Due to the deformation of the bones in children and adults, the curvature of the legs begins. Pathology is observed when the correct contour of the legs is violated and is not only a cosmetic defect. The lack of proper therapy is fraught with uneven distribution of the load on the joints and development. If the latter progresses, severe pains in the legs appear, which can only be eliminated through surgery.

General information

Doctors call the correct shape of the legs, in which through the head of the femur, which forms hip joint, the middle of the knee pad and the first interdigital space is a straight line. In this case, 3 spindle-shaped contours should be observed - in the perineal region, knee joints, ankles. Otherwise, the curvature of the legs is diagnosed. It can be due to bone deformation or poor soft tissue distribution. In any case, the pathology brings discomfort and causes dissatisfaction with the shape of your legs.

Note! Every fifth inhabitant of the planet is unhappy with the shape of their legs. If, at the same time, she notes a distortion of gait or lameness, she should immediately consult a doctor.

Classification

Curvature can manifest itself in 2 forms:

• - it is easy to recognize it by the characteristic letter "X", which is visible when the patient closes his legs together. That is why the pathology is called X-shaped. It should be noted that a slight outward deflection of the lower leg is allowed. For men, the permissible angle normally does not exceed 5 - 7 degrees, while for women it is 10 degrees.
• Varusnoy- due to the fact that both legs in the case of diagnosing a defect resemble the letter "O", it is called O-shaped. You can recognize it by the inner contour - the lower leg arches in an arc that stretches from the perineum to the closed ankles.

In addition, the curvature can be:

• true - when the bones are deformed lower limbs;
• false - when the defect is the result of a special arrangement of soft tissues that create curvature.

Important! Valgus curvature leads to the development of flat feet, and varus - to the appearance of secondary flat feet.

False curvature does not always require surgical intervention. Most often it is the result of an incorrectly distributed load on the hips, legs and feet during sports. This condition is not a serious pathology and can be easily eliminated with the help of regular training of the lower leg muscles, thanks to which they finally connect when the legs are closed.

Causes

Medicine identifies several causes of curvature of the legs. First of all, these are:

Due to the fact that many diseases, one way or another, affect the metabolism and subsequently lead to the development of pathologies of bone, cartilaginous and muscle tissues, at an early age children should be regularly brought to a pediatric orthopedist for examination. He will check how the musculoskeletal system is developing and exclude or confirm the presence of a curvature of the lower leg.

Symptoms

The first sign of pathology is an irregular contour of the legs. Flat feet may also indicate it. You can verify the presence of the latter by regularly checking how the shoes are worn down. If the sole is practically flat, all is well, however, when there is a stomping in or out, see a doctor.

Note! After injuries and fractures, curvatures may appear as a result of improper bone fusion. Any delay in treatment in this case is fraught with not only discomfort, but also pain.

It should be noted that with congenital defects, children learn to walk more slowly and lag behind their peers in physical development.

Diagnostics

To identify the curvature of the legs, it is enough to contact a traumatologist or orthopedist. After a visual examination and anamnesis, he will most likely prescribe:

• feet, legs;
• joints;
• , calcium level.

To identify flat feet, plantography is used - a method that involves obtaining a footprint or footprint.

Important!At this stage, the doctor seeks not only to make the correct diagnosis, but also to identify the causes of the deformity. That is why he takes into account everything, up to the quality of the kidneys, which can also provoke the development of a defect.

Treatment

It is worth noting that it is possible to correct the defect with the help of some physical exercises only in mild cases. Congenital pathologies accompanied by muscle underdevelopment or asymmetry are corrected by a plastic surgeon. In addition, the type of curvature matters.

Correction of hallux valgus in children

Therapy depends on the results obtained from the research. Identified diseases of the urinary or skeletal system, for example, are eliminated by prescribing special medications.

In addition, experts advise parents to ensure that the child stands with legs wide apart as little as possible. He is also advised to wear orthopedic shoes with a beveled heel, a special insole and a hard back.

Important! Walking barefoot has a beneficial effect on the condition of the lower legs. In this case, you can walk on grass, sand or pebbles, simultaneously trying to grab them with your toes.

If the situation worsens, special tires are used. Sometimes an operation is shown, which is reduced to removing the wedge from the femur and restoring the axis of the limb. Due to the fact that valgus is often the result of diseases of the kidneys or endocrine glands, together with the surgical intervention, the patient is prescribed treatment. If successful, the curvature does not recur.

Hallux valgus massage

The massage improves muscle tone and strengthens the limb. The main thing is to carry it out daily or every other day, for a month... After that, you can take a break for up to 4 weeks, and then repeat the massage from the beginning. With each subsequent course, experts advise increasing the intensity, as this will allow you to quickly achieve visible results.

Note!The correct massage is painless.

During the massage, the back, limb, lower back, buttocks are rubbed, stroked. There are several techniques for influencing the muscles and joints in these areas, which are owned by a specialist, which is why it is important to contact him.

When these procedures do not give a visible effect, it makes sense to come for a consultation with a plastic surgeon.

Plastic surgery methods in the fight against curvature of the legs

After the operation, the patient is put on a special orthopedic apparatus, which he is forced to wear for 5 - 8 months, depending on the complexity of the operation.

Important!To achieve the desired stable result, it is recommended to perform orthopedic surgery on the lower leg after the patient reaches the age of 18. At this time, the last growth spurt ends. bone tissue and the whole organism, due to which there is no need for repeated operations.

Curvature of the legs is a pathology that directly affects the quality of human life. At best, a cosmetic defect appears, at worst - it progresses, which entails a distortion of gait, discomfort, and soreness. Curvature treatment should start with a consultation with a traumatologist or orthopedist. He will recommend a visit physiotherapy exercises swimming. If they do not give results, the question will arise about the need for an operation.

Hallux valgus the lower leg is characterized by the X-shaped shape of the legs, as a result of the weakening of the muscles of the ligamentous apparatus. Violation can become the root cause of pathology spinal column, malfunctions of internal systems and organs.

Features of the development of hallux valgus

Hallux valgus in children can be both congenital and acquired pathology. The main changes occur in the knee joint of the child, visually one can notice hyperextension of the legs and the deviation of the heels outward.

The main causes of curvature of the feet and legs in children:

• Genetic trait;
• Shin anomaly;
• Violations of the integrity of bone and cartilage tissue;
• Improper assimilation of useful elements;
• Inflammatory or infectious processes;
• Severe injuries to the limbs;
• Rickets transferred in childhood;
• Overweight.

In such conditions, minor congenital deformities in children can be aggravated, the depth of the curvature arc increases. Subsequently, pathological processes occur in the joints of the knee and pelvis.

Attention!

Knee deformity - there is a gap of more than 5.5 cm between internal parties stop. Congenital anomaly in children is rarely diagnosed, most often associated with abnormal intrauterine development of the femoral neck, foot and lower leg.

A common cause of hallux valgus is a natural instinct to spread your legs in an effort to maintain balance. Such a non-pathological deviation can disappear by the age of 8-10 years of a child's life.

Illness in childhood occurs due to increased load on the feet, early planting on a walker, accelerated walking process of the baby, due to hereditary weakness and underdevelopment of the ligaments.

Symptoms of the disease

Hallux valgus in children is not only a cosmetic defect, but significantly reduces the quality of life. As the disease progresses, it is difficult for a person to move, gait becomes clumsy, the condition is accompanied by the following symptoms:

• Constant aching sensations in the limbs;
• Violation of blood circulation - cyanosis of the skin, the appearance of varicose veins;
• Fatigue while driving;
• Puffiness in the area calf muscles;
• Shuffling feet while walking.

Because of not correct load joints in children are gradually destroyed. If therapeutic measures are not taken in a timely manner to eliminate the disease, the patient will lose the ability to move.

On a note!

In the photo, the hallux valgus looks like an X-shaped curvature when it is impossible to bring the knees together. There is an obvious displacement of the axes of the limbs, and the distance between the inner ankles becomes more than 5 cm.

Degrees of violation

In the initial stage of the disease, the outward deviation to the lower leg does not exceed 10-15 degrees, in the second - by more than 15-20 degrees. With a severe degree of curvature, a deviation of 20 or more degrees is diagnosed.

Pathology treatment

After examination by an orthopedist, an X-ray of the legs in two projections, the disease is diagnosed. To identify the cause of the deformity, an ultrasound examination, blood test, and kidney function tests may be required.

The principles of the treatment of hallux valgus in children and adults:

• To eliminate painful symptoms, orthopedic measures are prescribed - corrective styling, fixing splints, orthopedic shoes are used. It is important that the heel is elastic and resistant, the heel is not lower than 5 mm, wide toe, individually selected insole;
• To stabilize the joint and strengthen the muscle corset, the child will need massotherapy- at least 20 sessions per month, the intensity of impact on the damaged area increases gradually, techniques of stroking, rubbing, vibrating, tapping, massaging with pinch movements are used;
• Physiotherapeutic effect - electrical stimulation of plantar muscles, improves blood circulation, maintains the physiological position of the legs during movement;
• Therapeutic gymnastics - the number of exercises and the regularity of their implementation is established by the doctor. With hallux valgus of the foot and lower leg, children practice flexion and extension of the ankle joints, rotation of the feet in turn, gripping and holding small objects with the toes, squatting, walking on the vernal side of the foot.

In an advanced case, when it is not possible to correct the pathology by conservative methods, an operation is prescribed - an osteotomy. As a result of the procedure, a part of the femur is removed, the rest of the parts are fused. After that, compression-distraction osteosynthesis is used: the Elizarov apparatus is installed to form the correct angle between the bones of the foot and lower leg.

After the surgery, the operated leg is cooled and anesthetized for 2-3 days, the patient is assigned special walkers for walking, and later - crutches.

Attention!

Complications after surgery are rare - it can be hemorrhage due to cuts in blood vessels, the addition of a secondary infection, severe pain when walking.

Thanks to the operation, an excellent result can be obtained, although the disease may also develop again - in the absence of preventive measures, excessive stress on the lower extremities.

Operation in childhood and adolescence is usually not used, most often it is indicated for the elderly, when the curvature of the lower leg is accompanied by inflammatory processes, profuse swelling, and impaired coordination of movement.

Prophylaxis

Can hallux valgus be prevented? In order for the child's legs to develop physiologically correctly, it is important to saturate the baby's diet with useful microelements, additionally give vitamin D, in order to avoid the development of rickets.

At the first steps of the child, purchase high-quality shoes, avoid unnecessary stress on the thighs and lower legs under the age of 7 months. It is useful to regularly do a relaxing massage of the legs, thermal baths with the addition of pine extract, decoction of medicinal plants.

Positively affects the installation of the legs:

• Swimming;
• A ride on the bicycle;
• Skiing, skateboarding;
• Football game;
• Climbing stairs, wall bars.

In the warm season, it is useful to walk barefoot on the grass, pebbles, sand, dirt road. It is important to avoid hypothermia or overheating of the extremities so as not to aggravate the course of the disease.

At the slightest sign of curvature, it is important to seek help from a doctor - self-medication can lead to disability and death (the development of thrombophlebitis, curvature of the spine, disruption of the internal systems and organs).

Timely treatment of hallux valgus of the lower extremities avoids surgery, eliminates fatigue, leg injuries, problems with the musculoskeletal system.

SHIN STUDY

Inspection 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 outward, is called the abducted lower leg - crus valgum. Since the deformity of the tibia is determined mainly by the curvature of the tibia, when formulating the designation in relation to it, they say “tibia valga”. Deformation of the opposite direction at an angle, open inward, is called the “reduced tibia” (tibia vara or crus varum). The curvature of the lower leg inwards and outwards 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 open anteriorly or posteriorly. In the first case, that is, with the posterior curvature of the lower leg (at an angle open forward), the deformation is denoted by the term crus recurvatum. If, on the contrary, the top of the curvature is facing forward, and the angle is open posteriorly, the deformation is called

c rus antecurvatum or kyphosis tibiae.

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

Among the unfavorable leg curvature include curvature at an angle, open outward (crus valgum), anteriorly (crus recurvatum), and also anteriorly-outward (orus valgum et recurvatum). Even a slight angular curvature of the lower leg in one of the indicated directions sharply disrupts 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 leg (crus valgum), secondary flat feet develops. Secondary changes in the feet also occur with less unfavorable curvature of the lower leg. The varus curvature of the lower leg forces the foot to be given a valgus position for the sake of correct load when supporting it. The secondary flat feet that develop with varus deformity of the tibia appears later than with the valgus curvature of the lower leg. The main deformity and secondary changes disrupt 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, adduction of the forefoot (pes adductus) with abducted lower leg (crus valgum), are usually unable to counterbalance the unfavorable deformity of the lower leg.

Incorrectly fused diaphyseal fractures can be the cause of angular curvature of the lower leg. With fresh fractures of the 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 in severe forms of rickets, osteitis deformans and a number of other common diseases that reduce bone strength. Curvature of the weakened lower leg bones usually occurs in the direction of increasing the natural

their curvatures.

The diagnosis of leg 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 can only be accidentally successful.

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

Congenital hypoplasia of the infant's leg with unilateral curvature of the 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 underestimated deformity in a newborn ends in a pseudarthrosis.

The curvature of the lower leg due to rickets is now rare. 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, that is, patients with osteomalacia, is found only in economically backward countries. Fetal bones with fetal rickets show changes similar to infantile rickets.

Infantile rickets occurs in an infant after the termination of breastfeeding, in a period requiring a large amount of vitamin D, in the event that the diet is deprived of it. Most often, with infantile rickets, there is a 0-shaped deformation of the legs (crura vara rachitica infantilis) and thighs; less often valgus. The curvature can be asymmetric, the varus curvature of one leg can be combined with the hallux valgus curvature. At the same time with

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

Adolescent (late) rickets appears in the period 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 limited exposure of a teenager to the open air and the sun. Late rickets also occurs with some diseases and other unfavorable conditions.

There are several types of late rickets that do not respond to conventional treatment with conventional doses of vitamin D. It is reported (Ferguson, 1957) that in most children's clinics, only half of the children suffer from common rickets due to a lack of vitamin D supplied with food. The other half suffer from some form of resistant rickets resistant to usual doses of vitamin D. Persistent rickets occurs as a result of steatorrhea, chronic kidney disease and genetic predisposition. Orthopedic treatment of rickets deformities, in particular corrective osteotomy, can be successful after prior adequate general treatment of the patient.

Rickets with steatorrhea (intestinal rickets) is caused by an intestinal disorder that interferes with the absorption of fats from intestinal tract long enough period; causes starvation with vitamins soluble in fats, calcium and phosphates. Any type of long-term steatoria can lead to the development of rickets in children and osteomalacia in adults.

Chronic renal failure is a disorder of osteoid calcification and can result from chronic long-term renal disease that interferes with serum retention of calcium and phosphate (renal rickets, renal osteodystrophy). There are two main groups of diseases: 1) renal failure due to imperfect filtration of the glomeruli (congenital anomaly of the kidneys, glomerulonephritis, chronic uremia, etc.), 2) renal disorders as a result of impaired renal tubular function (impaired phosphate reabsorption in the proximal convoluted tubules, and sometimes and weakening the absorption of glucose and various amino acids). The external symptoms, signs and bone changes of persistent 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, masking sometimes defective osteoid calcification, is possible.

Genetically determined resistant rickets is a hereditary disease that has been traced for several generations, although there may be isolated cases of spontaneous disease, the hereditary transmission of which has not been proven. With the usual rickets, arising on the basis of insufficient content in food

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

If a sick child is about a year old, and he is with a doctor for the first time, then during the study there is no way to distinguish resistant rickets from rickets caused by vitamin D deficiency. Physical symptoms in both forms of rickets are the same, as are the data of a chemical blood test. Resistant rickets is suspected if children are older. The suspicion is heightened when prior treatment with conventional therapeutic doses of vitamin D has been ineffective. Routine clinical analysis of urine confirms the suspicion, urine consistently maintains a low specific gravity in "renal rickets". The patient has polyuria, polydipsia. It is useful in the study to measure the daily urination, it is in such cases increased, and if this is not feasible, then you need to measure the amount of fluid taken orally.

It should be emphasized once again that the operative correction of the curvature of the lower leg caused by resistant rickets can be successful if the process is not stopped only as soon as possible 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 degree of severity as it was before the operation.

Deforming osteochondrosis of the tibia (osteochondrosis tibiae, tibia vara intern a, m. Blount). Varus curvature of the lower leg, which occurs with a disease of the inner part of the proximal epiphysis of the tibia, is most often mixed with a rickets curvature of the lower leg, with which it has nothing to do. In contrast to the arcuate rickets curvature, the lower leg in Blount disease is bent angularly and often rotated inward. The apex of the angular curvature of the tibia is located high, at the level of the proximal pineal gland. Below the angle of curvature, the diaphyseal part of the tibia remains completely flat; at its inner condyle, the coracoid protrusion is visible and well palpable -

it is an altered metaphysis located under the affected inside epiphyseal growth plate. In early childhood, from two to four years, the deformity is bilateral (tibia; vara interna infantilica bilateralis), at an older age it can be unilateral. The lower leg in the proximal metaphysis zone is angularly bent.

Metaphyseal dysostosis (dysostosis metaphysialis), no Schmid (1949), Dent, Nordmand (1964), also causes the curvature of the legs, reminiscent of rachitic deformity. The disease begins in early childhood in one-year-old or one and a half-year-old children with curvature of the legs. The epiphyses are widened, 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, curvature of the legs is observed with Paget osteitis deformans. The deformity takes the form of 0-legs, when the femur and tibia are involved in the change. Sometimes the process is limited to one bone (mono-osseous form of Paget's disease), more often to 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 caused by

the fact that bone is being built faster than it is destroyed; the newly formed bone trabeculae lack sufficient strength in Paget's disease due to incomplete calcification; they are thick, rough and soft. At the apex of the curvature, X-ray zones are foundrestructuring and sometimes infraction and transverse fractures. Under load, thickened and weakened bones gradually bend so that their normal curvature is overstressed. Paget's disease may be asymptomatic. Then she is discovered by accidentwith an X-ray taken for another reason. Sometimes osteitis deformans 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. Due to its relatively superficial location, the tibia is palpable over a large area; under the skin, its inner edge, front and inner edges are easily felt. The tibia can be felt in the upper third, in the area of ​​the head and neck, and also below, in the lower third in the area of ​​the external ankle (Fig. 435

).

Under the head of the fibula, the superficial branch of the peroneal nerve (ramus superficialis n. Peronei) is felt, passing over the neck of the fibula, in the direction from above to behind, forward and downward.

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

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

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

The posterior tibial muscle (m. Tibialis post.), Straining, gives the foot a position of adduction and supination. With its isolated contraction, the outer edge of the foot becomes convex, and the inner edge is concave. Joint contraction of the posterior tibial and long peroneal

muscle holds the foot at right angles to the lower leg. If the tibialis posterior muscle is paralyzed, the peroneus longus muscle holds the foot in the abducted 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 tibialis posterior muscle is studied with the knee joint bent. The foot is placed on the table with its outer edge. The examinee is offered 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 inner ankle and the tuberosity of the scaphoid.

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 is weaker, and even less the first. With contracture of the long flexor of the fingers, the third phalanges are set in the position of hyperflexia, as a result of which the support is made on the nail surface of the fingers.

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

Long flexor 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 two sesamoid bones, between which it passes, heading to the place of its 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. Fracture of the posterior process of the talus (proc. Posterior tali) causes contracture of the long flexor, resulting in persistent flexion of the thumb.

The flexor hallucis longus force is examined in the same manner as the flexor hallucis longus. The flexor flexor tendon tension is felt behind the inner ankle.

The long peroneal muscle (m. Peroneus long.) Produces plantar flexion of the foot, abduction and pronation of it. In addition, the peroneus longus muscle supports the arch of the foot. The prolapse or weakening of this muscle not only disrupts the abduction and pronation of the foot, but also leads to the development of flat feet.

The strength of the long peroneal muscle determined at bent position knee joint. The inside edge of the foot is placed on the table. The examinee is asked to raise the end of the foot above the table. By counteracting this movement, the strength of the muscle contraction is evaluated. Muscle tension is controlled by fingers set at the top on the outer surface of the lower leg, near the head of the fibula. It is impractical to feel the tension of the tendon of the peroneal longus muscle behind the external ankle, since the strand determined during muscle contraction here is common to the long and short peroneal muscles.

The short peroneal muscle (m. Peroneus brevis) retracts and penetrates the foot. It keeps the foot in a middle position at right angles 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, brings the foot out of plantar flexion, unbending it. The peroneus shortis muscle is the only pure abduction muscle. The common extensor of the fingers, taking the foot outward, bends it simultaneously to the rear; peroneus longus muscle combines foot abduction 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 move the foot and hold it

at right angles to the lower leg.

The strength of the peroneus muscle is investigated by the resistance of the doctor's hand to the active abduction of the foot outward. Tension of the tendon is determined by feeling behind the styloid process of the fifth metatarsal bone.

The anterior tibial muscle (m. Tibialis ant.) Is the dorsal flexor, adductor and instep support of the foot. Paralysis of this muscle causes the abducted position of the foot (pes valgus), to which the tone of the preserved gastrocnemius muscle adds a certain degree of persistent plantar flexion (pes equinus).

When examining the strength of the tibialis anterior muscle, the foot is placed in the plantar flexion position and the head of the first metatarsal bone is lowered. The examinee is offered to straighten the foot in the ankle joint, while lifting its inner edge. The force of contraction is assessed 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 ridge raised above the tendon.

The common long extensor of the fingers (m. Extensor digitor. Corn. Longus) extends the last four fingers. At the same time, the extensor longus of the fingers produces extension (dorsiflexion) of the foot, setting its anterior section to abduction (abduction), and the entire foot to the valgus position.

When researching muscle strength of the common long extensor of the fingers, the patient is offered to install the foot in dorsiflexion, simultaneously straightening the fingers. By counteracting this movement with the hand, the physician determines the strength of the muscle. The second hand can feel the tendons protruding in the antero-outer region ankle.

The long extensor of the thumb (m. Extensor hallucis long.) Produces extension of the first finger, together with this it serves as an additional dorsal flexor (extensor). It replaces the tibialis anterior muscle if it is paralyzed. With such a replacement, the long extensor of the thumb hypertrophies and its contraction becomes clearly visible on the front surface of the ankle joint. The replacement of the paralyzed anterior tibial muscle by the long extensor of the first toe is accompanied at the moment of dorsiflexion of the foot by overturning to the rear of the first phalanx of the big toe. The first phalanx is set at right angles to the foot, the terminal phalanx is bent and the thumb acquires a hammer-like shape.

The strength of the long extensor of the thumb is determined by actively extending it. On the back of the foot, in the area of ​​the first metatarsal bone, a tendon roller is visible, which lifts the skin.

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

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 joints. If curvature of the legs is detected in children, then treatment should be started immediately. In the initial stages, therapy is possible with conservative measures without surgery. Although sometimes the methods used can seem barbaric. For example, some orthopedists recommend applying a cast to your baby's shins to correct the shin bones.

In fact, there are a huge number of simpler and more affordable techniques. fixes. Read in this resource a description of the first signs of curvature of the tibia of the lower leg in a child. If you see these symptoms, seek immediate orthopedic advice.

Probable causes of deformation

You might be surprised, but all babies are born bow-legged! This is because the legs of the baby 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 has a reason to worry. Although it is necessary to know the probable causes of the deformation of the bones of the lower leg.

If the baby's legs remain crooked after three years, then we will talk about the 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 weak bone tissue. Children between the ages of six and twenty-four months are at risk because the condition can cause serious damage to muscles, limbs, back pain, and even fractured bones.

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

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

Sign 6 Blount disease and osteopsyrosis

O-shaped curvature of the legs in a child is sometimes a sign of 6 Blount disease.- pathology of the development of the tibia, as a result of which a strong curvature of one or both legs develops. Usually, varus curvature of the legs in children becomes noticeable between the ages of two and four.

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

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

X-shaped extended curvature of the legs in children

If your toddler is trying to walk as if his knees were turned inward- Most likely, your child has a fairly common deformity of the knee joint with an inward turn. When your toddler is learning to walk, this swinging of the knees is part of the normal process as it helps maintain balance.

Yes, for most children, a waddling gait looks like this up to three years old, 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 lower legs deployed inward will interfere with him during running and other types physical activity... In this case, physiotherapy and splints are of great help; in especially difficult situations, surgical intervention is recommended.

A child's non-flattening valgus curvature may be a sign of a tibial injury, a bone or bone marrow infection, or a bone disorder such as rickets (see Crooked Legs above). But with a valgus curvature of the leg in a child, even more eloquent signs appear - inflammation, pain and high fever.

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

Curvature of the legs is a violation of the structure of the bones of the legs or an improper distribution of the skin and subcutaneous fat, in which the legs are O or X-shaped.

The problem of deformed legs is not only an aesthetic defect, the violation adversely affects the physiological capabilities of a person. In a patient with a pathological structure of the bones of the legs, an incorrect distribution occurs physical activity on the joints of the knees and hips, which can lead to arthrosis of the knee joint or cause degenerative-dystrophic diseases of the joints. Quite often, doctors diagnose flat feet of various types and degrees in patients with crooked legs.

A doctor can determine the presence of curvature of the legs, and no special medical devices are required. During the examination, the specialist draws a straight line from the head of the femur, then through the midline of the patella and down to the first space between the fingers. If the line is straight, the shape of the legs is considered correct. Any deviation from the norm is classified as a pathology and requires treatment.

Most often, to eliminate the problem of curved legs, patients turn to plastic surgeons who can choose the right treatment option depending on the type of deformity. In the case when the curvature is a cosmetic defect (false curvature of the legs), formed due to improper distribution of the skin and subcutaneous fat, then you can fix it by special exercises and shin plastics; when the deformity affects the bones (true curvature of the legs), then the treatment will be carried out exclusively through surgery.

Calf curvature classification

In medicine, curvature of the legs is classified into two main types:

1. true curvature;
2. false curvature.

The greatest problem is the first type of deformity associated with a violation of the structure of the tibia.

In addition to the typical classification, the true curvature is divided into two types:

1. valgus - has the shape of the letter X, where the position of the legs is characteristic, in which there is a large external angle of curvature, in the closed position of the patient's legs, the inner part of the knees converges, and the ankles are at a considerable distance from each other;
2. varus - has the shape of the letter O, where curvature along the inner part of the lower leg is characteristic, while the patient in the closed position of the legs forms a large distance of the knee joints from each other, and the ankles converge.

In the event that a patient seeks help from a specialist to determine the type and type of pathology, the following indicators are considered to be the norm:

• in males, the deviation of the location of the legs outward from 5 to 7 degrees is considered normal;
• for female representatives, the deviation rate is considered to be an arrangement of up to 10 degrees.

The problems of true curvature of the legs in modern medicine, and in particular in plastic surgery, are usually eliminated by lipofilling.

Hallux valgus

The deformity of the legs, classifying as true, gives the patient a lot of inconvenience and is often the cause of functional disorders. The valgus type of curvature largely influences the development of flat feet, in addition, the recurved curvature modifies a person's foot in such a way that an external fold of the foot is formed and, as a result, secondary flat feet.

Varus curvature of the legs

As in the case described above, it negatively affects the function of walking, while flat feet develop even more rapidly. In patients with the pathology of the varus curvature of the legs, a reverse turn of the foot is formed. A true arcuate curvature of the legs can be both congenital and acquired. If the acquired curvature is associated with injuries, then the congenital defect appears against the background of serious diseases (such as severe rickets, inflammatory processes of the bones, metabolic disorders, pathology of the endocrine system).

False curvature of the legs

Doctors attribute this type of defect to a cosmetic defect, which is associated with the nature of its formation - an incorrect distribution of the soft tissues of the legs, which gives the impression that the shape of the legs is incorrect (curved), but after diagnosis it is established that the bones themselves are not damaged. The main indicator of false deformity is the lack of closing of soft tissues in the lower leg area with each other.

Causes of the curvature of the legs

The problem of curvature of the legs becomes noticeable already in adolescence, often to diagnose this defect there is no need to visit a medical institution, it is also noticeable with the naked eye. The main reason for the formation of the curvature of the legs is the lack of important vitamins and minerals in the child's diet. Vitamin D and calcium are involved in the development of bones, as well as in maintaining their strength, therefore, in order to prevent degenerative processes of bones in childhood, it is important to monitor the child's diet and saturate it with the necessary substances. It is also necessary to spend more time in the air and the sun, which leads to the enrichment of the body with oxygen and normalizes metabolism.

A fairly common cause of the formation of curvature of the legs (not only in childhood, but also in adults) is injury, especially when the tibia, femur or knee joints are affected.

The formation of a defect can be affected by intrauterine development: for example, if the mother, while carrying a child, has suffered serious illnesses or there is a genetic factor.

Shin curvature correction

Most often, the correction of the shape of the legs, as well as the correction of the curvature of the legs, is performed by the method of surgical intervention, which is associated with better results and greater efficiency... Correct pathology exclusively physical exercise almost impossible.

In the event that the patient is diagnosed with a false curvature of the legs, he will be offered a technique for contouring of the legs. Doctors note that this method of correction is used not only by people with cosmetic defects, but also professional athletes, which allows them to give the legs the necessary contour. However, the technique is applicable only when the lower leg bones are not deformed.

Another technique for eliminating false curvature of the legs is prosthetics, that is, implantation of prostheses under the skin in the area of ​​the calf muscles. Silicone implants are used as prostheses. It is this material that has high level elasticity and strength, which makes them invisible. After such a correction, the doctor will definitely tell you about all the restrictions in terms of physical impact on the lower leg area. Thanks to implants, you can not only correct the shape of the lower legs, but also make thin legs more voluminous.

If it is impossible to correct the defect with the above methods, an orthopedic operation is performed, during which the doctor performs a corrective osteotomy, which involves dissection of the bones and subsequent compression-distraction osteosynthesis according to Ilizarov. In the same way, you can perform an increase in growth, as well as make the length and shape of the bones proportional.

Surgical operations to eliminate the curvature of the legs are performed only for those patients who have reached the age of 18.