Varus deformity of the hip joints. Juvenile epiphysiolysis - symptoms, diagnosis, treatment

Most patients have deformity femur associated with changes in the structure of her cervix. Only 10% of patients have deformity of the femoral head. This group mainly includes patients after a femoral neck fracture due to improper fusion of bone tissue.

Primary changes begin with shortening of the neck and thickening of its section in the area of ​​the diaphyseal joint with the acetabulum of the pelvic bone. The cervical axis and central diaphysis are subject to minor deformation, which is further aggravated by the contraction of certain femoral muscles. With varus deformity, shortening occurs along the inner surface. With hallux valgus, the curvature occurs with damage to the external muscles.

In approximately 70% of cases, the prerequisites for such a disease of the musculoskeletal system are formed at the stage of intrauterine development of the baby. And only in 25% of patients, deformity of the femur is associated with dystrophic lesions of cartilage and bone tissue. Typically, the first signs in this case appear in old age, during menopause, against the background of the development of osteoporosis. The traumatic nature of hip curvature is present in only 5% of patients with clinically diagnosed cases. This is due to the fact that in Lately are actively used for hip fractures operational methods restoration of tissue integrity. This allows for complete recovery without the formation of various types of degenerative deformities.

In this material you can learn more about the potential causes of femoral deformity in children and adults. It also describes what methods of manual therapy can effectively and safely carry out treatment in order to completely restore the physiological state of the femur.

Why does femoral neck deformity occur?

Primary hip deformity occurs only as a congenital pathology, which may not appear until adulthood. Gradual deformation of the femoral neck is a consequence of the influence of negative factors, such as:

1. maintaining a sedentary lifestyle;
2. excess body weight;
3. smoking and drinking alcoholic beverages;
4. incorrect placement of feet when walking and running;
5. heavy physical labor with maximum load on the hip joints;
6. femoral neck fractures;
7. wearing high-heeled shoes.

Secondary deformity of the femoral neck always develops against the background of other diseases lower limbs. Among the most likely pathologies are:

• deforming osteoarthritis hip joints(cosarthrosis);
• deforming osteoarthritis of the knee joints (gonarthrosis);
• curvature of the spine in the lumbosacral region;
• symphysitis and divergence of the pubic bones during pregnancy in women;
• incorrect placement of the foot in the form of flat feet or club feet;
• tendonitis, tendovaginitis, bursitis, cicatricial deformities of the soft tissues of the lower limb.

It is also worth considering risk factors. These include intrauterine pathologies of bone skeleton development, rickets in early childhood, osteoporosis in middle and old age, vitamin D and calcium deficiency, endocrine diseases (hyperthyroidism, diabetes mellitus, adrenal hyperfunction, etc.).

For successful treatment Hip deformity requires eliminating all possible causes and negative risk factors. Only in this case is it possible to get a positive effect.

Varus deformity of the femoral neck (thigh)

The pathology is divided into two types: valgus and varus deformation of the femur; in the first case, the curvature occurs in an X-shaped manner, in the second - in an O-shaped manner. Both types are associated with changes in the angle located between the head and diaphysis of the femur. Normally, its parameter ranges from 125 to 140 degrees. Increasing this value to 145 - 160 degrees leads to the development of an O-shaped curvature. A decrease in the angle entails varus deformation of the femoral neck, in which the rotation of the lower limb will be sharply limited.

With hip varus, moving the leg away from the body is difficult and causes severe pain in the hip joint. Therefore, the primary diagnosis is often made incorrectly. The doctor suspects destruction and deformation of the femoral head and acetabulum. To confirm the diagnosis of deforming osteoarthritis, an X-ray of the hip joint in several projections is prescribed. And during this laboratory examination, varus deformity of the femoral neck is revealed, which is clearly visible on radiographic photographs in direct and lateral projections.

Several stages can be identified in the development of hip curvature:

1. slight deformation with a change in the angle of inclination by 2-5 degrees does not cause discomfort and does not give visible clinical signs;
2. the average degree is characterized by significant curvature and leads to the patient having problems performing certain movements in the hip joint;
3. severe deformity leads to shortening of the limb, complete blocking of rotational and rotational movements in the projection of the hip joint.

In adults, varus deformity often results from aseptic necrosis of the femoral head. This pathology also accompanies mucopolysaccharidosis, rickets, bone tuberculosis, chondroplasia and some other serious diseases.

Valgus deformity of the necks of the femurs (hips)

Juvenile and congenital valgus deformity of the femur is often diagnosed, which is characterized by a rapidly progressive course. When looking at a patient with such a deviation, it seems that he is bringing his legs together at the knees and is afraid to unclench them. X-shaped valgus deformity of the femoral necks can be a consequence of hip dysplasia. In this case, the first signs of hip curvature appear at approximately the age of 3-5 years. Subsequently, the angle of deviation will only increase due to the ongoing pathogenic processes in the cavity of the hip joint. Ligament shortening and contraction muscle fibers will increase curvature and deformation.

Congenital deformity of the femoral neck in a child may be caused by the following teratogenic factors:

• pressure on the growing uterus from the internal organs of the abdominal cavity or when wearing tight, constricting clothing;
• insufficient blood supply to the uterus and growing fetus;
• severe anemia in a pregnant woman;
• disruption of the ossification process in the fetus;
• breech presentation;
• transferred viral and bacterial infections to later pregnancy;
• taking antibiotics, antivirals and some other drugs without medical supervision.

Congenital valgus deformity of the femur is characterized by severe flattening of the articular surface of the acetabulum and total shortening of the diaphyseal portion of the femur. An X-ray examination shows an anterior and upward displacement of the femoral head with curvature of the neck and shortening of the bone section. Fragmentation of the epiphysis may appear at a later age.

The first clinical symptoms of valgus deformity of the femoral neck in children appear when they begin to walk independently. The baby may have shortened one leg, lameness, and a peculiar gait.

The juvenile type of pathology is that valgus deformity of the hip begins to actively develop in adolescence. At the age of 13 - 15 years, hormonal changes in the body occur. With an excessive amount of produced sex hormones, the pathological mechanism of epiphysiolysis (destruction of the head of the femur and its neck) can be triggered. When bone tissue softens under the influence of the growing body weight of a teenager, valgus deformation begins with deviation of the distal end of the femur.

Children with obesity and overweight who lead a sedentary, sedentary lifestyle and are addicted to carbohydrate foods are at risk. It is necessary for such adolescents to be periodically shown to an orthopedist for timely detection of the disease at an early stage of its development.

Symptoms, signs and diagnosis

Clinical symptoms of valgus and varus deformity of the femur are difficult to miss. A characteristic deviation of the upper leg, lameness, and specific positioning of the legs are objective signs. There are also subjective sensations that can signal such trouble:

• nagging, dull pain in the hip joints that occurs after any physical activity;
• lameness, dragging of the leg and other gait changes;
• feeling that one leg has become shorter than the other;
• dystrophy of the thigh muscles on the affected side;
• the rapid appearance of a feeling of fatigue in the leg muscles when walking.

Diagnosis always begins with an examination by an orthopedic doctor. An experienced doctor will be able to make the correct preliminary diagnosis during the examination. Then, to confirm or exclude the diagnosis, an x-ray of the hip joint is prescribed. In the presence of characteristic features the diagnosis is confirmed.

How to treat hip bone deformity?

Valgus deformity The hip bones of a child are perfectly amenable to conservative methods of correction. But only in the early stages can the physiological state of the head and neck of the femur be completely restored. Therefore, when the first signs of trouble appear, you should seek medical help.

The following manual therapy methods can be used to treat deformity of the femoral head:

1. kinesiotherapy and therapeutic exercises are aimed at strengthening the muscles of the lower extremities and, by increasing their tone, correct the position of the head of the bone in the acetabulum;
2. massage and osteopathy allow, through physical external influence, to carry out the necessary correction;
3. reflexology starts the recovery process by using the body’s hidden reserves;
4. physiotherapy, laser treatment, electrical myostimulation are additional methods of therapy.

Any correction course is developed individually. Before treating a femur deformity, you should consult an experienced orthopedist.

In our manual therapy clinic, each patient has the opportunity to receive professional advice from an experienced orthopedist completely free of charge. To do this, just make an appointment for the first time.

The main manifestation of the disease is a decrease in NAS of less than 120°. Two forms of the disease have been identified: congenital varus deformity and developmental varus deformity. Congenital deformity is found in a newborn. The causes of the disease are pressure from the walls of the uterus, aseptic necrosis of the physis and femoral neck, and delayed ossification due to insufficiency of the feeding vessels. Varus is accompanied by signs of dysplasia in the form of flattening of the acetabulum, congenital dislocation or congenital underdevelopment of the hip, as well as different leg lengths. Varus developmental deformity or secondary deformity is diagnosed after the age of 4 years. It is associated with metabolic disorders and occurs in diseases such as rickets, femoral head epiphysiolysis, Morquio's disease, osteogenesis imperfecta, mucopolysaccharidosis, metaphyseal chondrodysplasia, and infection. VDB is both unilateral and bilateral in nature. Unilateral curvature was noted in 60-75% of cases. A bilateral process, which occurs in 25-40% of cases, is largely associated with general metabolic disorders - rickets, osteomalacia, osteogenesis imperfecta.

With VDB, several processes simultaneously occur in the proximal femur that determine the nature of the disease. The action of etiological factors leads to disruption of the ossification of the cartilaginous matrix of the femoral metaphysis, which is called local fatigue dystrophy. The strength of the bone is not enough to resist the force of weight. There is a slow flexion of the femoral neck along with the head and the development of varus deformity of the proximal femur. The flexion moment of the force acting on the proximal femur increases. In the femoral neck, the compression component of the force decreases and its displacement component increases. Pathological flexion of the femoral neck and head develops simultaneously with the physiological growth of the greater trochanter in the cranial direction, as a result of which the apex of the trochanter is set higher than the center of rotation of the hip joint, and the attachment points of the abductor muscles of the hip move closer to each other. The abductor muscles weaken, muscle imbalance occurs, the adductor muscles become dominant, and hip abduction decreases. Varus deformity of the hip is accompanied by a decrease in hip anteversion up to its retroversion, resulting in a decrease in internal rotation of the hip. Varus and version reduce the space for abduction of the hip, which during abduction causes the greater trochanter and femoral neck to push into the edge of the acetabulum and into the ilium. The fixation points of the abductor muscles come closer and weaken. During walking, the strength of the abductor muscles is not enough to lift the pelvis upward on the side of the carried leg. Instead of lifting, the pelvis is lowered on the side of the transferred leg. On the side of the femoral varus, a Trendelenburg symptom occurs with deviation of the trunk towards the supporting leg to reduce the load on the abductor muscles.

A child with VDB has a delay in the onset of independent walking. From the age of 2 years, standing impairment becomes noticeable. The symptoms of the disorder are associated with the symmetry of the hip lesion. With unilateral varus deformity, there is an apparent increase in the size of the greater trochanter and its protrusion in the cranial direction. When the leg is shortened within 1-1.5 cm, there is lameness in the affected leg. If there is significant weakness of the abductor muscles, the child is diagnosed with Trendelenburg's symptom. With a bilateral process, there is a hobbling gait with a large amplitude of trunk deviation in the frontal plane. The difference in leg length increases with age, which leads to worsening symptoms.

VDB is diagnosed using radiography. The radiograph of the femur shows fragmentation of the metaphysis and epiphysis, expansion of the epiphyseal plate, as well as a triangular bone fragment at the junction of the neck with the epiphysis, often along its lower surface. In 3/4 of cases, flattening of the acetabulum was noted. On the radiograph in the anteroposterior projection, Hilgetzreiner's intertrochanteric line is drawn through the Y-shaped cartilage of the acetabulum and a second line along the edge of the femoral epiphysis. An interacetabular-epiphyseal angle is formed, which in a 7-year-old child ranges from 4 to 35°, averaging 20°. In an adult, an angle of less than 20-25° is considered normal. With varus of the proximal femur, the angle reaches 60°. VDB is characterized by a progressive nature of the course. An increase in deformity is accompanied by a deterioration in walking without pain. Spontaneous cessation of the development of hip curvature occurs when the interacetabular-epiphyseal angle is less than 45°.

Treatment

Conservative methods of treating femoral varus deformity in the form of traction or immobilization are considered ineffective. Preventive shoes are used to prevent the development of secondary deformity in the distal parts of the lower limb. Using a shoe insole, the length of the lower limbs is equalized and the progressive shortening of the affected leg is compensated.

Indications for surgical treatment depend on the magnitude of the deformity, the course of the disease and the age of the patient, of which the priority parameter is the angle of curvature of the hip. At MEU from 45 to 60°, observe and perform X-ray examination Once every six months. Radical treatment methods are resorted to in case of progression of the deformity. Indications for surgery are an increase in MEA of more than 60°, a decrease in NW of less than 100-110°, a positive Trendelenburg sign, as well as a visible deterioration in walking. A contraindication to surgery is the absence of clinical symptoms when the MEU is less than 45°, as well as the absence of curvature progression when the MEU is less than 60°. Compared to the magnitude of the deformity, age is a less important indication for surgery. Each age period has its own advantages for surgical intervention. Early operations before the age of 2 years are rarely performed due to the slight severity of bone deformation. On the positive side intervention at an early age is the possibility of complete remodeling of the deformed bone. The restoration of bone structures after surgery in children aged 18 months is described. In children over 2 years of age, there are more reasons to use surgical treatment methods due to a greater degree of deformity. U big baby It is relatively easier to fix the bone. The operation is performed for the following purposes:

• correction of varus curvature and anteversion of the femur to reduce the shear force and increase the compression force at the femoral neck;
• equalization of the length of the lower limbs;
• reconstruction of the greater trochanter in order to create conditions for the work of the abductor muscles.

Surgery: subtrochanteric osteotomy

Indications: varus deformity of the proximal femur, MEU more than 60°, NFS less than 100-110°.

A lateral skin incision above the greater trochanter is 10-12 cm long. A pin is inserted into the femoral neck parallel to the upper edge under the control of an image intensifier. Using a drill or oscillating saw, a slot is created in the femoral neck parallel to the wire for the plate. Use a plate bent at an angle of 140°. A horizontal branch of the plate is driven into the bone gap. An osteotomy is made in the subtrochanteric region at a distance across the femur below the angle of the plate. Under the control of the image intensifier, a transverse intersection of the femoral diaphysis is made using an oscillatory saw or osteotome. The proximal fragment of the femur is adducted and the distal fragment is abducted. The proximal fragment is installed on the distal one in such a way that the lateral cortical of the proximal fragment is in contact with the bone sawdust of the distal fragment. The vertical branch of the plate is screwed to the diaphysis of the femur. The triangular bone fragment is repositioned to the femoral neck. The needle is removed. A coxite plaster cast is applied to the affected leg for a period of 8 to 10 weeks.

Treatment results

On average, valgus osteotomy allows you to reduce the MEU5 to 35-40°, and increase the NSA to 130-135°. Subtrochanteric and intertrochanteric osteotomies give approximately similar correction results. IN postoperative period there is a loss of correction. 9-10 years after the intervention, NRL decreases from 137 to 125°, and MEU increases by almost half. In the postoperative period for 3 years, almost all patients experience closure of the growth zone of the proximal physis of the femur, after which a lag in the growth of the femur is noted. Shortening of the legs is compensated by orthopedic shoes. A significant decrease in thigh length is an indication for surgical intervention. Lengthening of the bones of the short leg is performed more often; shortening of the bones of the contralateral limb is performed less often. Half of the patients after the intervention have weakness of the hip abductors. In 60% of cases, excessive growth of the greater trochanter is observed, which is eliminated by apophysiodesis. In 87% of cases there is a decrease in the size of the femoral head, in 43% of cases there is its flattening, as well as flattening of the acetabulum.

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An analysis of the treatment of 47 children withcongenital varus deformity of the femoral neck(VVDShBK), who were treated at the Russian Research Institute for Children's Orthopedics named after. G.I. Turner and RSDKONRTS from 1975 to 2005. The age of the patients ranged from 1 month to 19 years, there were 14 boys, 33 girls. Right-sided localization was observed in 31, left-sided in 14, bilateral localization was noted in 2 patients.

The pathological symptom complex included shortening of the limb from 3 to 25 cm, external rotation, adduction or flexion contracture in the hip joint. X-ray manifestations of congenital varus deformity of the femoral neck were characterized by a violation of the spatial position and pathological state of the structure of the bone tissue of the proximal end of the femur. Femoral neck varus deformity (FNC) ranged from VP to 30°. The state of the bone tissue structure consisted of delayed ossification of the neck and head of the femur, dystrophy of the neck of varying degrees against the background of its dysplasia, intertrochanteric pseudarthrosis, as well asfemoral neck defect. Based on the conducted research, a classification of congenital varus deformity of the femoral neck has been developed, taking into account the magnitude of the femoral neck, the state of the bone tissue structure and the amount of shortening: 1st degree of severity: NDE 90-110°, delayed ossification or dystrophy of the femoral neck 1-2 degrees, shortening hips up to 30%; 2nd degree of severity: NAL less than 90°, dystrophy of the femoral neck of 2-3 degrees or pseudarthrosis in the intertrochanteric region, shortening of the femur by 35-45%; 3rd degree: NAL less than 70°, defect of the femoral neck, shortening of the femur by more than 45%.

The above classification of congenital varus deformity of the femoral neck served as the basis for developing indications, firstly, the method of treatment (conservative or surgical), and secondly, the choice of a specific surgical technique.

The indication for conservative treatment was grade I of congenital varus deformity of the femoral neck in children under 3 years of age. Conservative treatment consisted of creating a favorable position of the femoral head in the hip joint using a Freik pillow, a Mirzoeva splint, and in children older than one year - wearing an orthopedic device with a landing on the ischial tubercle (Thomas type). Massage and physiotherapy were carried out aimed at improving blood supply to the hip joint. The indications for surgical treatment were grades II and III of congenital varus deformity of the femoral neck, as well as grade I in children over 2-3 years of age with a NDE value of less than 110°.

Degree I of congenital varus deformity of the femoral neck with signs of dystrophy of the femoral neck and NAL less than 110° was an indication for surgery using the technique we developed. The basis of the operation was the transposition of a trapezoid-shaped fragment of the femur with the lesser trochanter under the zone of degeneration of the femoral neck and simultaneous correction of the femoral neck. II-III degree of severity of congenital varus deformity of the femoral neck was an indication for early surgical treatment, which was aimed at eliminating the vicious installation of the hip and consisted of operations on soft tissues surrounding the hip joint. The II degree of severity of congenital varus deformity of the femoral neck in children over 2-3 years of age was an indication for correction of the spatial position of the proximal femur according to the method we developed (patent for invention No. 2183103). The basis of the operation was intertrochanteric detorsion-valgus osteotomy of the femur, accompanied by myotomy of the adductors, lumboiliac, rectus and sartorius muscles, cutting off the fibrous cord of the anterior portion of the gluteus medius muscle and dissecting the fascia lata of the thigh in the transverse direction. III degree of severity of the lesion (defect of the femoral neck) in children over 6 years of age was an indication for osteosynthesis of the head and proximal end of the femur using (for neck plastic surgery) a musculoskeletal complex of tissues on a feeding vascular-muscular pedicle with fixation of fragments with knitting needles or screws.

The absence of the head, a pronounced adductor contracture in the hip joint in children over 12 years of age and adolescents was the basis for reconstructive surgery on the proximal femur with the formation of an additional point of support for the femur in the pelvis.

39 children were operated on using the proposed surgical methods; 8 patients received only conservative treatment. When applying the treatment tactics we developed for children with congenital varus deformity of the femoral neck, good and satisfactory functional results were obtained in 93.6%.


Vorobyov S.M., Pozdeev A.P., Tikhomirov S.L.
Republican specialized children's clinical orthopedic-neurological rehabilitation center, Vladimir, RNID im. G. I. Turner, St. Petersburg

Varus deformity of the femoral neck Cervical-diaphyseal angle is less than average (120 -130°) Causes: § Congenital dislocation of the hip § Juvenile epiphysiolysis § traumatic § rachitic deformity § with systemic diseases: fibrous osteodysplasia, pathological fragility of bones, dyschondroplasia § consequence of surgical interventions in the area femoral neck § consequences of osteomyelitis, tuberculosis, subcapital osteochondropathy

Clinic: With congenital duck gait, rapid fatigue in the hip joint while walking. functional shortening of the limb by 3-5 cm or more; limitation of abduction in the hip joint; positive Trendelenburg sign. Treatment: Subtrochanteric osteotomy

Valgus deformity of the femoral neck. Increased neck-shaft angle. ü Congenital ü Traumatic ü Paralytic Clinic: no visible deformities § with accompanying deformities of the knee and foot, gait changes, cosmetic defects Treatment: 1) exercises and corrective poses (“Turkish”) 2) surgical: subtrochanteric osteotomy of the femur.

Varus and valgus deformity of the knee joints Causes: § congenital, § rickets, § early standing Varus deformity – the angle is open inwards, Onogi Valgus deformity – the angle is open outwards, X-legs

Valgus deformity Varus deformity enlargement of the external condyle, reduction of the internal one - compression of the internal meniscus increase in the internal condyle, decrease in the external one - compression of the external meniscus joint space is wider on the outside joint space is wider with inside ligaments are stretched, strengthening knee-joint with later. On the sides, the ligaments that strengthen the knee joint are stretched on the medial side of the shin, often curved with a convexity outward, planovarus position of the feet (clubfoot), planovalgus position of the feet (Flatfoot) in severe cases: rotation (rotation) of the thigh outward, and the tibia (its lower third) inward. v Unilateral v Bilateral: symmetrical (concordant deformity) / discordant deformity.

Diagnostics 1) Protractor 2) Distance m/d medial. ankles (exceeds 1.5-2.0 cm - up to 2 years, 3 cm - 3-4 years and 4 cm - older age) 3) X-ray - 3 degrees

Treatment 1) 2) 3) 4) Massage Therapeutic gymnastics Orthopedic shoes Surgical treatment - valgus and varus osteotomy

Flatfoot is a change in the shape of the foot, characterized by drooping of its longitudinal and transverse arches. TYPES: longitudinal flatfoot transverse flatfoot longitudinal-transverse

Arches of the foot Longitudinal arches: 1) External/cargo (calcaneus, cuboid, IV and V metatarsals) 2) Internal/spring (talus, navicular and I, III metatarsals) Transverse arch (metatarsal heads)

Etiology Acquired Rachitic flatfoot Paralytic flatfoot (AFTER POLIOMYELITIS) Traumatic flatfoot (FRACTURES OF THE ANKLES, CALCANEAL, K. TARSAL) Static flatfoot (excessive load on the foot) Congenital

Clinic Complaints: § fatigue, pain in the calf muscles at the end of the day § pain in the arch of the foot when standing and walking Typical signs: Ø lengthening of the foot and expansion of its middle section Ø reduction or complete disappearance of the longitudinal arch (the foot rests on its entire plantar surface) Ø abduction (valgus abduction) of the forefoot (toe points outward) Ø pronation (outward deviation) of the heel bone over 5 -6°; In this case, the inner ankle protrudes, and the outer one is smoothed.

Stages of flat feet q. Hidden stage q. Stage of intermittent flatfoot q. Stage of development of the flat foot q. Stage of flatvalgus foot q. Contracture flatfoot

Diagnostics 2) Podometry according to Friedland - determination of the percentage of the height of the foot and its length (N = 31 -29) 3) Feis' line - a line drawn from the top of the inner ankle to the lower surface of the base of the head of the first metatarsal bone (in N - does not intersect the top of the scaphoid bone )

Diagnostics 4) Clinical method(normally the height of the arch is 55 -60 mm, the angle is 90◦) 5) X-ray method (normally the angle is 120 -130◦, the normal height of the arch is 35 mm)

Degree of flatfoot I degree: Friedland index 25 - 27 clinical angle 105◦ radiological angle up to 140◦ arch height less than 35 mm II degree: radiological angle up to 150◦ arch height less than 25 mm signs of def. Osteoarthrosis degree III: radiographic angle up to 170 -175◦ arch height less than 17 mm flatness of the forefoot

Treatment q In the stage of development of flat foot: I degree: warm baths for the legs, massage, exercise therapy to strengthen the muscles of the lower leg, wearing insoles for arch support of the 2nd degree: + wearing orthopedic shoes of the 3rd degree: + surgical treatment

q In the stage of contracture flatfoot Non-operative: ü blockade of the posterior tibial nerve; ü plaster casts Surgical: ü three-joint arthrodesis of the foot (talonavicular, calcaneocuboid, subtalar) After the onset of arthrodesis, it is necessary to wear orthopedic shoes to form the arch of the foot

ü Operation according to Bogdanov F.R. - resection of the calcaneocuboid and talonavicular joints with subsequent arthrodesis of these joints in the corrected position of the arches - lengthening of the peroneus brevis tendon - transplantation of the peroneus longus tendon onto the inner surface of the foot - lengthening of the calcaneal tendon with elimination of pronation heel and abduction of the forefoot ü Operation according to Kuslik M.I. - crescentic transverse resection of the foot - lengthening of the calcaneal tendon - transplantation of the peroneus longus tendon to the inner surface of the foot

Transverse flatfoot is a deformation of the foot, manifested by flattening of the distal metatarsus in combination with valgus deviation of the first toe, the development of deforming arthrosis of the first metatarsophalangeal joint and limitation of movements in this joint, as well as the occurrence of hammertooth deformity of the II-V toes Causes: § congenital weakness of the ligamentous apparatus/hormonal changes § incorrectly selected shoes.

Treatment of transverse flatfoot Operations on the tendons of the muscles of the first finger (t. extensor et flexor hallucis longus, t. Adductor ü transposition of the long flexor tendon of the first finger onto the long extensor tendon ü Adductorotenotomy Schede-Brandes operation - resection of osteochondral exostosis of the head of the first metatarsal bone, resection base of the main phalanx of the first toe McBride operation - cutting off the adductor tendon of the first toe from the base of the main phalanx and suturing it to the head of the first metatarsal bone Operations for bringing together the metatarsal bones: ü creation of an artificial transverse ligament of the forefoot

Hammertoe deformity Ø with transverse flatfoot Ø with childhood cerebral palsy Ø poliomyelitis (with planovalgus foot) Ø myelodysplastic cavus

Exostoses of the heads of the 1st and 5th metatarsal bones Subluxation valgus deviation *there are no signs of transverse flatfoot, deformities of other fingers are not observed

Varus deformity of the lower extremities is a serious pathology that is most often observed in children of primary school age. Therefore, mothers (both young and more experienced) need to carefully monitor their long-awaited baby in order to notice the problem in time and begin treatment in a timely manner.

However, varus deformity of the lower extremities can also appear at an older age. What could be the reason? Let's find out.

We will also look at how varus deformity of the lower extremities manifests itself in children, what preventive measures should be used to prevent it and what methods of treatment exist for this disease.

Description of the disease

How can you tell if your child has varus deformity of the lower extremities? You can even identify the disease by visually examining your baby’s legs, since at first the disease can be asymptomatic, without causing pain or other inconvenience to the child.

What does varus deformity of the lower extremities look like in children? The photos given in this article will help you identify the disease at the very beginning of its manifestation.

It is worth mentioning that when the baby’s feet are tightly compressed, his knees do not touch each other, but diverge from each other at a distance of five centimeters or more.

If your child is already walking, then pay attention to his shoes. If her sole is worn off outside, then this is a serious cause for concern.

If you find any abnormalities (regardless of whether you examined the child's lower limbs or his shoes), you should immediately consult a doctor. He will appoint necessary treatment to your baby. Naturally, if therapy is started as quickly as possible, the baby’s recovery will be quite easy and quick.

Danger

However, some parents do not attach much importance to this disease. They believe that it is a cosmetic or external problem, so they do not focus on the disease. However, it is not.

Varus deformity of the lower extremities can negatively affect a child's health and self-esteem. The pathology leads to the fact that the baby’s legs begin to tangle, he often falls, and gets tired faster. If the disease is not treated, it will provoke deformation of the foot, lower leg or the entire lower limb. Moreover, the child’s gait and posture will change, the spine will curve, and pain will appear in the back and legs.

Similar pathological changes can cause a lot of anxiety and confusion in the child.

What are the causes of varus deformity of the lower extremities?

Disease provocateurs

It is very important to know about the possible causes of the disease. This will help parents understand that their child is at risk and sound the alarm in time. In addition, loving parents will be able to create the necessary conditions for your baby to prevent a dangerous disease.

So, the causes of pathology can be:

1. Heredity. That is, one of the parents or grandparents has a history of deformity of the lower extremities.
2. Congenital pathologies, birth injuries, endocrine diseases.
3. Excess weight of the child, due to which it turns out high pressure on fragile bones of the legs and feet.
4. Injuries of the lower extremities.
5. Rickets, which is a consequence of a lack of beneficial vitamin D.
6. Weakened immunity, which causes the body to stop fighting infections.
7. Incorrectly selected comfortable shoes.
8. Trying too early to teach a child to walk. If you put your baby on the floor or in a walker before a certain time, his still weak legs may become bent.

Preventing illness

As we can see, prevention plays an important role in preventing the disease. To do this, it is necessary to ensure that the child is properly fed. healthy food, received the necessary vitamins and microelements, did not overeat and led an active lifestyle, avoiding injuries, falls, etc.

A necessary condition that many parents do not pay attention to is comfortable shoes that do not squeeze the foot, but are not too loose. Timely training of the baby in walking skills is important. There is no need to chase after those who started at eight months - this is not a sign of genius or special talent. All children are different, there is a time for everything, be patient.

But what should you do if your baby's legs are causing you concern? First of all, you need to contact a qualified orthopedic doctor.

Diagnosis of the disease

Before making a diagnosis, the specialist will send the baby for examination. What is it?

First of all, the doctor will examine the little patient and then send him for an x-ray. This diagnostic very effective. The photographs always show any developmental abnormalities or deformations. Sometimes it may be necessary to take x-rays of not only the lower extremities, but also the hips or joints.

An orthopedist may also recommend an MRI or CT scan if there is a suspicion of a genetic cause of the disease.

To exclude the development of rickets, it is necessary to take a blood test. The specialist will look at calcium, alkaline phosphatase and phosphorus levels.

But what to do if the diagnosis is confirmed? First of all, the Orthopedist will prescribe the necessary treatment, consisting of several stages. It will be important to carefully follow your doctor's orders. What do they include?

Drug treatment of varus deformity of the lower extremities

Before prescribing one or another, a specialist will determine the cause of the disease. If the disease was caused by a lack of vitamins, rickets, a violation of the mineral composition of bones or endocrine changes, then the specialist will prescribe drug therapy to eliminate the “culprit” of the disease. These can be specialized pharmacological drugs in combination with high-quality nutrition. Physiotherapeutic procedures are carried out in parallel.

However, this, of course, is not enough. The doctor will develop individual exercises, will prescribe therapeutic massage and wearing orthopedic shoes. More on this below.

A little about massage

With varus deformity of the lower extremities in children, massage is one of the primary values. It not only relieves pain and spasms, relaxes muscles and joints. A massage performed with the necessary strength and skill can slightly correct the position and arch of the child’s lower extremities.

It is necessary to massage the baby's feet, ankles, knees and, in some cases, hips. An orthopedist will show you what exactly to do and how. You can do the massage yourself, but it is better to entrust it to professionals with medical education. The attending physician will definitely familiarize parents with the step-by-step implementation of the antivarus technique.

A little about gymnastics

Gymnastics occupies a central place in the daily routine of a sick child. The orthopedist will again introduce you to a detailed set of exercises suitable for your child. Let us only mention that there is a whole range of movements that can correct the shape of the lower extremities. These may include:

• walking on toes and heels;
• forceful squeezing of a rubber ball with your feet;
• rolling your feet on the floor of the gurney;
• walking on an orthopedic mat;
• intense circular movements

Regular gymnastics and swimming are quite effective.

A few words about shoes

The issue of choosing the right shoes for varus deformity of the lower extremities is important. Orthopedic shoes can correct impaired gait, straighten feet and stop deformation of children's feet. The main goal of this treatment method is to properly fix the foot and prevent its curvature.

It is made according to a doctor’s prescription, taking into account specially removed ones from boots, shoes and even slippers. For a less advanced form of the disease, the baby may be recommended orthopedic insoles, instep supports and more.

And one more piece of advice - you should walk at home either in specialized orthopedic slippers or barefoot.

Surgical treatment of varus deformity of the lower extremities in children

In advanced forms of the disease, it can be carried out surgical intervention. What is it?

Surgery is a very serious way to treat varus deformity and can significantly improve your baby’s condition. During surgery, an orthopedic surgeon cuts out a small part of the tibia and attaches it to the lower leg using special screws or clamps. The next stage of the surgical intervention will be an installation that will need to be worn for a long time, perhaps several months.

Certainly, surgical method carries many dangers and complications, which may include:

• severe pain;
• the occurrence of inflammation or infections;
• vascular damage, blood loss or hematoma.

It is best not to delay treatment of the disease and contact a medical facility in time to avoid surgical intervention. If the surgical method was recommended by a specialist, do not worry! A positive attitude and competent care will help your baby quickly go through the rehabilitation stage and return to normal life.

Finally

Varus deformity of the lower extremities is a serious disease, fraught with serious negative consequences. Since it can be determined by visual examination of the child, try to take a closer look at your baby’s legs, gait and shoes more often. If you have any symptoms that bother you, you should consult a doctor as soon as possible. The specialist will prescribe the child treatment, which includes the necessary set of drugs and procedures that can be easily carried out at home.

Good health to you!