Valgus of the feet in a child: causes, treatment. Orthopedic footwear for children. Foot problems in a child Foot problems in children
WHAT IS ORTHOPEDICS
Orthopedics is a medical discipline that studies the prevention, recognition and treatment of diseases, deformities and the consequences of damage to the human musculoskeletal system.
Orthopedics has deep roots. Undoubtedly, even before our era, treatment of joint dislocations, bone fractures and congenital skeletal deformities was carried out. The date of birth of orthopedics as a science is 1741, when the French physician Nicolas Andry (1658-1742) published his two-volume work under this title. Translated from Greek, orthos means straight, paedos - child, and orthopedics is characterized by the author as "... the art of preventing and treating deformities of the body in children", and the parents of the child 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. In the future, they
improved, improved and made the foundation on which modern children's orthopedics stands.
Despite the fact that at present, orthopedics and traumatology are combined into one specialty of a surgical profile, prevention, detection and bloodless treatment of deformities are the main tasks of a pediatric orthopedist.
Orthopedics symbol from the book N. Andry
The symbol of this medical discipline is a crooked tree tied up. This 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 timely make the necessary adjustments to this process. They say about a boy: "Slender as a cypress", about a girl: "Slender as a birch tree." A crooked tree is usually pitying, just like a crooked child. I would like to straighten him, and it is easier to do this while the child is small and the formation of his skeleton is not completed.
The child must be created after his birth. The growth and development of the child is stimulated by the love of the parents, good nutrition, exercise and adequate sleep.
Orthopedic pathology in children is divided into two approximately equal groups in number. One is made up of congenital skeletal deformities and hereditary diseases leading to systemic disorders, the other is acquired pathology. In addition, deviations from normal development may be the result of a combination of individual characteristics that are inherited by the parents to the child. These include the constitution, tissue structure, metabolism, etc. For example, a child is born with great weight and height, which in itself is not a pathology, but in combination with a certain shape of the lower limbs, the factor of excess weight can lead to deformation of the feet at the stage of standing up baby to his feet and at the beginning of walking.
Groups of orthopedic pathology in children
It is possible to identify and eliminate the arising disorders of the musculoskeletal system in a timely manner. To do this, you need to know the main features of the normal anatomical structure of the child's skeleton, trends and key age terms 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 abnormalities of the musculoskeletal system are possible: the consequences of birth trauma, inflammatory diseases, altered metabolism and dysfunction of internal organs. Therefore, it is very beneficial for the child to be examined by an orthopedic doctor at the age of one month. By this time, the parents should have a definite impression of the baby's musculoskeletal system. They will share their observations with the doctor at the first visit, which will help to identify pathology and determine the correct tactics to eliminate it. In cases where the violations obvious to parents appear earlier, you should immediately contact your pediatrician or specialist.
CHILD IN THE FIRST MONTH OF LIFE
The structure of the upper femur
A newborn child is characterized by tenderness, slight vulnerability and high sensitivity of the skin. His muscles are poorly developed. Bones are represented mainly by cartilaginous tissue, although there is already “Newborn 6 years 10 years old _
skeleton image ”- its reduced exact model. Ossification or replacement of cartilaginous tissue with bone takes a long time, gradually. For each bone, a certain age range is determined by nature.
In some cases, these data are used to determine the final maturation, the biological age of the child.
Children have their own skeletal proportions. A child in the first weeks of life has a relatively large head, a long body and short limbs. Hands extended and pressed to the body reach only the upper third of the thighs with the fingers. The midpoint of the body is at 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 body - three times, the length of the arms - four times, 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 have yet been observed. For a child of this age, symmetry of constitution is characteristic, which is important to consider when identifying pathological disorders. This refers to the size, shape and position of individual body parts, folds of the skin and soft tissues in general.
The shape of the legs of a healthy baby of the first year is not quite straight, but O-shaped with the apex of a slight curvature at the level of the knee joints, and this is noted already in the first weeks. The feet are a little "clubfoot", with the plantar surfaces facing 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, but the child does not have the elevation characteristic of adults.
The shape of the legs of a child of the first year of life
The newborn does not hold the head on its own, and it is uncomfortable for him to lie on his stomach because of the bent legs. The baby's head is relatively heavy, and the torso is not a worthy counterweight, so the baby cannot raise his 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 needs to have an idea of \u200b\u200bthe usual position of the newborn's head in the first year of life, whether the mobility of his neck is not impaired. To do this, you need to pay attention to the distance between the auricles and the shoulder girdle on both sides - both in front and behind. They should be the same, which indicates that there is no lateral tilt of the head and neck. A constant tilt of the head is called torticollis.
Right-sided torticollis
A healthy newborn child does not have a pronounced tilt of the head back, as happens after an injury to the cervical spine during childbirth. On the contrary, normally the head is slightly tilted anteriorly, so the neck appears to be short. Neck height is considered normal if it matches the width of the child's palm. They check it this way: they raise the child's chin a little and put his palm across the neck.
Movement in the cervical spine is usually free and does not cause anxiety in the baby. These 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 bends to the right and left with the ear reaching for the shoulder of the same name; turns right and left until the line joining the shoulders. The child performs these movements easily. Rotational movements in children of the first year, as a rule, are not determined. Movement can be assessed while caring for the baby: feeding, lying down on one side and the other, while bathing, etc.
Despite the fact that the arms and legs of the child are bent, the mobility in the main joints can be easily determined by the hands of the parents. In this case, we are talking about passive movements.
The person performs active movements in the joints himself. Passive movements are performed with assistance.
The strongest in the first weeks of life are the flexors of the hip joints, then the knee, somewhat weaker are the adductor muscles. Therefore, passively in a child, to a greater extent, almost up to 180 degrees, it is possible to spread bent legs rather than straighten them. By the end of the first month of life, the ratio between the strength of individual muscle groups gradually changes, the tone of the flexors weakens. Active movements are usually symmetrical: the baby moves both arms and legs equally.
If you notice that the muscles of the child are very weak, there is a forced and unusual position of the limbs, impaired mobility in the joints and the child is worried about this, you should consult a doctor. Disorders of mobility 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 lightest - dysplasia to severe - congenital dislocation
Restriction of hip abduction. It is necessary to pay special attention to this, of the right thigh. Currently, this is the most common orthopedic pathology. In girls, it is observed 5-7 times more often than in boys.
Right hip abduction limitation
Dysplasia of the hip joints is a violation of their development. Almost always, the development of the fetus and the birth of a baby in the breech (leg, 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 quick to determine.
The formation of any joints can be disrupted after birth, for example, with rickets, endocrine disorders, hereditary systemic diseases. After birth, the hip joints are formed under the influence of active movements.
Restriction of movements is often caused not only by changes in the osteochondral elements of the joint, but also by the high tone of certain 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-height ratio.
In the first month of life, the main task of parents is not only proper breastfeeding, hygienic skin and navel care, but also creating conditions for the development of the musculoskeletal system.
Physical activity is an indispensable condition for the growth of a child, normal formation of joints and ossification of the skeleton.
It is necessary to lay the baby alternately on each side. The head pillow is used very flat, it should lift the neck only to a horizontal position. Legs should be swaddled wide and loosely so that they take a breeding position and are not constrained in movement.
Already in the first month of life with a child, it is necessary to engage in physiotherapy exercises, 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 life, the child must be shown to an orthopedist. The doctor evaluates the development of the baby, compliance with his age, the correctness, proportionality, symmetry of his physique is determined. The range of motion in all joints is checked at the same time. There are signs of congenital or acquired disorders of the musculoskeletal system that were not previously noted by doctors and parents.
What can an orthopedic surgeon find?
Child developmental 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 neck muscles are affected, but other general functional disorders also occur. As a rule, the behavior of the child changes. He can be lethargic, sedentary, with low muscle tone, or, conversely, loud, restless, restrained in movement. 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 spine, but the tone of the neck muscles is asymmetric, which is determined by feeling them. Such children are monitored 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, other pathologies of an orthopedic nature are often revealed. Disorders from the musculoskeletal system may appear in them in the process of further growth: in the form of a change in gait, impaired posture, joint function, and position of the feet.
All children with disorders of the central nervous system should be monitored for a long time by an orthopedic doctor.
Trauma to the cervical spine of a child at birth is so common today that in some maternity hospitals, fixing collars are worn for all newborns. This is not entirely correct, as even a good collar prevents children from sucking, swallowing, breathing and should only be used when really needed. In difficult childbirth, sometimes there are small displacements of the cervical vertebrae in the newborn. In such cases, a picture of neurogenic torticollis develops in combination with impaired mobility in the cervical spine. The child is worried about changing the position of the head, throws his head back and thereby relieves the tension of the vertebral ligaments and spinal cord. The muscles in the neck tighten and protect the neck from further bending. There is always a danger of injury 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, neck fixation with a collar and ultrasound examination of the cervical spine, brain are indicated, and some children are prescribed an X-ray examination of the neck and Doppler ultrasonography 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 spine 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 spine gradually stabilizes, and neurological disorders disappear.
Congenital muscle torticollis
Congenital muscle torticollis can also be the result of traumatic effects 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 a similar deformation, that is, torticollis is formed during the prenatal period. Then it is more pronounced and manifests itself already in the hospital.
Congenital torticollis muscle is the result of changes in the largest and most working muscle of the lateral surface of the neck. It is called the sternocleidomastoid, and we will designate it as the sternocleidomastoid, since it participates in the lateral tilt and rotation of the human head.
The location of the sternocleidomastoid muscle on the neck
Violation of the blood supply processes in the muscle leads to a specific reaction, which manifests itself in the form of a tumor-like thickening in sizes 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, "muscle swelling" can increase in size, and then gradually disappears. The sternocleidomastoid muscle itself is shortened, loses its elastic properties and turns into a dense cord. The latter does not position the nodding and only leads to a tilt of the head in the direction of changes in the muscle on the neck of the muscle and rotation in the opposite direction, but also disrupts mobility in the cervical spine: tilt of the head to the healthy side and turn to the sick are limited.
A tilted head in young children often leads to enlargement of the skin folds in the neck area 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 depression between the thickened sternocleidomastoid muscle and the angle of the lower jaw. To have a good look at the entire neck and see the main violations, you need to put the child on his back, slightly raise his shoulders, placing his palm 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 been diagnosed with torticollis from birth, then by one month he develops a typical asymmetry of the face: its height on the side of the slope decreases, and the slope of the back of the head indicates the usual turn of the head. In young children, the main part of the face is the cheeks, and therefore it is from 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 after the age of three years, the asymmetry of the face remains.
When a child has different cheeks, one must think about a possible torticollis.
Deformity is treated for several months. First of all, at home, the child must be properly laid in the crib, constantly giving the head a tilt position to the healthy side. When he lies on the side of the torticollis, that is, on the side of the tilt of the head, a large pillow is used, and if on the other side, the pillow is removed, and a thick diaper folded in four is placed under the shoulder. Laying the child on his back, a cotton-gauze roller is placed between the shoulder and the head, preventing tilt, and the 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 your stomach, that is, from 4-5 months of life, for
Neck fixation uses asymmetric collar -Neck fixation. They prevent the tilt of the head and wear with a collar-like collar only for special times of the day.
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, ironed diaper, the child's head should be gently tilted to the healthy side with a simultaneous slight turn in the opposite direction. The correct position must be held for a few seconds. Such movements should be done 15-20 twice or three times during the day before feeding.
Neck fixation with asymmetrical collar
From the arsenal of traditional medicine, you can advise compresses with cakes of steamed oats and honey, especially if there is a tumor-like formation in the sternocleidomastoid muscle.
Children are shown neck and shoulder massage. It is carried out by a competent massage therapist in courses every 2-3 months. Physiotherapy courses in the polyclinic 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 within the first year of life. The orthopedic surgeon monitors 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, the child undergoes surgery to lengthen the sternocleidomastoid muscle or cross it together with other shortened soft tissues. After the operation, long-term rehabilitation is carried out, which includes fixing the neck with a collar "massage, physiotherapy exercises, physiotherapy, since only the operation can not solve all the problems in treating such children.
Children with this form of torticollis are observed by an orthopedic surgeon not only during treatment, but also after elimination of the deformity. An examination before school is mandatory for them, when, after the second period of stretching, some return of violations may be noted, and especially - curvature of the spinal column. This is because the altered muscles on one side do not stretch as quickly as the cervical spine grows.
Congenital bone 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. The movements in the cervical spine are limited in various 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 are always varied.
Of course, 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 severity of the 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, their anatomical and functional inconsistency can be reliably determined only with congenital dislocation of the hip, when the articular surfaces are completely separated. In less severe cases, pathology is only assumed, and an accurate diagnosis is established when the child turns 3 months old.
Pathology of the development of the hip joint
Asymmetry of folds and external rotation of the right lower limb at rest
Different lengths of the child's legs 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 in front, gluteal and popliteal in the back. In this case, folds can differ 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, the 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 is impaired, which complicates the identification of dysplasia by comparison. Such a child can be examined using ultrasound, but the large number of options for the normal structure of the hip joint makes this method currently very indicative.
If a child is suspected of underdevelopment of joints, 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 turns 3 months old.
At this age, an x-ray examination of the hip joints is performed, and thereby a summary of previously emerging suspicions is made. Girls born in a 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 compulsory examination. X-ray examination is also needed by those children who have neurological disorders in the lower extremities, especially feet, or pronounced orthopedic defects of the legs.
X-ray examination is the most informative method for 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. The 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 performed strictly according to the indications.
X-ray confirmed hip dysplasia requires long-term, careful functional treatment. The child is placed in the Frejk pillow, which holds the legs in the flexion position and the greatest Frejk pillow for breeding. This position contributes to the best centering of the femoral head in the acetabulum (with congenital dislocation - the reduction of the latter) and allows the bone-cartilaginous structures to develop over time.
The pillow must be used most of the day, during sleep it is mandatory. The child very quickly realizes that it is better without a pillow, so you need to show perseverance in order to accustom your baby to it. The first time the pillow is put on after a warm bath only for a few hours, and it is removed at night. The next day - and leave for a night's sleep.
To speed up the process of forming joints and avoid possible complications, it is imperative to carry out physiotherapeutic treatment in a polyclinic: electrophoresis with calcium and phosphorus on the joints, with aminophylline or nicotinic acid on the lumbar spine, and at home - dry heat for 10 procedures per month on the area of \u200b\u200bthe joints, as well as coniferous or salt baths.
Massage of the legs and back is carried out in courses in 1.5-2 months, and physiotherapy exercises - constantly, but only with dysplasia of the joints or subluxation in them. In cases of congenital dislocation, physical activity with the use of massage and physical education is possible only two months after the reduction and fixation of the joint with the adjusted femoral head into the acetabulum.
The child should be monitored regularly by an orthopedic doctor. One stage of such treatment lasts 3-4 months, and its effectiveness is monitored by an X-ray of the hip joints in frontal projection at the end of each stage.
For the correction of dysplasia, 1-2 stages are usually sufficient; with congenital dislocation of the hip, the 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 maximum flexion and extension 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.
Freyk's 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 leading to a slowdown in bone development, the child develops a subluxation of the joint, which requires surgical correction.
Surgical treatment of children with congenital hip dislocation is carried out for children over two years of age, and surgical interventions for subluxations are carried out over the age of 3 years. These complex traumatic operations are the only and last opportunity to cure a child and get rid of his disability.
The final results of treatment, taking into account the growth and development of the child, are summed up at 5-6 years old, that is, in front of the school. In case of any dysfunctions of the hip joints in combination with different lengths of the lower extremities, an 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 engage in physical education and sports at school, and make a certain forecast for the future.
Foot deformities
Heel position of the feet
The calcaneal position of the feet is one of the most frequent and mildest forms of pathology in young children and arises as a result of their special fixed position during intrauterine development. With this pathology, the feet are in the dorsiflexion position in the ankle joints, sometimes in combination with both adduction and abduction. This condition of the feet is detected already in the hospital and by the first month of life can be corrected by physical therapy. To do 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.
Calcaneal installation of the foot
Holding the feet with a plaster splint in the middle position, continuing the treatment with physical education and massage over the next few weeks allows you to completely eliminate the vicious heel position.
Neurological abnormalities on the part of the lower extremities associated with a birth injury of the lumbar spine or with impaired development of the spinal cord in the lumbosacral spine are manifested by asymmetric muscle tone and various functional disorders of the position of the feet: they deviate outward from the middle position, occupy a heel position or reverse it, when the feet are lowered to the plantar side. Disorders of passive movements in the ankle joints gradually join.
Calcaneal feet can be the result of neurological disorders of the lower extremities.
Such children are carefully examined for bone deformities of the spine and are consulted by a neurologist. In this case, orthopedic treatment should be combined with neurological, aimed at correcting the work of the spinal cord.
Reduced feet
The reduced feet often appear only by one month of life, and parents learn about this from the orthopedic surgeon at the first examination. The essence of the deformity is inward deflection of the forefoot in relation to the heel and rounding of the outer edge of the foot. This is clearly visible from the side of the sole. The first interdigital space is widened, and the first finger "looks" inward. Some people take this deformity for clubfoot, but this is not so, 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.
These feet are successfully treated in a non-surgical way in children under the age of 3 years. The pathology is eliminated by the doctor gradually by manual corrections and fixation with fixed plaster splints of each achieved position. Corrections are carried out once a week. It takes several weeks to several months to correct the deformity - even with timely early initiation of therapy.
Reduced foot print
After the 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 by removable plaster splints. The question of prescribing orthopedic shoes for a baby is decided individually at the age of 10 months.
Late detection of such a pathology not only complicates its correction, but also significantly lengthens the treatment time. Surgical intervention is indicated for children over the age of 3
of the reduced foot.
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 are changed. Movement in the ankle joint is always disturbed.
Clubfoot may result from an abnormal development of the spinal cord at the lumbosacral level. 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 in general.
Active treatment for congenital clubfoot should be started at one month of age. It consists in staged corrections of the position of the foot and simultaneous fixation with plaster splints of each achieved state. Manual correction of foot deformity is performed once a week at the first stages and every 10-14 days thereafter. It is advisable to combine this with physiotherapy in a polyclinic. Conducting electrophoresis with vasodilators in the lumbar spine improves blood flow and nerve function of the lower extremities.
From three months of life, the feet are already held in circular plaster casts. Treatment is carried out in stages, for a long time and persistently until all components of the deformity are completely eliminated, and then the child is supplied with orthopedic shoes and removable splints for the feet during sleep. Active rehabilitation of the patient and observation of the correct growth of the foot are carried out for at least
Congenital clubfoot (back view)
five years. In cases where there is a partial return of individual signs of deformity, they are corrected conservatively or promptly, and the child's observation 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 fixation bandages require a sufficiently high qualification and experience of a 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, it is the conservative, proven, classical methods of treatment that are shown. In cases where individual elements of clubfoot cannot be eliminated conservatively, small surgical interventions are performed on the soft tissues of the foot at the age of over a year.
With a late start of treatment, the effectiveness of conservative measures is less high, and after the preparation of the altered foot, children over a year old undergo extensive surgical interventions, followed by long-term rehabilitation treatment.
Finger pathology
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. Accessory fingers are usually represented by underdeveloped 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 that can only be removed by surgery. In cases where the fingers hang on a thin skin leg, removal is performed in the first weeks of the child's life. But if the accessory fingers have pronounced bony structures or they are tightly spliced \u200b\u200bwith the main fingers, you should not rush to remove them. It is more correct to carry out surgical treatment closer to the age of one year: 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 and which is the additional, so they are the same in the first weeks of life.
Fusion, fingers
Finger fusion (syndactyly) is the union of two or more fingers with skin, soft tissue, or even bones. The toes can be spliced \u200b\u200bat the base, all over, or at the tips. More often than others, the connection of the third to fourth fingers is observed, 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 deformation, 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 advisable to separate the fingers at the age of 4-5 years, that is, before school. Only with end fusion, surgical treatment is performed earlier, starting from the first year of life, since this type of violation interferes with the normal growth and development of the child's fingers.
Plastic separation of fingers is a complex jewelry operation. The resulting skin defect is closed either by the surrounding tissues, or by a flap taken from another part of the body. It is better not to eliminate the soft tissue fusion of the toes on the feet, when their shape and function are not disturbed, since the formed scars after the operation bother the person more in the future than the fusion 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 the increase in weight and height of the child. The length of the body by one year increases by half, the limbs lengthen, the circumference of the chest increases. Muscle tone is gradually normalized, and movements in the joints of the limbs become smooth, of greater amplitude than in a newborn. In this case, the symmetry of the shape, length and circumference of the arms and legs should be preserved.
The length of the upper limbs is indirectly determined by the level of the fingers pressed to the body. Roughly the equality of the length of the lower extremities can be judged by the level of the heels, inner ankles, knee joints with full extension of the legs or by the level of the knee joints of the bent legs. This period is very important for creating the correct shape of the spinal column.
By 1.5-2 months of age, the child begins to raise and hold his head, lying on his stomach. In this regard, there are moderately pronounced cervical and thoracic-girdle lordosis of the spine, that is, its bends anteriorly. By the age of 5-6 months, when the child begins to sit, thoracic kyphosis is formed - posterior bending 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 the individual characteristics of the structure, nutritional conditions, physical activity, diseases, etc. The shape of the spine is the basis for the future posture of a person. Posture is the usual vertical position of the body in E space without active tension of individual muscle groups.
In the first year, the muscles of the trunk develop, stereotypes of keeping the body in an upright position are formed with the active participation of the central nervous system, and the processes of ossification are vigorous. By the end of the first year of life, the child begins to walk independently. At the same time, he slightly bends his legs, 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.
In a child of this age, the so-called physiological flat feet is observed due to soft tissues that fulfill and smooth the entire plantar surface. However, the load on the feet is correct if it rests on the outer edge. The child should not "roll 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 stiff shoes, not to allow the house to constantly run barefoot or in socks. It is necessary to keep the foot within the shoe and always with a stiff heel.
Every healthy baby in the first year of life needs to receive courses of 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, rickets curvature of the limbs and spine are observed. They are associated with a load on the bones softened by rickets. In this case, first of all, their physiological bends are enhanced, less often - new curvatures appear.
Correct feeding of the child, prevention and treatment of rickets are the basis for the prevention of skeletal deformities.
Most of the curvatures acquired as a result of rickets disappear without a trace on their own during the growth process, provided that the exchange of calcium and phosphorus in the body is early normalized and other therapeutic measures are used: therapeutic massage, special physical exercises, salt or pine baths. A significant reduction in O-shaped curvatures or their complete correction occurs by the age of 5-6 years of a child's life.
Incorrect stop setting
Limb axis disorder
The situation is more complicated only with the X-shaped legs. On the one hand, it disrupts the correct development of the feet, since the center of gravity falls inward from their inner edge, and on the other hand, it corrects itself worse on its own. In order to support the feet and contribute to the normalization of the axis of the extremities, children need to wear hard shoes and orthopedic insoles-instep supports for a long time, which raise the inner edges of the feet.
CHILD BEFORE SCHOOL
By the age of 5-6, the ratio of the length of the limbs to the body changes in a child. Hands reach the border of the upper and middle third of the thigh. The midpoint of the body is below the navel. The axis of the lower extremities can be straight or deviate in the area of \u200b\u200bthe knee joint both inwardly (more often in boys) and outwardly (in girls) by 10 degrees. The curvature of the legs associated with rickets transferred in the first year of life decreases or completely disappears. The child ceases to overextend his knee joints, he more effectively uses the possibilities of the osteoarticular and muscular apparatus due to the improvement of the nervous regulation of movements.
Very often, the growth of the lower extremities is uneven, asymmetric. So, by the end of the second period of stretching, 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 the spine in the thoracolumbar region. This allows the child to maintain the balance of the trunk in an upright position.
By school age, the longitudinal and transverse arches of the feet are normally formed. An unloaded sub-arch appears on the inner side, 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 of this age should wear hard, preferably leather shoes with a medium (2-3 cm) heel and a loose toe. Factory-made instep supports in the shoe 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 pronounced in adolescence. Most often, doctors designate the following types of addition: asthenic, normosthenic, hypersthenic. A given division is certain features of physiological processes in the body, a tendency to one pathology or another.
The asthenic type of constitution is distinguished by a narrow, flat chest with an acute angle of rib attachment to the sternum, a long neck, thin and long limbs, narrow shoulders, an elongated face, poor muscle development, pale and thin skin.
The hyperstep type is characterized by a broad, stocky figure with a short neck, round head, broad chest and protruding belly.
The norm-steppe type of constitution is a good development of the bone and muscular systems, a proportional build, a wide shoulder girdle, a convex chest.
During this period, the future shape of the human spine is determined.
The normal form is moderately expressed 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 from the side of its bone structures and soft tissues of the trunk. A decrease in the correct bends or their strengthening determine other forms of the spine, which add up to 5-6 years.
The posture of a person depends on the shape of the spine. At an early age, there is no definite, developed posture for an upright position, and the posture is often called unstable. The body is supported in an upright position by bones, ligaments, muscles and tensions in the chest and abdomen. Normal posture in children under 5-6 years old: lordotic, kyphotic, equilibrium, which is determined by the ratio of the thoracic and lumbar bends 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, psychoemotional 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 the displacement of the center of gravity of the body. Poor posture can occur with any shape 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, slouches, breaking his posture.
Spinal column shapes
Correct posture in 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 changes 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 posture disorder in the frontal plane, is a lateral deviation of a large part of the spine without any bone changes, in contrast to scoliosis. The reason for this may be the different lengths of the child's legs. This static factor can lead not only to scoliotic posture, but also to the development of a complex progressive deformity of the spinal column, which is called scoliosis.
Children need to measure, compare and equalize the functional length of the lower limbs before going to school.
In such cases, the reduction in leg length should be compensated for with an additional insole. The amount of shortening of the limb and the required thickness of the insole will be determined by the orthopedic surgeon. Such a simple action, performed before the age of 10, 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 a child grows, the length of the lower extremities, as a rule, is self-equalized, therefore, the compensating insole must be removed in a timely manner. But even the maintenance of such a minimal difference is not visible to the eye in the future, it does not affect the gait and should not bother the child and parents.
Insufficient development of the muscles of the trunk, which should involuntarily return the spinal column to its original correct position, also serves as the basis for scoliotic curvature. With scoliotic posture, the child can correct the axis of the spine on his own, both actively tensing the muscles and completely relaxing them in the supine position, therefore, an important task of treatment is the formation of a muscle corset that holds the spine in the correct position.
A set of social activities allows you to form the correct posture: good nutrition, outdoor games, hardening, a long period of sleep, the use of furniture appropriate for the 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 with the use of biofeedback techniques. These children should be seen annually by an orthopedic doctor.
Chest deformities
In the process of growth, the existing congenital disorders of the structure of the chest and ribs increase. These include, first of all, a funnel-shaped deformity - when the sternum is depressed inward, and when inhaling, its depression increases. "The shoemaker's chest", as it is sometimes called, is always accompanied by impaired lung and heart function, a decrease in the body's resistance to overload. Severe deformity requires surgical removal already at the age of 4-6 years, but in some cases, treatment is postponed until adolescence. With small changes in the shape of the chest, children are shown physical education to increase the muscle mass of the anterior surface of the chest and shoulders, which will correct the external manifestations of the defect.
Keel 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 heavy load on them (with an overweight child). The reduction of the arches gradually increases and leads to leg fatigue after prolonged exertion, pain in the calf muscles. The child's gait becomes heavy, he does not keep up with the speed of his peers, turns into a "bum" and "clumsy". A decrease in the spring function of the feet is reflected in the state of the entire skeleton, especially the spine, and the existing disorders are amplified.
Not only a careful examination of the child's legs, but also a plantographic study of foot prints, allows to confirm the presence of flat feet. The most reliable method for determining the size of the arches is radiography of the feet while standing under load.
The beginning of the treatment of flat feet from preschool age allows not only to preserve the vaults, but even to 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 the 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 should wear orthopedic insoles, arch supports or arch-forming insoles. In cases where not only the height of the arches is lowered, 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 are used, including using biofeedback techniques, contrasting (alternating warm and cool) baths, Kuznetsov's applicators or corrugated insoles, physiotherapy procedures. In severe cases, surgical treatment of flat feet is possible.
The formation of a child's musculoskeletal system does not end at the age of 5-6 years, and the violations we have cited are only a small fraction of those deviations that occur in children and require treatment. Already schoolchildren develop conditions associated with wear and tear of individual bone and cartilaginous structures, their aging. Numerous diseases of an inflammatory nature and the consequences of trauma complement congenital and dysplastic skeletal disorders in children.
I would like to remind you that human health is formed in childhood. A child's skeleton is a soft, malleable and grateful material that lends itself well to correction in the treatment of disorders. By joining forces 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 bone fractures 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 lead 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, household injuries predominate, of which one third are burns and only one fifth are bone fractures. At school age, the frequency of personal (transport and non-transport) injuries increases.
In children, trauma differs not only in the mechanism of occurrence, which is due to the extraordinary mobility and curiosity of the child, but also in the manifestations of the disorders that have arisen, the timing of healing, and the outcomes. This is primarily due to the anatomical and physiological characteristics of the child's body, very intensive recovery processes. Treatment methods for fractures and dislocations in children and adults differ significantly.
In the child's musculoskeletal system, there are much more soft tissues (muscles, fat, cartilage) than bones; they mitigate the direct traumatic effect on bones, which are more difficult to break than in adults. Fractures of the upper limb in children are much more common 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 of age: there is only one dislocation per 10 fractures. However, the total number of fractures in children is higher than in adults, and this is the price to pay for the child's extraordinary mobility and inexperience. The most common fractures in children are fractures of the forearm and elbow joint, among dislocations - dislocations of the bones of the forearm, subluxation or dislocation of the radial head. There are also so-called fracture-dislocations, that is, a combination of fracture and dislocation. These include dislocations of the forearm bones with a detachment of a portion of the humerus or a fracture of the ulna in the lower part with a dislocation of the radial head in the elbow joint.
Children's bones are thin, but contain more organic matter, which makes them firm and flexible. The articular parts 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 child's growth - throughout childhood.
Between the articular part of the bone, which is located in the joint cavity, and the bone itself is the so-called growth zone. It is also present near various bone outgrowths, to which ligaments, tendons, etc. are attached. These cartilaginous layers ensure the growth of bones in length and exist until the end of human growth.
Cartilage structures are not susceptible to fractures due to their high elasticity, shock absorption capacity and homogeneous structure. But fractures - bone tears along the growth zone - are quite common, and only in children. Such fractures are difficult to identify because the cartilage tissue is not visible on x-rays, they require accurate comparison, otherwise the function of the nearest joint is impaired. Tears of bones along the growth zone "replace" joint dislocations in children. However, this does not mean that the cartilage tissue itself is not damaged by mechanical stress. As a result of injury, cartilage can move, dissolve, change its content and properties. The consequences of such violations are very sensitive for the body: this is shortening of the limbs, and disturbances in the shape of bones, and limitation of mobility in the joints. Osteochondrosis, arthrosis, osteochondropathy - all these conditions are based on pathological changes in cartilage tissue.
Knee-joint
Types of fractures:
a - fracture of the "willow twig" 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 for accurate matching 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 splitting of the bone, small fractures without displacement and impacted fractures are characteristic, when one part of the bone is embedded in another. The dense elastic periosteum often keeps the fragments from dislodging, and such fractures resemble a broken green willow twig. Doctors sometimes refer to these fractures as "green twig fractures."
Bone is able to regenerate completely through the callus stage without any scarring. The impetus for the formation of callus are the products of tissue destruction at the site of the fracture. The severity of callus depends on the accuracy of matching the 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", which are self-corrected over time.
The obligatory task of the traumatologist is to eliminate the displacement of the articular parts of the bones along the line of the 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 general anesthesia.
Children rarely have open fractures when the skin over the fracture site is damaged and there is a threat of infection in the bone with the subsequent development of osteomyelitis (inflammation of the bone tissue). Even less common are gunshot (always infected) wounds of bones and joints. Inflammation in fractures is more often a complication of treatment and develops 5-7 days after infection. Antibiotics must be used to treat these infected fractures.
Any injury is damage to the whole organism as a single integral system, for the restoration of which absolutely all protective forces are included. Therefore, bone damage is accompanied by local and general symptoms that differ from those of an adult. In most cases, the child's condition with bone fractures and dislocations is satisfactory. A severe or extremely serious condition with manifestations of traumatic shock occurs with multiple fractures or when they are combined with trauma to internal organs and the brain.
Special 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, and its mobility. It should be remembered that children, especially young children, cannot always clearly tell what happened to them, they are not able to accurately localize the pain. Communication with a child is even more difficult due to the general reaction: screaming, crying, anxiety, fever. A traumatized child is looking for protection, so an adult must keep himself in control, look confident and calm, not panic, and calm down the child if possible. You should not immediately try to consider, touch the affected limb. With all your appearance and behavior, you need to show the child that soon he will 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 reaction to injury, including feeling a healthy limb.
Clinical signs of fractures and dislocations of bones can be divided into probable and reliable. The former include pain, swelling, bruising, hematoma, deformity, dysfunction, the latter - 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 the bone landmarks of the joint.
The manifestations of fractures and dislocations of a specific localization have their own characteristics. In addition to examination and palpation, in order to establish a diagnosis, tapping is sometimes used, especially with fractures of the spine, measuring the length and circumference of the damaged part of the limb, etc.
You should always pay attention to the color of the skin on the periphery of the injury, in the area of \u200b\u200bthe hand and foot, check the mobility of the fingers. Severe pallor, "marbling" of the pattern, stagnant-cyanotic skin tone in combination with the absence of any movements can be caused by damage to large vessels or nerves. Serious damage is evidenced 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 dorsum of the foot or in the popliteal region, as well as a violation of the sensitivity of the skin or a feeling of "goose bumps", 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 disruption of vital functions of the body.
It is always necessary to determine whether the blood supply to the peripheral parts of the limb is not impaired.
In typical cases, the diagnosis of fracture or dislocation is not difficult as there is evidence of injury and all signs of fracture or dislocation are present. The peculiarity of diagnosing injuries in young children is that they have a large number of soft tissues and they often do not have displacement of fragments with subperiosteal or impacted fractures. All this makes it difficult to identify a fracture by inspection and palpation, and it can be very difficult to get 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 especially 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 displacement of bone fragments, the presence of one or more fragments, and accompanying disorders. Only taking into account these radiographs can you build a correct treatment plan for a sick child.
First aid
Providing first aid to 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 the immobility of the damaged area, which significantly reduces pain. Temporary immobilization of a limb can be carried out by bandaging the arms 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. These 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 supine position until the arrival of the doctor, or with the motionless position of the limbs and torso, transport the victim to the nearest medical institution.
Even the suspicion of shock requires rewarming the patient and effective pain relief. Before the doctor arrives, the child should be given some kind of analgesic - baralgin, analgin, pentalgin, etc. The doctor can inject anesthetic medicine directly into the area of \u200b\u200bthe fracture - 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. The first two are preferred. 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 can not only walk on their own, but they also do not need special emergency assistance, especially when it comes to the upper limb. Don't just put off going to the doctor.
In case of fractures, hospitalization is most often not necessary, most patients are successfully treated on an outpatient basis. The child must be admitted to the hospital in cases where fracture reposition is required, that is, the comparison of fragments, when there is damage to internal organs or combined (fracture and burn) trauma, as well as in the course of trauma complicated by infection. Fracture reduction 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 operative - with an open comparison of the fragments. The main method of treating fractures in children is conservative. The principles of treating patients with fractures and dislocations are as follows.
Providing emergency care - anesthesia, immobilization, X-ray examination, the choice of the optimal method of treatment.
Mandatory pain relief before starting treatment.
The most accurate comparison of fragments.
Ensuring the stability of retention of bone fragments until the end of the fracture union.
Early start of functional treatment - massage, exercise therapy, physiotherapy in order to restore movement in the joints.
The three laws of the German orthopedist Beller remain immutable in the treatment of any patients with bone fractures. Nice juxtaposition. 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 the imposition of bandages that hold the fragments until the fracture is completely healed or immobilize the joint after the dislocation of the bones is reduced for the period of edema resorption and restoration of the damaged capsular-ligamentous apparatus. The fixation bandage should cover two joints adjacent to the fracture, be comfortable, not disrupt the blood supply and function of the nerves of the limb, and be aesthetically pleasing. Circular plaster casts are not applied to children immediately after injury, since fractures and dislocations in them are accompanied by significant swelling from the soft tissues, which creates a high risk of impaired blood supply in 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 juxtaposition of the fragments. Find out if there have been secondary displacements associated with the disappearance of edema and the appearance of free space under the plaster cast. The following X-ray images are performed after removing 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, the severity and age of the child.
In children, the timing of bone fusion is much shorter than in adults. The younger the child, the faster his bones grow together.
In some cases, traction is used to match the fragments. 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 onset of callus formation.
Active surgical, or operative, treatment
The doctor has to resort to active surgical, or surgical, treatment in the following cases:
For fractures with displacement, which cannot be compared and treated conservatively;
if the conservative comparison of the fragments is unsuccessful, including when soft tissues get between the fragments, as well as when their displacements are inadmissible;
for fractures, conservative treatment of which can lead to very poor results, for example, with fractures along the growth zone with displacement;
for fractures with delayed consolidation, affecting the function of the limb;
in case of damage to the neurovascular bundle or the threat of damage during conservative treatment of the patient;
with multiple fractures with difficult conservative treatment;
for fractures in children with malformations of the limb or its shortening. In this case, fracture treatment is combined with deformity correction or simultaneous limb lengthening;
with open bone fractures;
with combined injuries, for example, with a combination of a fracture with a burn. In the course of treatment, it is necessary to constantly monitor the state 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 extremities. Currently, medications are widely used to improve the healing processes of fractures and restore 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 both a general order: wound suppuration, osteomyelitis, fatty embolism, which is practically not observed in childhood, shock, vascular thrombosis and thromboembolism, anaerobic infection, and a particular order: damage to the neurovascular bundle, the formation of os-syphicates (formations bone density in soft tissues), etc.
Early complications most often develop at the time of injury, during fracture repositioning, dislocation reduction, or in the course of further treatment.
Late complications develop after the main treatment period. This is a non-union of a fracture or a pseudarthrosis between fragments, deformities and shortening of the limb due to improper standing of the fragments or disruption 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 restorative treatment in rehabilitation centers.
Fractures of bones and dislocations of joints in childhood are a frequent and serious pathology that 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 row, spine and head injuries are of special importance.
Parents should pay special attention to the prevention of traumatic disorders in children. This does not mean that you need to keep the child with you at all times, on a "short leash." Physical education, hardening, the correct daily regimen and long sleep with adequate 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 child's physical activity should be comparable to the age-related capabilities of his body.
It is necessary to educate the child with safety skills on the street, when doing physical education and sports. Adults cannot remain indifferent when the threat of injury is obvious to strangers.
When damage has happened, you should be able to navigate correctly, be able to provide first aid and create conditions for the child's recovery. Qualified specialists of children's trauma centers, hospitals, institutes of traumatology will always help you with this.
Parents perceive the first steps of the child as a very joyful family event. But it can be overshadowed by the identification of such orthopedic pathology as hallux valgus. This violation, usually, becomes apparent just at the time of the beginning of walking and after some time. Evgeny Komarovsky, a well-known children's doctor 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 called such a deformation of the feet, in which they are in a cruciform position in relation to each other, resemble Latin H. Most often, pathology becomes noticeable when a child tries to step on the legs and take the first steps - pathology is expressed in the fact that when walking, the crumb rests on the inside of the foot.
Steps for such a baby are extremely difficult - he gets tired quickly, sometimes feels pain, the steps themselves are shaky and unsure. 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 area, 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 the orthopedists will already say that the child has flat-valgus feet. Hallux valgus is considered the most common diagnosis in pediatric orthopedics.
Such a curvature of the feet is of 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, about which medicine still does not know much. Congenital foot pathologies are usually quite severe, and it is possible to see them 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, 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 suffered frequent and severe viral infections in the first year of life. The legs are at risk of twisting in obese children, since the load on the lower limbs with excess weight is very significant.
Sometimes the parents themselves are to blame for the occurrence of the pathology. For example, putting the baby on his feet too early may well "start" the mechanism of deformity of the feet, and insufficient load on the foot, walking exclusively on a flat floor can cause acquired flat feet or flat-valgus feet.
Flat feet scares parents just as much. 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 grows, and everything is in the hands of the parents, with the exception of congenital flat feet, which can only be corrected surgically.
Pathology degrees
There are four main degrees of valgus disease according to the severity of the defect and the severity of the course:
- First degree. The deviation angle does not exceed 15 degrees. Pathology lends itself well to correction by conservative methods.
- Second degree. The deflection angle is no more than 20 degrees. This condition can also be successfully treated with exercise, massage, and physical therapy.
- Third degree. The deflection angle is no more than 30 degrees. Pathology is difficult to correct, treatment is long-term, but with due patience and perseverance on the part of parents and doctors, the prognosis is very favorable.
- Fourth degree.The deviation angle from normal values \u200b\u200bis more than 30 degrees. If conservative treatment is ineffective, a surgical operation is prescribed.
Flat feet also have several degrees, which are similarly classified by 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 common flat feet are treated quite simply and quickly enough. It will be more difficult with the third and fourth.
Diagnostics
The diagnosis is made by an orthopedic doctor. This is done on the basis of a visual examination and prescribed additional studies, which include foot radiography, 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, young 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 reasons 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 found 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 deformation is located incorrectly with a deviation in one direction or another.
- Compensatory deformation. If the child has a shortened Achilles tendon, sloping legs, the foot will be functionally deformed when walking.
- Correctional deformity.Such a curvature occurs if the child has been completely wrongly treated or not treated at all for the usual clubfoot.
- Spastic nervous deformity.The reason for this curvature is the malfunctioning of the cerebral cortex, which often results in spasms of the limbs.
- Paralytic deformity.It is usually the result of early encephalitis or complicated poliomyelitis.
- Rachic deformity.Occurs with rickets.
- The 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
The child's foot is finally formed only by the age of 12, therefore, many problems found by specialists and by the parents themselves at a more tender age can and should be corrected precisely 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 the arch. For this, foot baths, therapeutic massage, magnetotherapy, electrophoresis, swimming, physiotherapy exercises are prescribed. In congenital pathology, the lower limbs are immobilized using plaster. In the absence of the desired effect from 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 year and a little older, with appropriate therapy, has very favorable projections - the probability of eliminating the problem completely and permanently approaches one hundred percent.
If the disease is detected late or the child has not received the necessary medical care for a number of reasons and the disease is neglected, in adolescence, there is a very high probability of developing problems with the spine. The more time has passed since the beginning of the curvature before the start of treatment, the less chances of a complete successful recovery.
Footwear
Quite often, parents tend to blame themselves for the child's foot problems. Moms feel guilty that they may have chosen the wrong shoes for their child, which caused the violation of the anatomy of the foot. ... Evgeny Komarovsky reassures parents - the deformation of the legs does not in any way depend on the shoes.Since a person was originally born 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, you can correct some pathological changes in the foot. 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 is, the less likely the acquired curvature of the feet or flat feet.
Most parents are interested in when to start putting on their child's shoes. Komarovsky says that there is no point in doing this right 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 your child's shoes.
In case of severe hallux valgus, it is often recommended to buy insoles with instep supports, which prevent the foot from falling inward. These shoes usually have rigid sidewalls that fix the foot in the correct position, a solid heel lock. Most often, you have to make such shoes 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 mom that the legs of the crumbs were not located in the right way.
When choosing ordinary everyday shoes, Komarovsky advises to adhere to the basic rules:
- Shoes should be in size, not small and not large, the child should be comfortable and comfortable.
- It makes no sense to buy shoes "for growth", since the geometry of the foot changes during the growth of the foot.
- It is advisable that the shoes are not made of synthetic materials, the leg must "breathe".
- Pointed toes and heels are unacceptable in models of children's shoes.
Baby's health is the most valuable thing in the life of a parent. Unfortunately, sometimes an orthopedic surgeon diagnoses abnormalities that can be treated with an immediate reaction. Among the orthopedic problems in children, the main ones can be distinguished:
Hip dysplasia
This common condition is diagnosed in the first months of a baby's life. Its obvious signs are:
- limited hip abduction
- audible clicks when hip abduction
- uneven skin folds
- shortening of one of the legs, noticeable to the naked eye.
For more information about the symptoms of dysplasia in children, you can
To understand the mechanism of this deviation, you need to remember the structure of the hip joint.
The acetabulum is located on the femur bone, and the femoral head rotates within it. The head fits snugly into the cavity, and from above it is covered with a vault.
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In case of dysplasia, the head is not in place and requires fixation. For this, orthopedic devices are used, which help to set it and fix it (pillow splints, Gnevkovsky's diverter apparatus, orthopedic struts). In each case, the orthopedist determines the angle at which the legs are spread to "set" the head. In mild forms of dysplasia, treatment may be limited to wide swaddling and massage, and in some more difficult cases, the child's legs are cast.
Dysplasia not detected in time threatens in the future not only with a wobbly gait, but also with more serious problems with the spine. When treating this deviation with orthopedic devices, everything goes away without a trace in a few months.
Clubfoot
Abnormal development of the bones of the foot or the muscles of the lower leg can lead to clubfoot. More often this phenomenon occurs in boys, then they stomp "like bears." This defect can be noticed with the first steps of the child. If you look closely, it seems as if he is braiding at his feet. If the parents do not take measures, disorders of the bone skeleton of the foot gradually develop, and this can threaten with subluxation. The calf muscles that are supposed to work remain unused and atrophy.
Orthopedists recommend not taking it to the extreme, but using massage and special exercises. As soon as the muscles regain strength and the joints of the foot become mobile, splints or plaster casts are applied for a while to fix the position.
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Toe walking
Some toddlers, around the age of 2, have the habit of walking on their toes. Such a nuance can be corrected by a neurologist, since this is usually associated with a disorder of motor activity. Treatment consists of massage courses. Ignoring this habit can lead to impaired development of the bones of the foot.
Flat feet
At the appointment with an orthopedist, an examination of the footprint is performed. Sometimes the joint can fall inward - this is the most important sign of developing flat feet.
Such a diagnosis at the age of 6-7 years is not a cause for great concern. In children of this age, the arch of the foot is not yet fully formed, therefore preventive measures can eliminate the incipient flat feet. Such children are shown therapeutic exercises and wearing orthopedic shoes (orthopedic insoles).
/ Pediatric Orthopedics: Foot Problems
Flat feet, club feet, curved toes, valgus feet - these and other orthopedic troubles can affect absolutely any child. Such diseases are congenital and acquired, but in both cases they do not go unnoticed. There is a deviation from the norm in the development of the baby. The task of parents is to take action as early as possible.
From the article you will learn about common orthopedic abnormalities in children.
Problems and causes
Let's start with flat feet - the most common disease in children. It is possible to understand exactly "it" or not only in kids 5-6 years old - with normal development of the musculoskeletal system, the arch of the foot acquires the necessary shape for proper functioning.
It is very simple to determine the disease: it is enough to stand on a dry floor with wet feet - the print will be in full contact with the floor surface.
Factors affecting the development of flat feet:
- heredity;
- wrong shoes;
- strong loads on the legs;
- excessive joint flexibility;
- rickets (calcium deficiency in the joints), muscle paralysis.
Very often, parents do not attach much importance to this disease, because from the outside it is not very noticeable and, at first glance, does not have a negative effect. But this is far from the case. Flat feet violate the spring functions of the foot (the ability to absorb 80% of the impact energy that occurs when the foot touches the support when walking), depreciation almost disappears, as a result of which all the "excitement" during movement goes to the shins and hip joint - this can lead to arthrosis. Often, flat feet provoke the appearance of scoliosis, therefore prevention and treatment are prerequisites for children with such ailment.
Large selection of orthopedic shoes for children and adults.
Hallux valgus in children is a very common problem in pediatric orthopedics. Pathology occurs in 80% of cases of ontogenesis of the lower extremities. A significant proportion of abnormal foot development is recorded in children of different ages: from one year to school age.
This kind of deformity of the foot is a kind of flat feet, in which the line of the legs is shifted inward. In other words, the foot tilts inward relative to the axis position during walking under the pressure of the weight. At the same time, it does not touch the outer side, that is, the lower limbs are not completely in contact with the surface while walking.
This is how the X-shaped position of the feet is formed (if the anomaly is observed on both legs), which over time is reflected in the lower limbs, they also take an X-shape. From the outside it looks like this: the legs are connected in the knee area, which in everyday life I call "kissing knees."
This anomaly has two forms of manifestation:
- anatomical (true);
- functional (acquired).
Anatomical deformity is a congenital pathology that can be corrected only by a surgical method, but this is not always done. It occurs as a result of a change in the relative position of the bones of the legs during intrauterine development. The defect is caused by severe pathological pregnancy and a genetic factor. The defect is detected immediately in the first months after the birth of the baby.
The functional form is temporary and disappears either on its own or as a result of timely treatment. It occurs due to underdevelopment of the bone elements of the foot, tendons and ligaments, as a result of muscle hypotension. The reasons that lead to the pathology of the lower extremities are often joint diseases and the wearing of uncomfortable shoes that do not sufficiently fix the foot in a physiologically correct position.
This defect of the musculoskeletal system is typical for weakened children, often premature (hypotrophic), which is due to a deficiency of nutrients during intrauterine development (embryogenesis). Also, one of the reasons for the development of the anomaly is connective tissue dysplasia. The reasons for the development of anomalies of intrauterine development are the consumption of poor-quality food and poor ecology. Often this problem is joined by congenital dislocation of the hip, dysplasia of the hip joint and rickets of the bones, which also affects the condition of the bone elements, ligaments and tendons. Among the factors that can provoke an ailment are: child obesity, hereditary predisposition, endocrine diseases. But against the background of obesity and muscle hypotonia, the arch of the foot is flattened under the baby's own weight, and the weakening of the ligamentous and muscular apparatus prevents the foot from being kept in a normal physiologically correct position.
In children of primary school age, hallux valgus can develop after injuries as a result of wearing a plaster cast.
The reasons for the development of the anomaly
The main reason for the formation of pathology is the absence of appropriate healthy loads on the foot, as a result of which the muscles weaken and are not able to function normally, that is, they do not perform the actions that are assigned to them. When the muscles of the foot experience an adequate load (when walking on irregularities), then they are in good shape and effectively redistribute the load on the entire plane of the foot, keeping the body in balance. With hallux valgus, the feet cannot cope with the loads, since at present a person is constantly moving on even asphalt and floor, which relaxes the feet, and they lose their tone. In addition, wearing the wrong high heels and platform shoes interferes with the anatomically correct position of the foot when trying to lean on it.
In addition to the congenital nature of the pathology, there are a number of factors that can provoke the development of a defect:
- hereditary weakness of the ligamentous apparatus;
- disorders in the development of the musculoskeletal system;
- an early attempt to put the baby on its feet (up to 5 months);
- D- hypovitaminosis (due to metabolic disorders);
- deficiency of phosphorus and calcium (insufficient intake with food);
- hip dysplasia;
- obesity in a child;
- musculoskeletal system injuries;
- wearing shoes with heels as a child;
- genetic predisposition to flat feet;
- neurological diseases (polyneuropathy).
Curvature of the lower extremities is not the worst complication of a valgus defect. Much more dangerous are the excessive loads that the hip, lumbar, sacral and knee joints experience as a result of hallux valgus. Since the constant stress on these joints will cause joint displacement and chronic pain in them. In addition to flat feet, scoliosis, osteochondrosis, joint deformities, arthritis, and asymmetry of the limbs can occur. Therefore, an important task is the timely detection of the defect, first of all by the parents, and then by the pediatric orthopedist.
Symptoms of pathology
A baby under one year old is not able to tell about his feelings, so the disease is first discovered by the attending pediatrician, who examines the child monthly. But an attentive parent is also able to understand that something is wrong with the child's legs. If you put a baby up to a year old on a flat surface barefoot, then looking at his legs from the back, you can see how the baby falls on the inside of the foot.
In other words, the baby rests with his legs on the inner side of the leg, but almost does not step on the outer part, while the legs remain, as it were, raised. A kid with such a defect in his legs begins to move around in a funny way, which makes some parents feel tender. You can also check the presence of deformation in the baby by making a wet imprint of his legs. To do this, moisten the baby's feet and force him to walk over clean sheets of paper. The footprints will show you which part of the foot is heavily stressed. With valgus curvature, the imprint will be more pronounced precisely from the inside of the foot.
An adult child may complain of discomfort and pain in the legs while walking, and the pain will bother him not only in the feet, but also in the ankle and even higher: in the knees, hip region and back. The pain can get worse after intense exertion and long walks. The kid can be capricious and complain that it is uncomfortable for him to walk in shoes. And even when trying to change shoes, he will still be uncomfortable. It is difficult for such children to pick up shoes, since they are more trampled on the inner edge. They need special orthopedic shoes or insoles. As a rule, deviations in the development of the musculoskeletal system become noticeable by 10 months, when the child tries to stand on his own feet.
Diagnostics
A defect can be detected during a routine examination by a pediatric orthopedist. An experienced physician can diagnose a curvature of the foot and the degree of its deformity just by looking at how the child is standing. However, in some difficult cases, special instrumental diagnostics are performed for accuracy.
Most often these are:
- x-ray examination;
- computer podometry;
- computer plantography;
If the parents independently discovered a defect in the foot, then it is necessary to consult a doctor as soon as possible. Firstly, there are cases when treatment is urgently needed, in other cases treatment is not required, and thirdly, individual treatment is required in each case. Consultation with a competent specialist is very important, because only he is able to choose an individual tactics for further action.
Treatment
It is possible to correct a foot defect only up to a certain age (10 - 12 years), since it is up to this age that the children's foot is still being formed. However, some experts believe that if no treatment was provided before the age of 8, then the defect (more or less pronounced) will remain with the child forever.
Of course, treatment should be started as early as possible, but not too early. Plemu so? Almost all children are born with flat feet, because they have not yet had physical exertion on their legs. The foot and its arch will be formed depending on the weight of the baby and only as he stands up on his legs. This process begins by about three years, but quite often the pathology is diagnosed when the baby takes his first steps (about a year). But if you follow medical statistics, then for the first time hallux valgus is detected by 1.5 - 3 years. But in this case, it is too early to talk about the presence of pathology, since such a baby has a fat layer on the foot, which acts as a shock absorber (due to temporary anatomical flat feet). This situation lasts until the necessary arch of the foot is formed.
Thus, it seems quite natural that when starting to walk, children put their legs incorrectly, that is, hallux valgus in children under three years old is a normal physiological stage in the development of the arch of the foot. During this period, preventive measures are very effective, which will help to form the arch of the foot and avoid the transformation of a temporary anomaly into a serious orthopedic pathology.
So, the deformity of the foot is formed due to the lack of adequate load and muscle training. It follows from this that as soon as the child begins to walk, conditions should be created for him to train the musculoskeletal system. The most effective and easiest way is to walk barefoot. The child should be allowed to walk barefoot not only around the apartment, but also on the ground, grass, sand, pebbles. You can purchase a variety of massagers in the form of rugs, paths that will create a variety of obstacles for the baby's feet. You can put pebbles in the bathroom and allow you to walk on it.
However, what if the time is lost and the child has already formed a hallux valgus? In this case, treatment is indispensable. It will be long and painstaking, and also include a whole range of different procedures.
The main treatment of pathology is therapeutic exercises, massage, foot baths, physiotherapy procedures (electrophoresis, ozokerite, paraffin therapy, acupuncture, electrical stimulation). Prescribe calcium and phosphorus preparations, as well as vitamin D.
Orthopedic products
Orthopedic products are included in the complex treatment of foot defect. Special orthopedic insoles can lift the tilted part of the foot outward to align and fix it in the correct physiological position. Therefore, such products are indispensable for diseases of the musculoskeletal system. Insoles, like other orthopedic products, are selected individually, taking into account the size, shape, degree of deformation and anatomical structure of the foot.
However, wearing insoles does not always give the desired option. In addition to them, the baby will have to wear special orthopedic shoes. Moreover, you will have to walk in it constantly, at home in a preschool, school, on the street. With stable flat feet, walking barefoot is prohibited, as this will only aggravate the problem. The feet must be fixed in a physiologically correct position so that they get used to it. Therefore, small children wear orthopedic orthoses and braces to align the correct arch of the foot. Wearing orthopedic orthoses and braces can be very uncomfortable, but this is a necessary measure to avoid surgery.