There are two main types of curvature of the legs in children. Varus deformity of the lower leg is an O-shaped curvature of the lower leg, as a result of which it strongly deviates outward. If a patient is diagnosed with valgus, the lower limbs form the letter X.

Varus leads to the appearance of a large gap between the knees, the load on the knee joint is distributed incorrectly. The result is the wear of the menisci, condyles and cartilage, the development of arthrosis, ankylosis.

Symptoms

The disease occurs in both children and adults - in the latter case, the disease can be the outcome of an injury or remain from childhood. Pathology leads to disorders in the entire musculoskeletal system, including back scoliosis, foot deformity, development of osteochondrosis and flat feet. In a severe stage, even the hip joint suffers, and in many cases a person loses the ability to walk.

In infants after birth and up to 3 months, varus is physiologically normal, associated with hypertonicity of the muscles of the thigh and lower leg. Later, the legs are aligned, but with a tendency to varus deformity, they may remain crooked.

Closer to 1 year in a child, with careful attention, parents may notice the first signs of varus deformity:

• unsteady walking;
• uneven abrasion of the sole and heel in shoes from the inside;
• too narrow a footprint if the baby walks barefoot;
• frequent falls.

After, already during the formation of the O-shaped deformation, it is difficult not to notice the defect. The center of the lower leg protrudes outward, the legs, even with a cursory examination, look crooked. If you start the problem, the bone is bent, a clubfoot appears.

A late sign of varus-type curvature is underdevelopment of the knee joints, when the outer condyle is large and the inner one is too small. This causes deformation of the joint space, regular overstretching of the knee ligaments. The child can often dislocate the legs, which only increases the risk of complications.

Flat feet with varus of the lower leg is secondary, it develops as compensation to balance the load on the limbs.

Among the symptoms of curvature, pain in the feet, shins, knees and even in the thigh can be noted. At an older age, a person feels constant fatigue, can not walk for a long time, legs swell. Sometimes the pains become sharp, twitching, inflammation in the joint and muscles of the lower leg joins.

Causes and stages of development

One of the main causes of the curvature of the lower leg in childhood is rickets. Against the background of a lack of vitamin D in the mother, the disease sometimes occurs even in utero.

Vitamin D should be given at a very early age as a dietary supplement, otherwise the child's bones will become too soft, fragile, prone to deformation when walking. In adolescents, varus can also occur if adverse living conditions, poor nutrition, diseases are noted. bone tissue. Late resistant rickets is especially difficult to treat against the background of hereditary disposition, the problem is associated with kidney disease and steatorrhea.

Varus curvature of the lower leg can develop for the following reasons (in children and adults):

• Blount's disease - deforming osteochondrosis of the tibia;
• Paget's disease;
• injury;
• rarefaction of bone tissue;
• endocrine and metabolic diseases;
• severe infections;
• impaired absorption of calcium.

Usually, varus deformity that occurs in childhood is always bilateral. If the disease has already started in an adult, the problem is more often one-sided. In an adult, in the vast majority of cases, the cause is trauma or osteoporosis.

The degrees of varus curvature of the leg region differ in the severity of the condition. The first, light, causes deviation of the lower leg up to 15 degrees, the second (medium) - by 15 - 20 degrees, the third (heavy) - by more than 20 degrees.

Features of leg deformity in children

Do not confuse the primary clubfoot in children and the development of varus curvature of the legs. Clubfoot is most often congenital, if there is a problem, the bone is curved, so the legs arch in the shape of the letter O. Varus curvature is acquired, develops during the first years of life.

It is worth noting cases of false curvature of the legs in children. In such a situation, there is only a cosmetic defect of the soft tissues; this does not affect the structure and function of the musculoskeletal system.

Diagnosis of leg deformity

If there is any suspicion of a curvature of the limbs in a child, you should consult an orthopedist. You can not skip scheduled appointments per month, per year. Conducting simple tests will allow the specialist to draw conclusions about the correct development of the legs, knees and hips in a child.

Varus deformity is noticeable to the orthopedist from the first months of appearance according to physical diagnostics. To identify the cause of the deviation, to exclude other serious problems (for example, Paget's disease), a number of examinations are carried out:

1. Radiography. The picture will show all types of deformation of the limbs, the consequences - signs of arthrosis, narrowing of the joint space, etc.
2. Blood tests for alkaline phosphatase, calcium, phosphorus, vitamin D. Blood biochemistry will give a complete picture of mineral metabolism, help diagnose rickets.
3. Stool tests, ultrasound internal organs, the study of the function of the pancreas and thyroid glands. It will be required if there is a suspicion of a violation of calcium absorption in the body, for endocrine problems.
4. MRI and CT of the hip joints, knees. They are used if the varus deformity is presumably caused by an organic lesion of other elements of the limb.

Treatment of leg deformity

Therapy in a child or adult is the more difficult, the more time has passed since the onset of the pathology. It is important not only to mechanically correct the lower leg, but also to influence the cause of the deformity. The disease can be treated most easily until the age of 5-6 years, when the bones have not yet completely ossified. In other cases, the surgical method of treating curvature is preferable.

Gymnastics, massage are necessarily carried out, until the age of 3 these techniques are usually enough for a complete recovery. At a very early age, deformities are corrected by gypsum or taping. The leg is fixed in the required position, then fixed with a plaster boot. After a certain time, the procedure is repeated, correcting the position of the leg, taking into account the positive dynamics. Between plasterings, a certain interval is made in which therapeutic exercises are practiced.

Medicines

The treatment course should include drugs and supplements that improve metabolic processes. Strengthening bone tissue will be based on calcium and vitamin D, vitamin and mineral complexes with magnesium, iron, phosphorus.

To correct the function of damaged knee cartilage, chondroprotectors are required (especially indicated for adults and children from 7 years of age). With severe pain, age-appropriate ointments with non-steroidal anti-inflammatory components are used in a short course. Adolescents and adults are additionally recommended to apply bischofite cream to the knees and ankles to improve cartilage function.

Massage

Therapy for varus curvature of the leg area requires mandatory implementation massage courses. It is desirable that the massage be done by an experienced specialist; in the absence of such an opportunity, the procedures are performed by the child's parents. An adult, if necessary, can perform self-massage of the lower extremities.

Usually the procedure is divided into several parts (3 sets of 10 minutes every half hour), in adults one approach is allowed for 30 to 40 minutes. First, they knead the feet, then the ankles, shins, knees, and at the end of the session, the hips. For warming up pass through the muscles in a circular motion, in the area of ​​​​the Achilles ligament, acupressure is done. After they produce stroking, rubbing the muscles, rotating movements.

Corrective footwear

The tibia varus should be kept in a normal position so that the deformity will correct much faster. Doctors recommend orthopedic shoes for use, and they prepare them only on an individual order.

First, all measurements are taken, the angle of deviation of the lower leg and foot is determined, then shoes are sewn or a special insole is made. The constant wearing of shoes in young children will significantly improve the situation in 2-3 months.

Arch support helps to get rid of the accompanying flat feet, and high rear part does not allow the joints to deform even more. Solid outsole and heel form a natural position of the foot and lower leg.

Physiotherapy

For the treatment of deformities of the lower leg, it is mandatory to appoint exercise therapy complex. System gymnastic exercises should be properly selected, which will help strengthen muscles, reduce stress on the joints, improve blood circulation in the tissues of the lower extremities.

Here are popular exercises for correcting calf deformity in children and adults:

• take a small ball, throw it on the floor, then try to grab it with your toes (the lower leg must be kept strictly straight);
• in the same way, try to throw the ball with your foot;
• roll the ball with your foot in different directions;
• sit on a chair, bend and unbend the feet, stretching the legs;
• turn your feet;
• do squats with support on the wall;
• walk like a goose step, on the heels, on the toes.

The duration of the exercises from the deformation of the legs - up to 10 - 15 repetitions for each, daily, at least 2 - 3 months. It must be remembered that with varus curvature of the legs, one cannot sit in the "Turkish position" - this is very harmful to the position of the legs.

Surgical correction

The operation is prescribed only after 5-7 years, before this age, it is most often possible to correct the situation with less traumatic methods. In adolescents and adults, surgery is almost always performed, conservative methods are recommended during the rehabilitation period.

A corrective osteotomy is performed. In its course, the doctor removes a fragment of the tibia, fixes the bone with screws to the lower leg. Then, treatment is carried out on the Ilizarov apparatus (osteosynthesis) under local or general anesthesia. Within 2 months the patient walks with this device, then it is removed, the leg is carefully developed.

Postoperative complications

Surgical intervention does not always go smoothly, sometimes complications arise: bleeding in case of damage to blood vessels, infection of the wound. Sometimes, after the installation of the Ilizarov apparatus, its elements break down, you have to do the intervention again to correct the situation.

The operation is repeated and in case of a large hemorrhage in the tissue or joint, the hematoma is opened and emptied. Pain after the intervention is very common, in this case, non-steroidal anti-inflammatory drugs are indicated.

Prevention of leg deformities

In order not to know problems with the position of the legs and the curvature of other parts of the legs, it is important to early childhood take care of your child's health. The diet should have enough food with calcium, the entire preschool period is given vitamin D. Shoes for playing, running should be comfortable, made of quality materials, with an arch support and a heel.

If the slightest deviations appear, you should immediately contact an orthopedist - the doctor will tell you how to cure the child quickly and without the use of radical methods.

An O-shaped change in the lower leg in medicine is called varus deformity of the lower extremities. Pathology is diagnosed when the knees are located at a distance and do not touch each other. According to statistics, the disease is classified as congenital, in rare cases an acquired form of the disease is detected. Untimely therapeutic methods can lead to complications, and the patient will need surgical care.

Varus deformity of the legs develops for a number of reasons. Over the years of medical practice, therapists, orthopedists, surgeons distinguish the following factors in the formation of pathology:

In most cases, the curvature of the legs occurs due to congenital hypoplasia or tibial dysplasia. Uneven changes are observed, in which it is easy to distinguish the pathological process from the individuality of the physiological state.

Doctors draw parents' attention to the problem from the first months of a baby's life, prescribing therapy to eliminate development and complications.

O-shaped legs may be due to the development of rickets. A small amount of vitamin D in the bones makes them fragile. When the baby begins to walk, the lower limbs are deformed under the pressure of the weight of the crumbs. The legs have a unilateral or bilateral curvature configuration. Today, rickets is extremely rare, but cases of the disease are not excluded. Vitamin deficiency can occur during fetal development, in the first months of life, after the transition from breastfeeding to artificial nutrition.

Varus deformity of the lower leg can also form in older children. Adolescents are at risk of developing rickets at the time of the formation of organs and systems. Important factors for the pathological process are:

• malnutrition;
• passive lifestyle;
• poor environmental conditions;
• chronic diseases of different directions;
• staying indoors for longer than fresh air.

With prolonged, gastrointestinal diseases, intestinal disorders, a deficiency of substances necessary for the body, vitamin D is possible, which leads to intestinal rickets. The disease contributes

Bone tissues are susceptible to deformation due to the small amount of required minerals. They do not enter the body due to frequent kidney diseases that develop renal rickets. The disease is able to deprive the body of calcium and phosphates in a short period of time.

O-shaped curvature of the legs at an angle is called Blount's disease. The disease develops due to the pathology of the tibia. Treatment is possible only under the strict supervision of the attending physician.

What symptoms indicate the disease?

The pathological process is characterized by uneven development of the knee joints. This process is able to increase the condyle of the femur from the outside, reducing the inside. In this case, the inner meniscus is compressed. The joint space expands from the outside. From the inside, it narrows considerably. The ligaments that strengthen the knee joint are stretched. A bulge is formed on the outside of the lower leg. In case of complications on visual examination, the doctor fixes the pathological process:

• the thigh turns outwards;
• shins turned inward;
• feet are in a flat varus position.

With such indicators, the curvature of the legs in children and adults is called clubfoot. The baby is not able to fully straighten his knees. Corrective therapy is needed immediately. If you ignore the treatment, the progression of the disease proceeds quickly:

• gait is disturbed;
• the patient complains that he often falls;
• there is increased fatigue;
• psychological discomfort occurs.

The patient is observed. In some cases, scoliosis is diagnosed.

Diagnostics

For a competent diagnosis of the pathological process, it is recommended to contact an orthopedist. If the patient is young, it is necessary to visit a pediatric orthopedic traumatologist. How to correct the o-shaped curvature of the legs will be prompted by a narrow profile specialist, finding out the cause of the deformation. the main task doctors to eliminate the underlying disease that provokes clubfoot.

The first consultation begins with an anamnesis and visual examination. The doctor examines the patient's medical record. It is important to answer the questions in a detailed form, so that the specialist at the time of therapy takes into account all the individualities of human organs and systems.

An obligatory diagnostic event is an X-ray of the legs. If the pathology is accompanied by deformation of other parts of the legs, an x-ray of the hips, hip joints, and feet is prescribed.

To prevent rickets, the doctor must receive the result of laboratory tests of a blood test, which determines the level of alkaline phosphatase, phosphorus, and calcium. At the slightest suspicion of the presence of a stable type of rickets, pathologies of the kidneys, gastrointestinal tract, the patient is recommended to visit a nephrologist, gastroenterologist. Additional diagnostic measures may be radiographs, MRI, CT scan of the legs.

How is the treatment?

The treatment of varus deformity of the lower extremities is long and difficult. It is supervised by a specialist at every stage. The earlier a competent diagnosis is made, the lower the risk of developing unwanted complications. It is forbidden to correct the deformation on the recommendations of people without proper education.

Orthopedists are fighting pathological processes with complex actions. The method of therapeutic measures is selected for each patient individually.

conservative

Therapeutic exercises for O-shaped legs developed by orthopedists. With their help, the shape of the foot is corrected, the muscles of the lower extremities are strengthened. Physiotherapy is carried out together, which includes therapeutic massage of the lower back, buttocks, upper and lower parts of the lower extremities.

It is important at the time of correcting the deformity of the shape of the legs to choose the right shoes. It must meet all the requirements:

• hard back;
• correct fixation ankle joint;
• size matching, taking into account the rise and fullness of the foot.

Doctors advise for development small muscles feet more time to walk barefoot. When the pathology is in advanced form, corrective styling should be used during night sleep.

The main direction in treatment should be aimed at eliminating the underlying cause of the pathology. The fight against varus deformity of the legs is ineffective if only accompanying symptoms stop for a while. With illiterate treatment, the progression of curvature, the formation of false joints is possible.

Surgical intervention

Long-term conservative treatment without positive results requires surgical intervention. Orthopedists have been practicing corrective osteotomy for many years. Surgical manipulation is quite serious. During the operation, the specialist cuts out a fragment from the tibia of the appropriate size and special clamps, attaches it to the lower leg with screws.

Osteosynthesis, which is performed by the Ilizarov apparatus, is the next stage of treatment. The period of wearing a special device depends on the degree and form of varus deformity. On average, this period lasts 6-8 weeks.

Complications after surgery are not excluded. It is important to report each suspicious symptom to the doctor in a timely manner in order to avoid serious consequences. Among the complications most often doctors record:

• the formation of bleeding due to damage to blood vessels;
• weak functionality immune system allows penetration of a bacterial infection;
• patients are in severe pain.

After surgery, the patient is waiting for recovery. Rehabilitation is carried out different methods, the main ones are exercise therapy, massage. It is important to come to a scheduled examination in a timely manner and not ignore the recommendations of the medical staff.

Prevention

For many years of treatment, orthopedists have carefully studied the problem of valgus deformity. It is important to contact a specialist at the first manifestations, without practicing self-treatment, even with exercises. therapeutic gymnastics. Development may progress due to non-professional actions of the patient.

The initial form of pathology is eliminated without special problems with proper treatment and fulfillment of all requirements of the orthopedist. After recovery, it is necessary to carry out preventive actions to strengthen the muscles.

During the period of prevention, it is advised to pay special attention to the daily diet. Diet therapy consists in taking foods containing the required amount of vitamin D. If the patient is breastfeeding, the mother is fully responsible for his health, eating only fresh, healthy, high-quality food.

The next step in prevention is the choice of orthopedic shoes. The foot should be comfortable, for this the size should correspond to its length. In summer, it is recommended to carry out exercise therapy in the fresh air, walk more barefoot.

Conclusion

Diagnosis of varus deformity of the lower extremities can be at any age. The main direction of therapy is to eliminate the main cause of the development of pathology. Patients should not panic, but follow the doctor's prescription.

Any curvature of the lower leg in a child ultimately leads to a violation correct setting feet. Therefore, such diseases of the musculoskeletal system are always accompanied by flat feet or clubfoot, destruction of the ankle and knee joint. If a curvature of the legs is detected in children, then treatment should begin immediately. In the initial stages, therapy is possible with conservative measures without surgery. Although sometimes the methods used may seem barbaric. For example, some orthopedists recommend putting a cast on the baby's shins in order to correct the tibia bones.

In fact, there are a huge number of simpler and more affordable methods. fixes. Read in this material a description of the first signs of curvature of the tibia of the lower leg in a child. If you see these symptoms, immediately consult an orthopedist.

Probable causes of deformation

You may be surprised, but all children are born bow-legged! This is because the baby's legs are constantly bent while in the uterus. The curvature may not be noticeable until the baby begins to walk. In the second year of life, the baby's legs begin to straighten. So neither you nor your child most likely have a reason to worry. Although you need to know the probable causes of deformation of the bones of the lower leg.

If the baby's legs remain crooked after three years, then we will talk about o-shaped curvature of the legs. This condition is dangerous, a sign of rickets, a bone disease caused by a lack of vitamin D, characterized by bone weakness. Babies between the ages of six and twenty-four months are at risk because the condition can lead to severe muscle and limb damage, back pain, and even broken bones.

To prevent the development of rickets, watch out for; so that the baby gets enough vitamin D from food, mineral and vitamin supplements and has been in the sun. In more rare cases, o-shaped curvature of the legs is a hallmark of an excess of fluoride in the body and even lead poisoning.

Although breast milk is an ideal food for babies, it does not contain the vitamin D needed to prevent rickets. Therefore, all breastfed babies need an extra dose of vitamin D. The American Academy of Pediatrics has raised the amount of vitamin D required per day from two hundred units to four hundred IU (for babies who are breastfed from birth).

Sign 6 of Blount's disease and osteopsatirosis

O-shaped curvature of the legs in a child is sometimes a sign of Blount's disease.- pathology of the development of the tibia, as a result of which a strong curvature of one or both legs develops. Usually, leg varus in children becomes noticeable between the ages of two and four.

Blount's disease is most often hereditary and mostly occurs in girls. At risk are children who began to walk early, dark-skinned infants and toddlers with overweight. For the treatment of young children, special prostheses (splints) are usually successfully used, but in some cases, such as adolescents, surgical intervention is required.

And finally, a varus curvature of the lower leg in a child in any direction can be the first sign of a rare genetic disorder - osteogenesis imperfecta (osteopsatirosis). Among the main signs of this disease are frequent fractures, small stature, discoloration of the teeth and a bluish or grayish tint of the sclera of the child's eyes. Children born with osteogenesis imperfecta usually have brittle bones. Although this disease is incurable, there are many remedies that reduce the frequency of fractures and reduce pain.

X-shaped extended curvature of the legs in children

If your baby tries to walk as if his knees are turned inward- most likely, your child has a fairly common deformity of the knee joint with an inward turn. When a baby is learning to walk, this knee rotation is part of the normal process, as it helps to maintain balance.

Yes, for most children, the waddle gait looks exactly like this until the age of three, for some - up to five or six. In the same way as with the o-shaped curvature, for overweight children there is a threat to maintain this position, because the growing bones are deformed under the pressure of unnecessary kilograms.

The X-shaped curvature of the legs in a child is not only a cosmetic problem, the shins turned inward will interfere with him while running and other types physical activity. In this case, physiotherapy and splints are of great help, in especially difficult situations, surgical intervention is recommended.

Not leveling hallux valgus legs in a child may be a sign of a tibial injury, a bone or marrow infection, or a bone disease such as rickets (see Crooked Legs above). But with a valgus curvature of the lower leg, the child shows even more eloquent signs - inflammation, pain and high fever.

See how the curvature of the legs in children is manifested and corrected - the video shows modern techniques impact:

Crooked legs are not only a cosmetic defect, but often a serious disease, manifested by the curvature of the lower leg. Depending on the shape of the legs, there are varus deformity of the legs (limbs in the form of the letter "O") and valgus deformity of the legs (limbs in the form of the letter "X"). It is not difficult to understand whether a person has a problem with his legs: any deviation from a straight line drawn through projections hip joint, knee joint and the first interdigital space indicates pathology. You can also ask the patient to put his feet close to each other and try to compress his knees: he simply cannot do this, because. the knee joints will turn outward, clearly demonstrating a large gap between the legs. If the knees are squeezed by a person suffering from valgus, then the shins will diverge to the sides, then with a discrepancy of more than five centimeters, they speak of the presence of a valgus anomaly in the development of the limbs.

Reference. A slight deviation of the ankles outward (up to 7 ° in men and up to 10 ° in women) is not considered a pathology. Valgus curvature is characterized by a large angle of curvature, at which there is a significant divergence of the legs with closed knees. It is interesting that in some cases, the reverse inversion of the foot, characteristic of varus deformity, leads to the gradual development of a valgus curvature in the patient.

Causes of hallux valgus in children and adults

Sometimes a child is born with a hereditary valgus curvature of the lower leg, but the pathology manifests itself most often after the child gets on his feet. In addition, the shins in children are usually deformed due to rapid growth bones against the background of slow formation of the musculoskeletal system as a whole. With valgus curvature of the lower leg, the knee joint suffers first of all, which leads to "over-extension" of the leg in the knee area. If a child has a valgus deviation of the legs, then over time he will most likely develop flat feet and scoliosis.

Causes of hallux valgus in children:

• hereditary or genetic disease of the limbs;
• congenital anomaly of the legs;
• bone and cartilage disease;
• metabolic disorders (improper absorption of vitamins and minerals);
• inflammatory processes;
• rickets in severe form;
• dietary deficiency of calcium and vitamin D, which contributes to its absorption (possibly due to insufficient sun exposure);
• excess weight.

Causes of valgus curvature of the lower leg in adults in many cases, “comes from childhood”, since due to the slow development of the disease, obvious symptoms fully manifest themselves with age, for example, due to. In addition, injuries to the lower extremities lead to deformation of the lower leg (usually one).

Symptoms of hallux valgus deformity

The main sign of hallux valgus is the X-shaped shape of the legs, that is, the obvious displacement of the axes of the limbs. But the matter is not limited to external manifestations: a person experiences pain with any movement of the lower leg and foot, including while walking. The load on the limb is unevenly distributed and mainly falls on the knee and ankle joints, which are gradually destroyed because of this. If you do not begin to treat hallux valgus deformity of the lower leg, then the person will lose the ability to move normally and become disabled.

Surgical treatment of hallux valgus deformity

The defect is corrected during corrective (varus) osteotomy - an operation during which a part of the femur is removed, and then the remaining parts are fused using compression-distraction osteosynthesis, for which the Elizarov apparatus is installed on the limb (it can be used to lengthen the limb if necessary) . If the patient has significant destruction of the knee joint, then reconstructive chondroplasty is additionally performed. Surgery Valgus deformity of the lower leg is not performed in patients under 18 years of age, since their musculoskeletal system is not yet fully formed.

Curvature of the legs: video consultation with a specialist

Conservative treatment of valgus deviation of the lower leg

If the valgus of the lower leg is diagnosed in time, without waiting for changes in the joints, then the curvature of the limbs can be avoided. To a greater extent, this applies to children who, at the first signs of pathology, should be shown to an orthopedic doctor. At all stages of valgus curvature of the legs in children, physiotherapy exercises and massage, in addition, select orthopedic shoes that reduce the load on the joints. The same techniques are suitable for the prevention of curvature of the legs in children. Special attention it is required to pay attention to nutrition - it is recommended to include foods rich in calcium, phosphorus and vitamin D (dairy products, fish, eggs, nuts) in the diet.

Physical exercise. Experts advise cycling, swimming, playing ball and walking up the stairs. For patients with valgus deformity of the foot, a complex has been developed exercise therapy exercises . If a pathology is found in a child, then he must be taught to sit in Turkish (the feet touch each other, and the knees are spread apart).

Massage. In case of valgus deformity of the lower leg, it is important not to allow the divergence of the ankles to progress, that is, to increase the tone of the ligaments and muscles and thus strengthen the limb. To do this, the patient is prescribed a massage course, which usually includes 15-20 sessions held every other day (every day is possible). It is desirable to repeat courses in two weeks or in a month. The intensity of the procedures is gradually increased, but pain they shouldn't call. During the massage, the specialist first strokes, rubs and kneads the muscles of the gluteal and lumbar regions, and then acts on the muscles of the legs, working with, shins, knees and ankle joints.

False curvature of the legs

Valgus and varus are true deformities of the lower leg, but there is also a false curvature in which the bones are even and the limbs seem crooked due to improper distribution or underdevelopment of soft tissues, leading to non-closure of the calf muscles.

False curvature of the lower leg is corrected physical activity(by doing special exercises you can “pump up”, that is, increase the volume of the calf muscle), contour plastics (Macroline filler) and the installation of silicone implants (cruroplasty). Usually, the shape of the lower leg is changed by patients with underdeveloped, deformed and asymmetric lower leg muscles, among them there are many athletes and bodybuilders, that is, people for whom it is important to have a proportional body.

The main thing about hallux valgus deformity

Photos before and after treatment of hallux valgus deformity

SHIN EXAMINATION

Examination of the lower leg from the front reveals changes in its shape in the frontal plane; when examining the lower leg from the side, its curvature in the sagittal plane becomes visible. The curvature of the lower leg at an angle (angulatis cruris), open outwards, is called the abducted lower leg - crus valgum. Since the deformation of the lower leg is determined mainly by the curvature of the tibia, then, formulating the designation in relation to it, they say “valgus of the tibia” (tibia valga). Deformation of the opposite direction at an angle open inward is called the “adducted lower leg” (tibia vara or crus varum). Curvature of the lower leg inward and outward occurs in the frontal plane. Changes in the shape of the lower leg in the sagittal plane are accompanied by the formation of an angle that is open anteriorly or posteriorly. In the first case, i.e., with a posterior curvature of the lower leg (with an angle open forward), the deformation is denoted by the term crus recurvatum. If, on the contrary, the apex of the curvature is facing forward, and the angle is open posteriorly, the deformity is called

c rus antecurvatum or kyphosis tibiae.

Angular curvature of the lower leg is functionally unequal. Some of them sharply violate the supporting function of the leg and, from this point of view, are among the unfavorable curvatures; others are less unfavorable.

Among the unfavorable curvatures of the lower leg are curvature at an angle, open outwards (crus valgum), anteriorly (crus recurvatum), and also anteriorly outwardly (orus valgum et recurvatum). Even a slight angular curvature of the lower leg in one of the indicated directions sharply impairs the musculoskeletal function of the leg.

Unfavorable curvature of the lower leg is complicated by the development of secondary deformities of the feet. For example, with the abducted lower leg (crus valgum), secondary flat feet develop. Secondary changes in the feet also occur with less unfavorable curvature of the lower leg. Varus curvature of the lower leg forces to give the foot a valgus position for the sake of correct load when relying on it. Secondary flat feet that develops with varus deformity of the tibia appears later than with valgus curvature of the lower leg. The main deformation and secondary changes violate the functional ability of the limb and entail secondary changes in the overlying sections. Compensatory devices that develop with unfavorable curvature of the lower leg, for example, bringing the forefoot (pes adductus) with the abducted lower leg (crus valgum), are usually unable to balance the unfavorable deformity of the lower leg.

The cause of angular curvature of the lower leg may be improperly fused diaphyseal fractures. With fresh fractures of the lower leg, unfavorable angular displacement of bone fragments is most often observed.

In contrast to the angular curvature of the lower leg, typical for fractures, arcuate curvature of the tibia or fibula can be congenital, and also occur with severe forms of rickets, osteitis deformans, and a number of other common diseases that reduce bone strength. The curvature of the weakened bones of the lower leg usually occurs in the direction of an increase in the natural

their curvature.

The diagnosis of shin curvature is not limited to determining the localization of the deformity and the morphology of pathological changes. The diagnosis should reflect the disease that caused the development of the deformity. An attempt to correct a vicious form without a clear understanding of the cause that caused it, only occasionally can be successful.

In infancy, the lower legs are slightly arched (crus varum neonatorum) in accordance with the intrauterine articulation of the fetus; varus curvature of the legs in infants is symmetrical. The position and shape of the feet at this age may be asymmetrical. Asymmetric curvature of the legs raises the suspicion of a possible pathological nature of the changes.

Congenital hypoplasia of the infant's leg with unilateral curvature of the lower leg (angulatio tibiae), localized in the middle or lower third of the tibia, is of great clinical importance. Arcuate deformity can be varus (tibia vara congenita) or in the form of recurvation (tibia recurvata cong.). In most cases, the cause of this congenital curvature is congenital neurofibromatosis or, less commonly, fibrocystic dysplasia of the tibia. Congenital curvature of the lower leg is a condition preceding the development of congenital pseudarthrosis. Early surgical correction (osteotomy, osteoclasia) of an unrecognized and properly unestimated deformity in a newborn ends with a false joint.

The curvature of a shin caused by rickets meets now seldom. Rickets can develop in three phases of life: in utero in the fetus, in infancy, and in adolescents (late rickets).

Fetal rickets of fetuses from mothers suffering from vitamin D deficiency, i.e., patients with osteomalacia, occurs only in economically backward countries. Fetal bones in fetal rickets show changes similar to infantile rickets.

Infantile rickets appears in an infant after the cessation of breastfeeding, during a period requiring a large amount of vitamin D, if the diet is deprived of it. Most often, with infantile rickets, a 0-shaped deformity of the legs (crura vara rachitica infantilis) and hips occurs; less often valgus. The curvature may be asymmetrical, varus curvature of one leg may be combined with valgus curvature of the other. At the same time with

with varus curvature, the lower leg can be bent anteriorly, forming a “saber” lower leg. The anterior rachitic curvature of the lower leg differs from the syphilitic “saber” lower leg in a number of ways: with rachitic antecurvation, the lower leg is deviated anteriorly and sideways (outward or less often inwards), with syphilitic curvature - only anteriorly; the crest of the tibia with rickets is sharp, with syphilitic deformity it is rounded and smooth; the surface of the tibia with rachitic curvature is smooth, flat, with syphilis - convex. General signs of the underlying disease (rickets and syphilis) also help to find out the cause of the curvature.

Teenage (late) rickets appears during a period of rapid growth, when the body needs large amounts of vitamin D and mineral salts. It develops under the same conditions as osteomalacia in adults - with a deficiency in the diet of calcium and vitamin D, with a limited stay of a teenager in the open air and the sun. Late rickets also occurs with certain diseases and other adverse conditions.

There are several types of late rickets that do not respond to conventional treatment with the usual doses of vitamin D. It is reported (Ferguson, 1957) that in most children's clinics only half of the children have ordinary rickets from dietary vitamin D deficiency. The other half suffer from some form of resistant rickets resistant to normal doses of vitamin D. Resistant rickets results from steatorrhea, chronic kidney disease, and genetic predisposition. Orthopedic treatment of rachitic deformities, in particular corrective osteotomy, can be successful after adequate preliminary general treatment of the patient.

Rickets with steatorrhea (intestinal rickets) occurs on the basis of an intestinal disorder that disrupts the absorption of fats from intestinal tract a sufficiently long period; causes starvation with vitamins, soluble in fats, calcium and phosphates. Any type of prolonged steatorrhea can lead to rickets in children and osteomalacia in adults.

Chronic renal failure is a disorder of osteoid calcification and may result from chronic long-term renal disease that interferes with serum calcium and phosphate retention (“renal rickets”, renal osteodystrophy). There are two main groups of diseases: 1) renal failure due to imperfect glomerular filtration (congenital anomaly of the kidneys, glomerulonephritis, chronic uremia, etc.), 2) renal disorders as a result of dysfunction of the renal tubules (impaired reabsorption of phosphates in the proximal convoluted tubules, and sometimes and reduced absorption of glucose and various amino acids). External symptoms, signs and bone changes of stable rickets are the same as usual.

In both of these groups of “renal rickets”, the development of secondary parathyroid hyperplasia with associated fibrocystic changes in the bones, sometimes masking defective calcification of the osteoid, is possible.

Genetically determined resistant rickets is a hereditary disease traced over several generations, although isolated cases of spontaneous disease are possible, the hereditary transmission of which has not been proven. With ordinary rickets, which occurs on the basis of insufficient content in food

vitamin D, usually develop varus deformities of the lower extremities; with "renal rickets" most often there is a valgus curvature of the legs.

If a sick child is about a year old and is seeing a doctor for the first time, then the study cannot distinguish resistant rickets from rickets due to vitamin D deficiency. The physical symptoms in both forms of rickets are the same, as are the results of a chemical blood test. Resistant rickets is suspected if the children are older. Suspicion is heightened when previous treatment with the usual therapeutic doses of vitamin D has been ineffective. A routine urinalysis confirms the suspicion that the urine is persistently low in specific gravity in "renal rickets". The patient has polyuria, polydipsia. It is useful in the study to measure daily urination, in such cases it is increased, and if this is not feasible, then it is necessary to measure the amount of fluid taken orally.

It should be emphasized once again that the surgical correction of the leg curvature caused by resistant rickets can be successful if the process is not stopped only in the short term after the operation. If the treatment of the underlying disease was not carried out or was insufficient, then the corrected deformity recurs to the same severity as it was before the operation.

Deforming osteochondrosis of the tibia (osteochondrosis tibiae, tibia vara intern a, m. Blount). The varus deformity of the lower leg, which occurs when the inner part of the proximal epiphysis of the tibia is diseased, is most often confused with the rachitic curvature of the lower leg, with which it has nothing to do. In contrast to rickety arcuate deformity, the lower leg in Blount disease is angled and often internally rotated. The apex of the angular curvature of the tibia is located high, at the level of the proximal epiphysis. Below the angle of curvature, the diaphyseal part of the tibia remains completely flat; at its inner condyle, a coracoid protrusion is visible and well palpable -

this is a modified metaphysis located under the affected inside epiphyseal growth plate. In early childhood, from two to four years, the deformation is bilateral (tibia; vara interna infantilica bilateralis), at an older age it can be one-sided. The lower leg in the zone of the proximal metaphysis is angularly curved.

Metaphyseal dysostosis (dysostosis metaphysialis), no Schmid (1949), Dent, Nordmand (1964), also causes curvature of the legs, resembling rachitic deformity. The disease begins in early childhood in one-year-old or one and a half year old children with a curvature of the legs. The epiphyses are enlarged, the lumbar lordosis increases, the gait is waddling from the very beginning of walking. Blood chemistry, plasma calcium, phosphate and alkaline phosphatase are normal.

In adults, the curvature of the legs is observed with Paget's deforming osteitis. The deformity has the appearance of 0-legs when the femur and tibia are involved in the change. Sometimes the process is limited to one bone (monosseous form of Paget's disease), more often several, including the spine and pelvis. The affected bones thicken and if the thickened bone is located superficially, under the skin, such as the tibia, then this change is striking. Bone thickening is caused

the fact that bone is built faster than it is destroyed; newly formed bone beams are deprived of sufficient strength in Paget's disease due to incomplete calcification, they are thick, rough and soft. X-ray zones are detected at the top of the curvatureremodeling and sometimes infractions and transverse fractures. Under load, thickened and weakened bones gradually bend so that their normal curvature becomes overly emphasized. Paget's disease may be asymptomatic. Then she shows up by accidenton x-rays taken for other reasons. Sometimes deforming osteitis occurs with severe aching pain in the affected bones, with an increase in the size of the skull, kyphosis and curvature of the limbs. In such cases, the diagnosis is simple.

Feeling. The tibia, due to its relatively superficial location, is accessible to palpation over a vast area; under the skin, its inner edge, anterior and inner edges are easily palpable. The fibula can be felt in the upper third, in the region of the head and neck, and also below, in the lower third in the region of the outer ankle (Fig. 435

).

Under the head of the fibula, the superficial branch of the peroneal nerve (ramus superficialis n. Peronei) is probed, passing over the neck of the fibula, in the direction from top to rear, front to bottom.

Examination of the muscles of the leg. The triceps muscle of the lower leg (m. triceps surae) with tension sets the foot in the position of plantar flexion and slight adduction. If triceps paralyzed, the foot assumes a dorsiflexion position.

To determine its strength, the subject is asked to give the foot maximum plantar flexion. Putting a hand on the outer edge of the foot, they try to counteract this movement. With the other hand, the tension of the Achilles tendon is felt.

If the triceps muscle is weakened, a study of its strength is carried out by putting the patient on his knees; feet should hang over the edge of the table. The own weight of the feet exerts a certain resistance when the muscle is tensed.

The tibialis posterior muscle (m. tibialis post.), tensing, gives the foot a position of adduction and supination. With its isolated contraction, the outer edge of the foot becomes convex, the inner one is concave. Joint contraction of the tibialis posterior and long fibula

muscle holds the foot at a right angle to the lower leg. If the tibialis posterior muscle is paralyzed, then the long peroneal muscle holds the foot in the allotted position (pes valgus). It should be borne in mind that with paralysis of both of these muscles, the foot also assumes a retracted position, which, however, is passive, depending on the shape of the subtalar articular surfaces.

The strength of the posterior tibial muscle is studied with the knee joint bent. The foot is placed on the table with its outer edge. The subject is asked to raise the end of the foot. With one hand, the doctor counteracts this movement, and with the other, he probes the tensing tendon between the medial malleolus and the tuberosity of the navicular bone.

The common long flexor of the fingers (m. flexor digitorum corn. longus) flexes the second - fifth toes. The third phalanges of the fingers are most strongly bent, the second phalanges are weaker, and the first are even less. With contracture of the long flexor of the fingers, the third phalanges are set in the position of hyperflexion, as a result of which the support is made on the nail surface of the fingers.

The strength of the general flexor is examined with the foot fixed in relation to the lower leg at a right angle. The patient is asked to bend the fingers. To feel the tense tendon, you should place your fingers between the back edge of the inner ankle and the Achilles tendon.

The long flexor of the thumb (m. flexor hallucis long.) strongly flexes the second phalanx of the finger and weaker than the first. With persistent abduction of the thumb (hallux valgus), the flexor tendon, together with the two sesamoid bones between which it passes, heading towards its place of attachment at the base of the second phalanx, is displaced into the first metatarsal space. The long flexor of the thumb, having shifted, begins to abduct the thumb, becoming an abductor. With each step, its contraction increases the outward deflection of the finger. A fracture of the posterior process of the talus (pros. posterior tali) causes contracture of the long flexor, resulting in persistent flexion of the thumb.

The strength of the long flexor of the thumb is examined in the same way as the general long flexor of the fingers. Tension of the flexor thumb tendon is felt behind the medial malleolus.

Long peroneal muscle (m. peroneus long.) produces plantar flexion of the foot, abduction and pronation of it. In addition, the long peroneal muscle holds the arch of the foot. Loss or weakening of this muscle not only disrupts the abduction and pronation of the foot, but also leads to the development of flat feet.

Force long peroneal muscle determined with the knee joint in flexion. The foot is placed on the table with the inner edge. The subject is offered to raise the end of the foot above the table. By counteracting this movement, the force of muscle contraction is assessed. Muscle tension is controlled by fingers placed at the top on the outer surface of the lower leg, near the head of the fibula. It is not advisable to feel the tension of the tendon of the long peroneal muscle behind the lateral malleolus, since the strand determined during muscle contraction here is common to the long and short peroneal muscles.

The short peroneal muscle (m. peroneus brevis) abducts and pronates the foot. It holds the foot in the middle position at a right angle to the lower leg. If the foot is in dorsiflexion, then the tension of the short peroneal muscle produces plantar flexion of the foot and, conversely, removes the foot from plantar flexion, unbending it. The short peroneal muscle is the only muscle that gives pure abduction. The common extensor of the fingers, moving the foot outward, flexes it simultaneously to the rear; the long peroneal muscle combines abduction of the foot with plantar flexion. With paralysis of the short peroneal muscle, the synergists replacing it (the common long extensor of the fingers and the long peroneal muscle) hardly abduct the foot and hold it

at right angles to the ankle.

The strength of the short peroneal muscle is studied by the resistance exerted by the doctor's hand to the active abduction of the foot outward. Tension of the tendon is determined by palpation behind the styloid process of the fifth metatarsal.

The anterior tibialis muscle (m. tibialis ant.) Is the back flexor, adductor and arch support of the foot. Paralysis of this muscle causes the allotted position of the foot (pes valgus), to which the tone of the preserved calf muscle adds a certain degree of persistent plantar flexion (pes equinus).

When examining the strength of the anterior tibialis muscle, the foot is placed in the position of plantar flexion and the head of the first metatarsal bone is lowered. The subject is offered to straighten the foot in the ankle joint, simultaneously raising its inner edge. The strength of the contraction is measured by the opposition to this movement. The tense tendon is visible on the anterior-inner side of the foot in the form of a skin roller raised above the tendon.

The common long extensor of the fingers (m. extensor digitor. corn. longus) unbends the last four fingers. At the same time, the long extensor of the fingers produces extension (dorsal flexion) of the foot, setting its anterior section into abduction (abduction), and the entire foot into the valgus position.

When researching muscle strength of the common long extensor of the fingers, the patient is offered to set the foot in dorsiflexion, simultaneously straightening the fingers. Counteracting this movement with a hand, the doctor determines the strength of the muscle. With the second hand, the tendons protruding in the region of the anterior-outer part of the ankle joint are palpated.

The long extensor of the thumb (m. extensor hallucis long.) produces extension of the first finger, along with this it serves as an additional dorsal flexor (extensor). It replaces the tibialis anterior if it is paralyzed. With this replacement, the long extensor of the thumb is hypertrophied and its contraction is clearly visible on the anterior surface of the ankle joint. The replacement of the paralyzed tibialis anterior muscle with the long extensor of the first toe is accompanied at the moment of dorsiflexion of the foot by tipping to the rear of the first phalanx of the thumb. The first phalanx is set at right angles to the foot, the terminal phalanx is bent and the thumb takes on a hammer-like shape.

Strength extensor longus thumb is determined by its active extension. On the back of the foot, in the area of ​​the first metatarsal bone, a tendon roller is made visible, lifting the skin.

The results of a clinical study of the muscle strength of the diseased leg are evaluated by comparison with the opposite, healthy side and are recorded in the medical history in the form described above.