too big, and the child should be comfortable and comfortable.
It makes no sense to buy shoes “for growth”, since the geometry of the foot changes as the leg grows.
It is advisable that the shoes are not made of synthetic materials; the feet should “breathe”.
Pointed toes and heels in children's shoe models are unacceptable.

Children's flat feet are a fairly common deviation among diseases of the musculoskeletal system. The term flatfoot in medicine refers to a foot with a flattened and reduced longitudinal or transverse arch, in which its shock-absorbing function is lost. If you ignore the disease, there is a high probability of developing concomitant pathologies. What are the symptoms, complaints and development - details below.

Correct formation of a child's foot

The formation of a child's foot begins in the embryonic period, starting from the 8th week, and continues to change until 5-6 years. During this period, the muscles, ligaments and bone apparatus of the foot continue to strengthen and change.

At the age of up to 2 years, infants experience physiological flat feet.

The reason for this is that the shock-absorbing functions are performed by the fat pad, which replaces the not yet formed arch of the foot. Starting from about 3 years of age, the bones and ligaments of the feet are finally strengthened. During this period, you should pay close attention to the formation of the arch of the child’s feet, which is necessary for the full functioning of the child’s legs.

Main functions:

Spring functions – help soften actions (shocks) during any type of movement.
Support function - helps maintain balance and withstand loads when moving.
Balancing – helps maintain a given human posture during movement or uneven support.

The child should regularly walk barefoot on uneven surfaces (this could be a massage mat, or a walk on the street or beach). This massage helps strengthen the supporting function of the foot. Use your toes to pick up small objects and move them, or have your child try to draw while holding markers or a pencil with their feet.

Causes of flat feet in children

Scientists do not identify a specific cause for the development of flat feet, identifying several factors that contribute to the manifestation of the pathology. You can significantly reduce the risk of flat feet by eliminating, if possible, the following factors.

Reasons for the development of pathology:

Genetic factor. The possibility of developing flat feet is inherited, causing weakness of the joints and muscles of the ankle.
Injuries to the lower leg and foot joints.
Incorrectly chosen shoes. Shoes that are too hard or too soft interfere with the formation of the correct arch of the foot.
Excess weight and increased stress.

Any causes of flat feet can contribute to the manifestation of other serious diseases, so the disease should be prevented. Often, suspicion of childhood flatfoot does not cause concern among the baby’s parents, and seems to be a minor deviation. However, this approach can be considered extremely incorrect.

Signs of flat feet in children

If not treated properly or completely ignored, the pathology can lead to a number of other diseases of the musculoskeletal system, these include: scoliosis, hernia, osteochondrosis and many other pathologies, including diseases of the internal organs.

To avoid possible consequences, you should pay attention to the signs of the disease in your baby.

Under the age of 3 years, it is very difficult to identify the disease on your own; to do this, you should consult a specialist. In addition, examination and consultation with an orthopedic doctor is included in the list of mandatory recommendations for children of this age.

Possible signs of flat feet in children:

Fatigue when moving;
Swelling of the foot;
Change in gait;
Change and expansion of the foot;
Aching pain;
Curvature of toes and nails growing into the skin;
Change in foot print.

At an older age, the disease can be determined independently, knowing the signs and symptoms. If symptoms are detected, you must undergo an examination and consult a doctor. He will help you accurately determine the disease and its stage, and then prescribe the appropriate treatment.

Treatment options for flat feet in children

Doctors divide flat feet into 3 types and 3 degrees of complications. The transverse view is formed between the base of the phalanges of the fingers. Longitudinal - along the inner arch of the foot. Valgus flatfoot - this diagnosis is made when the axis of the limbs is deviated.

I degree – subtle deformation of the foot, without pain.
II degree – signs of deformation become more noticeable, pain appears when moving.
III degree – stage of complete deformation of the foot. Movements are accompanied by severe pain, concomitant diseases appear: scoliosis, hernia, osteochondrosis, etc.

Before starting treatment, it is necessary to undergo a series of examinations and tests to determine the degree of deviation, based on the results of which specialists will be able to determine the necessary course of treatment. To treat flat feet, doctors prefer to use physiotherapy and medication.

Surgery is resorted to only in extreme cases.

With the first degree of deviation, a set of exercises and massage is used, aimed at strengthening the muscles and joints of the ankle, to prevent and prevent further deformation. For grades II and III diseases, medications are added to the course. If this treatment does not help, then surgery may be necessary.

Exercises to prevent flat feet

In order to prevent the disease, experts and traditional medicine advise carrying out a set of exercises aimed at strengthening the general tone of the muscles and joint-ligamentous apparatus.

Rolling from heel to toe and back;
Exercise on the wall bars;
Squats on toes;
Walk on inclined and uneven surfaces;
Squeezing the ball with your feet;
Walk on the inner and outer edges of the foot;
Rise and move on your toes;
Rolling round objects on the floor;
Play “Okay” with your feet;
Make squeezing and unclenching movements with your toes.

Such classes are carried out as a game or exercise in older groups of kindergartens (preschoolers) and primary schoolchildren. At the same time, you should carefully consider the number of exercises performed in order to prevent increased stress on the foot muscles.

Also, do not forget that properly selected shoes play an important role in the prevention of flat feet.

It should be carried out taking into account the structural features of the child’s foot and prevent pathological deviations. In addition, you should not choose shoes for growth. Using simple recommendations for the prevention of flat feet, you can not only prevent the disease, but also teach your child to a healthy lifestyle.

Treatment of flat feet in children (video)

Knowing and preventing diseases at an early age, you can contribute to the formation of a strong and healthy body in the future of the child, which is no less important, taking into account the changing factors of life.