The longitudinal arches found in 20% of all cases of flat feet. The reasons for the static longitudinal flat muscle weakness of the foot and lower leg bones ligaments. This reduces the internal longitudinal arch of the foot. Calcaneus is rotated medially, the tendon calcaneus is displaced outwards.
There is a movement of the bones of the foot so that the front part of the foot deviates laterally. Peroneus longus tendon stretched, the tibialis anterior muscle is stretched on the contrary. The appearance of the foot is changed. The foot is extended. Average part expanded. Longitudinal arch is omitted, the entire foot is turned inwards. On the inner margin of the foot through the skin can be seen the outlines of the navicular bone. This state is reflected in the gait of the foot, which has become unwieldy, with highly diluted in hand socks.
Distinguish the following stages of the current longitudinal flat:
prodromal stage
stage of tidal flat
stage of development of flat feet
In the prodromal stage (stage predbolezni), the patient appeared tired, sore feet after a long static load on it. The pain usually occurs in the calf muscles at the top of the arch. In support of the foot include calf muscles that become painful from the constant voltage. At this stage of the disease the patient is recommended correct gait, without dilution of socks when walking. Those who by the nature of their work must stand long need to set foot in parallel, and from time to time to give your muscles a set of discharge. To do this, put feet on their outer surface, and while standing in that way.
A good effect has walking barefoot on uneven terrain and sand. Appointment is necessary physical therapy, special exercises to train the leg muscles and foot arch support. We recommend massage, physiotherapy, daily baths for feet and legs. All these activities help to improve blood circulation and lymphatic outflow, and to improve the nutrition of muscles, ligaments and bones of the foot.
The next stage - the stage of tidal flat. At this stage, pain in the feet and legs are amplified by the end of the day, but they often appear after a long walk, especially walking on his heels, after prolonged standing. The muscles become tense, it may be time to contracture (shortening, compaction muscle). The longitudinal arch of the foot by the end of the day it becomes more flat, but the morning after sleeping the normal form of the foot is restored. Determine the degree of severity of flatfoot with special techniques: plantografiya, Podometry, x-rays. At the stage of tidal flat show a slight decrease in the vault. At this stage of conducting the same activities, we recommend that you change the conditions of employment.
If the arch is no longer able to recover after a long rest, it starts the next stage - the stage of development of flat feet. The patient has pain and fatigue in the feet developed after a small static load. Gradually the pain becomes almost constant. The foot is extended, the front part of its expanding vault becomes lower. At this stage, may change gait, which becomes awkward. At this stage, depending on the height of the arch are three degrees of the disease.
First degree - this is the beginning of the formation of a flat foot. Height of the arch when it is below 35 mm. With second-degree arch height from 25 to 17 mm. At this stage, due to the increased load and declining terms of circulation and nutrition of developing osteoarthritis in the joints of the foot. Lowering the body of 17 mm below the third stage of development means a flat foot.
Changes in the shape of the foot leads to the fact that body weight is not distributed as normal, on the whole foot, and are found mainly in the talus and the anterior calcaneus. The foot is rotated inward, its front part is spread. The first toe is deflected outward. The pain is decreased, but this does not mean better. Treatment at this stage of disease than the foregoing, includes wearing insoles instep, orthopedic shoes. In the absence of disease progression and the effect of surgical treatment is recommended.
If the patient is not treated, it develops the next stage - ploskovalgusnaya stop. At this stage the pain in his foot appears already at low load. Arch of the foot flat, and she stops abruptly turned soles medially (valgus deformity of the foot). At this stage the possibility of conservative treatment are limited, appointed by the surgery. Performs complex plastic surgery by different methods: a long tendon transplant peroneus longus at the inner edge of the foot, resection of talocalcaneal joint and the other type of surgery depends on the degree and kind of flat on the qualifications of trauma surgeons.
