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Varus deformity of the femur: causes, classification, symptoms and treatment. Valgus deformity of the legs - types, symptoms, treatment, massage Congenital varus deformity of the femoral neck

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

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

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

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

Treatment

Conservative methods of treatment of varus deformity of the hip in the form of traction or immobilization are considered ineffective. Prophylactic shoes are used to prevent the development of secondary deformity in the distal parts of the lower limb. With the help of a removable shoe insole, the length of the lower limbs is aligned and the progressive shortening of the diseased leg is compensated.

Indications for surgical treatment depend on the magnitude of the deformity, the course of the disease, and the age of the patient, of which the angle of femoral curvature is a priority parameter. With MEU from 45 to 60 °, observation is carried out and an X-ray examination is performed once every six months. Radical methods of treatment are resorted to in case of progression of the deformity. Indications for surgery are an increase in MEU greater than 60°, a decrease in NSA less than 100-110°, a positive Trendelenburg symptom, and a visible deterioration in walking. A contraindication to surgery is the absence of clinical symptoms with MEU less than 45°, as well as the absence of progression of the curvature with MEU less than 60°. Compared with the size of the deformity, age is a less important indication for surgery. Each age period has its own advantages for the implementation of surgical intervention. Early operations before the age of 2 years are rarely performed due to the low severity of bone deformity. The positive side of the intervention at an early age is the possibility of complete remodeling of the deformed bone. The restoration of bone structures after surgery in children aged 18 months is described. In children older than 2 years, there are more reasons for the use of surgical methods of treatment due to the greater degree of deformity. In a large child, it is relatively easier to fix the bone. The operation is done for the following purposes:

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

Operation: subtrochanteric osteotomy

Indications: varus deformity of the proximal femur, MEA greater than 60°, NSA less than 100-110°.

Lateral skin incision over the greater trochanter 10-12 cm long. A pin is inserted into the femoral neck parallel to the upper edge under the control of the image intensifier tube. Using a drill or an oscillatory saw, a gap for the plate is formed in the femoral neck parallel to the spoke. A plate bent at an angle of 140° is used. A horizontal branch of the plate is hammered into the bone gap. Osteotomy is done in the subtrochanteric region at a distance of the diameter of the femur below the angle of the plate. Under the control of the image intensifier with the help of an oscillatory saw or an osteotome, a transverse intersection of the femoral shaft is made. The proximal fragment of the thigh is adducted and the distal fragment is retracted. The proximal fragment is placed on the distal one in such a way that the lateral cortical of the proximal fragment is in contact with the sawdust of the bone of the distal fragment. The vertical branch of the plate is screwed to the diaphysis of the femur. The trihedral bone fragment is repositioned to the femoral neck. Remove the needle. A coxite plaster cast is applied to the affected leg for a period of 8-10 weeks.

Treatment results

On average, valgus osteotomy can reduce MEU5 to 35-40°, and increase NSA to 130-135°. Subtrochanteric and intertrochanteric osteotomies give approximately the same correction result. In the postoperative period, there is a loss of correction. 9-10 years after the intervention, the NSA decreases from 137 to 125°, and the MEU increases by almost half. In the postoperative period for 3 years, in almost all patients, the growth zone of the proximal femur physis is closed, after which a lag in the growth of the thigh is noted. The shortening of the leg is compensated by orthopedic shoes. A significant reduction in the length of the femur is an indication for surgical intervention. More often, lengthening of the bones of the short leg is done, less often shortening of the bones of the contralateral limb is performed. Half of the patients after the intervention have weakness of the hip abductors. In 60% of cases, there is an overgrowth of the greater trochanter, which is eliminated by apophyseodesis. In 87% of cases, there is a decrease in the size of the femoral head, in 43% of cases - its flattening, as well as flattening of the acetabulum.

Varus deformity of the femoral neck (juvenile epiphyseolysis) is a disease of adolescence and is quite rare.

Risk factors include, including prolonged microtrauma, increased stress on the bone, rickets, metabolic disorders and hormonal status.

In the pathogenesis of this condition: dystrophy in the spongy part of the paraepiphyseal zone of the neck, destructive changes, the formation of cysts and fibrosis.

  • slight soreness in the groin or popliteal region;
  • mild lameness;
  • restriction of movements in the hip joint (limitation of internal and increase in external rotation);
  • often the symptoms are triggered by trauma.

Diagnostics

At the onset of the disease, a radiograph reveals an inhomogeneous bone structure in the paraepiphyseal zone of the femoral neck, a violation of the beam longitudinal structure of the femoral neck along the line of axial load.

Against the background of osteoporosis of the neck, the contours of the epiphysis stand out as circled in pencil, and the epiphyseal cartilaginous plate seems to be expanded. The joint space is often narrowed, and the height of the epiphysis with a significant displacement of it posteriorly may decrease. Reducing the epiphyseal-diaphyseal and increasing the cervical-epiphyseal angle.

Characterized by osteoporosis of tubular bones with thinning and a decrease in the density of the cortical layer. There may be scoliosis, kyphosis, paradiscal defects in the vertebral bodies and their wedge-shaped deformity.

Treatment

  1. Hospitalization.
  2. Complete exclusion of the load on the limb: bed rest, blind plaster cast, skeletal traction.
  3. Surgery. Apply quite often: tunnelization of the femoral neck, osteotomy.

Valgus deformity of the hip joints is extremely rare and most often this disease is detected in children during a routine examination by an orthopedist, after additional X-ray examination. Boys and girls are the same. In 1/3 of patients, this congenital defect is bilateral.

The cause of the occurrence is considered to be a partial lesion of the lateral part of the epiphyseal cartilage under the head, as well as damage to the apophysis of the greater trochanter. Valgus deformity of the femoral neck (coxa valga) often occurs during the growth of a child due to untreated hip dysplasia.

At the birth of a child, the head with the neck of the femur is in physiological valgus and turned back, gradually during the growth of the child, as a result of physiological torsion (turn), the ratios change, and in an adult, the neck-diaphyseal angle averages 127 °, and the angle of anteversion - 8-10 °. With the above violations in the epiphyseal cartilage during the growth of the child, this physiological process is disturbed, which causes the occurrence of coxa valga.

In addition, valgus deformity is "symptomatic":

  • with the predominance of adductor muscles (adductors) of the thigh;
  • with Little's disease;
  • after poliomyelitis;
  • with progressive muscular dystrophy;
  • as well as with tumors and exostoses that disrupt the normal growth of the epiphyseal cartilage.

Very rarely, hallux valgus occurs after rickets, improperly treated femoral neck fracture, and untreated hip dysplasia.

The main thing in the diagnosis of coxa valga is an x-ray examination, which is necessarily carried out with internal rotation (rotation) of the limb, since the lateral rotation of the thigh on the radiograph always increases the angle of the valgus deviation of the neck.

Clinic

Clinically, hallux valgus may not manifest itself with bilateral lesions, that is, there are no symptoms. While a unilateral lesion can cause functional elongation of the limb, as a result of which the gait is disturbed, lameness on one leg.

Valgus of the femoral neck is clinically difficult to detect, since the function of the hip joint is preserved.

As a rule, people with minor hallux valgus are treated conservatively. Post-rachitic deformities self-correct with the growth of the child, which is also observed with the correct treatment of children for hip dysplasia, when the head is well centered (fixed) in the acetabulum.

Children are also conservatively treated with coxa valga, which has arisen with lesions of the growth cartilages. Since the process has a long course, complex treatment is carried out in courses.

Varus deformity of the femoral neck (coxa vara)

coxa vara Under the name "coxa vara" understand the deformation of the proximal end of the femur, when the cervical-diaphyseal angle is reduced, sometimes to a straight line, with a simultaneous shortening of the neck.

Varus deformity of the proximal end of the femur in children and adolescents is 5-9% of all diseases of the hip joint.

Varus deformities of the femoral neck are congenital and acquired.

Diagnostics

X-ray at the birth of a child does not show cartilaginous trochanters and femoral heads. Only after 5-6 months does secondary ossification of the ossification nuclei of the heads appear. As the child grows, these nuclei become more and more ossified and the femoral neck grows in length. This process is interconnected with the epiphyseal cartilage of the skewers, which also gradually ossify.

Between the fifth and eighth years of life, the proximal end of the femur is fully formed. The cervical-diaphyseal angle, which at birth is 150°, becomes smaller and equal to 142°. Also, retroversion of the neck due to torsion during growth turns into anteversion (position to the front). These physiological changes take place slowly, until the end of human growth.

Congenital disorders of ossification of the femoral neck are caused by the incorrect location of the epiphyseal (articular) cartilage, while normally it is located more horizontally and perpendicular to the axis of the neck and the direction of its load. This causes varus deformity of the neck and its slow growth in length.


Sometimes congenital varus deformity of the neck can be combined:

  • with hypoplasia (underdevelopment) of the femur;
  • with a lack of the proximal end of the femur;
  • with multiple epiphyseal dysplasia.

The third group may have an acquired form of varus neck deformity:

  • post-traumatic at an early age;
  • due to rickets;
  • be combined with Perthes disease;
  • after congenital dislocation of the femur or hip dysplasia.

There is also a group of patients with isolated cervical varus deformity who do not have a combination of congenital malformations, trauma, or metabolic disorders that would explain cervical insufficiency or cartilage growth disorders. In these patients, shortening of the limb at birth is not visible, so the diagnosis is made only when the child's body weight increases and cervical endurance decreases. This happens more often when the child begins to walk.

There are several more classifications of varus deformity of the femoral neck. For example, four types of deformities are distinguished radiographically:

  • congenital isolated varus deformity (coxa vara congenita);
  • children's deformation (coxa vara infantilis);
  • youthful deformation (coxa vara adolescentium);
  • symptomatic deformity (coxa vara sumpomatica).

(coxa vara congenita) without any combination with other diseases of the skeleton is today recognized by all. It is extremely rare and is detected immediately at birth, as shortening of the femur and high standing of the greater trochanter are visible. Sometimes in such cases, congenital dislocation of the hip can be suspected, so additional examinations clarify the diagnosis.

On examination, shortening of the lower limb due to the thigh is found. The greater trochanter is palpable above the opposite. The hip is supportive because the head of the femur is located in the acetabulum.

When the child begins to walk, lameness appears. A positive Trendelenburg sign can then be identified. In a one-two-year-old child, X-ray reveals typical signs of congenital varus deformity of the femoral neck, which is bent down to a right angle and somewhat shorter. The epiphyseal cartilage is located almost vertically, and the femoral head is sometimes enlarged, deployed and tilted downward, but is located in the trochanteric cavity. The trochanteric cavity is shallow and flat when the cervical-diaphyseal angle is less than 110°. When this angle is corrected to 140° or more, then the depression develops normally. The greater trochanter is located above the level of the neck and is slightly inclined medially, and its size increases in the course of the progression of the neck deformity.

Infantile varus deformity of the femoral neck(coxa vara infantilis) in children occurs at the age of three to five years. Parents go to the doctor due to the fact that the child began to limp on the leg and warps when walking, although he does not experience pain in the leg. From the anamnesis, it is mostly known that the child was born normal and the leg was healthy before that.

Timely access to an orthopedic doctor to establish a diagnosis and start treatment significantly reduces the recovery time. Treatment is conservative, in very rare cases, a surgical operation is prescribed. If left untreated, a person will eventually have a “duck walk” with rolling from one side to the other, which affects the decrease in working capacity and fatigue. Therefore, treatment should begin from childhood.


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Valgus and varus deformity

The normal position of the leg corresponds to a conditional line drawn through the first gap between the toes, the middle of the knee and the hip joint. Deviation from this line is considered a deformity (disturbance of the normal position, curvature), which can be varus and valgus.

With varus deformity (O-shaped), the middle part of the lower leg visually deviates outward, with hallux valgus(X-shaped) lower leg moves inward, legs resemble the letter X.

femoral neck

Valgus deformity of the femoral neck is characterized by a change in the cervical-diaphyseal angle, its increase. Most often it is combined with valgus deformity of the legs and flat-valgus deformity of the feet. In most cases, this disease is a congenital pathology due to hip dysplasia, but can also develop as a result of trauma or damage to the nervous system. May lead to the development of coxarthrosis (damage to the hip joint).

Legs

Deviation of the axis of the leg, in which the distance between the inner ankles is visually determined by about 5 cm, the knees are tightly compressed.

Valgus deformity of the legs appears in childhood as a result of premature allowing the baby to stand, a long stay in a standing position (in the arena), crawling disorders. This is due to insufficient strength of muscles and ligaments, and increased load on them. Significant causes of this pathology include rickets, hip dysplasia, knee injuries. The main changes initially affect the knee joints, there is some overextension of them, the appearance of flat-valgus flat feet. The child complains of fatigue of the legs, asks for hands, notes pain in the legs during long walking. With an asymmetrical curvature of the legs, there is a risk of developing scoliosis (curvature of the spine).

Ankle joint

Valgus deformity of the ankle joint is characterized by the displacement of the heel outward and the collapse of the foot itself inward. Often leads to the development of flat-valgus flat feet.

Foot

Plano-valgus deformity of the foot (flatfoot) is the most common type of valgus deformity of the foot. It is characterized by a change in the direction of the axis of the foot, and a decrease in its arches. Most often occurs in childhood.

Main reasons:

  • congenital disorder;
  • traumatic flat feet with a bone fracture, damage to the ankle joint, ligament rupture;
  • static flat feet due to increased stress on the joints as a result of excess weight, etc .;
  • rachitic flat feet;
  • paralytic flat feet as a complication of osteomyelitis.

Valgus deformity of the first toe (Hallux valgus)

With a hallux valgus deformity of the big toe, the metatarsophalangeal joint changes, as a result of which the big toe moves inward. In this case, the position of the remaining fingers is also violated.

Possible causes of deformity of the big toe

Among the causes of valgus deformity of the big toe:
  • endocrine changes;
  • genetic predisposition;
With this pathology, weakness of the ligamentous and muscular apparatus of the foot is observed. The deformity and arthrosis of the joint of the first toe is caused by an increased and uneven load on the forefoot, which is aggravated by wearing shoes with a narrow toe and/or high heels.

Symptoms

The manifestations of this disease are the appearance of a "bone" in the area of ​​the altered joint, a change in the position and shape of the remaining fingers. This is accompanied by pain in the joint and foot, rapid fatigue of the legs. In the area of ​​\u200b\u200bthe "bump" there is redness, slight swelling.

Degrees of severity of deformity:
1. Deviation of the thumb outward to 15 o .
2. Deviation of the thumb from 15 to 20 o .
3. Deviation of the thumb from 20 to 30 o .
4. The deviation of the thumb is more than 30 o .

With 3 and 4 degrees of deformation, the development of complications is possible, such as:

  • hammer-shaped curvature of the fingers;
  • painful corns and callusesprone to inflammation;
  • pain when walking;
The curvature of the finger is preceded by the inconvenience of wearing shoes and the appearance of pain when walking. Due to the deformation of the joint, a change in the foot occurs, the appearance of an elevation in the middle, where painful calluses and corns are easily formed. The second toe also changes, takes the form of a hammer, and a corn also forms on it.

Similar symptoms can occur in some other diseases: deforming osteoarthritis, arthritis, gout. To find out the cause of the appearance of "bumps" and pain, you need to consult an orthopedist. After the examination, the doctor will prescribe you an X-ray examination (a picture of the foot in three projections) and plantography.

As a result of the further development of the pathological process with untreated valgus deformity, many patients develop chronic bursitis (inflammation of the periarticular bursa) and Deichlander's disease (change in the structure of the bones of the metatarsus).

Treatment

flat feet

Treatment of flat feet is a long and laborious process. In this case, it is necessary to constantly wear orthopedic shoes with a hard back, special orthopedic insoles (preferably custom-made), regular massage courses and physiotherapy exercises.

Treatment of valgus deformity of the big toe

Conservative treatment
Non-surgical methods of treating hallux valgus include wearing orthopedic insoles and night splints, insoles, interdigital pads, physiotherapy, therapeutic exercises for the toes and feet. To reduce inflammation, intraarticular administration of diprospan, hydrocortisone (hormonal drugs) is used.

Conservative treatment does not lead to complete recovery, it is used only in the early stages, and as a preoperative preparation.

Surgery
There are a large number (more than 100) methods of surgical treatment of hallux valgus. The main ones are presented below:

  • Exostectomy (excision of some part of the head of the metatarsal bone).
  • Osteotomy, or removal of part of the phalanx of the finger or metatarsal bone.
  • Creating a state of immobility of the joint of the big toe (arthrodesis).
  • Restoration of ligaments around the metatarsophalangeal joint of the big toe, and their comparison.
  • Resection arthroplasty, or resection (removal) of a part of the metatarsophalangeal joint from the side of the metatarsal bone.
  • Replacement of the affected joint with an implant.
However, it should be noted that in some patients re-formation of the "bone" is observed. In the postoperative period, patients are forced to limit physical activity on the foot for a long time. This creates some inconvenience.

Currently, less traumatic methods of surgical treatment of hallux valgus are used, in which the period of postoperative rehabilitation is significantly reduced.

Rehabilitation after surgery

On the second day after the operation, you are only allowed to move your fingers. You can walk without stepping on the operated area after 10 days. The load on the entire foot can be given only one month after treatment. Six months later, with a successful postoperative period, it is allowed to play sports with a load on the legs, and wear shoes with heels.

An effective method for facilitating rehabilitation after surgical treatment of hallux valgus is shock wave therapy, the action of which is aimed at improving blood circulation in the tissues, as well as reducing swelling and pain at the surgical site.

Shoes

With hallux valgus deformity of the first toe, shoes should be soft, with a wide toe and low heels (up to 4 cm).

With flat-valgus deformity of the foot, it is necessary to wear new shoes with a high and hard back, 3 cm above the heel, with a dense and high arch support.

Orthopedic insoles

Various types of insoles and semi-insoles are used to correct foot deformity. Custom-made insoles are best suited for this. With their help, the load on the joints of the legs is reduced, the blood circulation of the foot improves, and the feeling of fatigue in the legs is reduced.

Sometimes insoles are hard to fit in shoes, especially standard ones. Therefore, in order to correct pathological disorders in the foot, half insoles can be used - a shortened version of the usual insole (without the anterior section).

In some mild cases, the orthopedist may allow the wearing of orthopedic heel pads.

Massage for hallux valgus deformity

1. The course of massage is from 10 to 20 procedures, with an interval of about 1 month. Massage affects not only the legs and feet, but also the back and thighs, because. of no small importance is the state of the entire muscular apparatus involved in the movement.
2. You should start from the lumbar region. Movements - stroking and rubbing, from the center outwards.
3. Next, you should go to the buttocks area, where circular stroking, rubbing and kneading, tapping and stroking are used.
4. On the back of the thigh, intensive rubbing is performed from the knee joint up the thigh, chopping and stroking.
5. On the lower leg, massage should be carried out in different ways, on the inner and outer surfaces. All techniques (rubbing, kneading) are carried out intensively inside, and softly outside. This allows you to stimulate the internal muscles and relax the external ones, which leads to the correct installation of the foot.

Valgus deformity of the foot in children

Valgus deformity of the foot in children is represented mainly by flat-valgus flat feet. In this case, there is a deviation of the heel outward, the appearance of pain during long walking and increased fatigue. With timely started and regularly carried out treatment, it is possible to achieve a complete recovery of the condition of the foot. To determine the degree of violations and determine the methods of treatment, it is necessary to consult an orthopedist.

Treatment

For the treatment of hallux valgus in a child, attention should be paid to the position of a small patient: in a standing position, the legs should be closed - this reduces the load on the joints and the foot. Walking time should be limited. Good effect on the installation of the legs:
  • swimming;
  • a ride on the bicycle;
  • walking barefoot (especially on sand, grass and pebbles);
  • football game;
  • classes on the Swedish wall;
  • climbing stairs.
To correct the installation of the legs, orthopedic shoes with a high hard back or insoles should be worn. Your orthopedic surgeon will help you choose the right one. Shoes should fit well on the foot. Shoes that have already been used must not be worn. At home, you can walk without shoes.

Massage is the best way to influence the healing process. It needs to be done on a regular basis. Physical therapy is also very important, exercises should be carried out daily. It is better to present it in the form of a game, so that the child performs them with pleasure. Of the exercises, it should be noted lifting small objects and crushing the towel with your toes, rolling the stick with your foot, getting up from the “Turkish” pose.

With the ineffectiveness of the treatment, they resort to a surgical operation. For this purpose, a varus osteotomy is performed. During the operation, a wedge is cut out of the bone (with valgus deformity of the lower leg - this is the thigh). The bone is connected with screws. After the operation, devices are used for external fixation of the bone, osteosynthesis according to the Ilizarov method.

Before use, you should consult with a specialist.

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

Clinic: Congenital - duck gait fatigue in the hip joint during walking. functional shortening of the limb by 3-5 cm or more; limitation of abduction in the hip joint; positive Trendelenburg symptom. Treatment: Subtrochanteric osteotomy

Valgus deformity of the femoral neck Increase in the neck-diaphyseal angle. ü Congenital ü Traumatic ü Paralytic Clinic: no visible deformities § With concomitant deformities of the knee and foot, gait changes, cosmetic defects Treatment: 1) exercises and corrective postures (“in Turkish”) 2) operative: subtrochanteric osteotomy of the femur.

Varus and valgus deformity of the knee joints Causes: § congenital, § rickets, § early rising to the feet Varus deformity - the angle is open inside, Onogi Valgus deformity - the angle is open outward, X-legs

Valgus deformity Varus deformity increase in the external condyle, decrease in the internal - compression of the internal meniscus increase in the internal condyle, decrease in the external - compression of the external meniscus the joint space is wider on the outside the joint space is wider on the inside the ligaments are stretched, strengthening the knee joint from the later. the sides are stretched ligaments that strengthen the knee joint on the medial side of the lower leg are often curved with a bulge outward, flat-varus foot setting (clubfoot) flat-valgus foot setting (flat feet) in severe cases: rotation (turn) of the thigh outward, and the lower leg (its lower third) inwards. v Unilateral v Bilateral: symmetrical (concordant deformity) / discordant deformity.

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

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

Flat feet - a change in the shape of the foot, characterized by the omission of its longitudinal and transverse arches. TYPES: longitudinal flatfoot transverse flatfoot longitudinal-transverse

Foot arches Longitudinal arches: 1) External / cargo (calcaneal, cuboid, IV and V metatarsal bones) 2) Internal / spring (talar, navicular and I, III metatarsal bones) Transverse arch (metatarsal bones heads)

Etiology Acquired Rachitic platypodia Paralytic platypodia (AFTER POLIO) Traumatic platypodia (ANKLE BRAKES, CANERAL TO., TARSAL TO) Static flatfoot (excessive load on the foot) Congenital

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

Stages of flat feet q. Hidden stage q. Stage of intermittent flat feet q. Stage of development of a flat foot q. Stage of flat-valgus foot q. Contracture flatfoot

Diagnosis 2) Podometry according to Friedland - determination of the percentage ratio of the height of the foot and its length (N = 31 -29) 3) Face Line - a line drawn from the top of the inner ankle to the lower surface of the base of the head of the I metatarsal bone (in N- does not cross the top of the navicular bone )

Diagnosis 4) Clinical method (normal vault 55-60 mm, angle 90◦) 5) X-ray method (normal vault 120-130◦, normal vault 35 mm)

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

Treatment q At the stage of development of a flat foot: I degree: warm foot baths, massage, exercise therapy to strengthen the muscles of the lower leg, wearing arch support insoles II degree: + wearing orthopedic shoes III degree: + surgical treatment

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

ü Operation according to F. R. Bogdanov - resection of the calcaneocuboid and talo-navicular joints with subsequent arthrodesis of these joints in the corrected position of the arches - lengthening of the tendon of the short peroneal muscle - transplantation of the tendon of the long peroneal muscle on the inner surface of the foot - lengthening of the calcaneal tendon with the elimination of pronation heel and abduction of the forefoot ü Kuslik M. I. operation - crescent-transverse resection of the foot - lengthening of the calcaneal tendon - transplantation of the tendon of the long peroneal muscle on the inner surface of the foot

Transverse flatfoot deformity of the foot, manifested by flattening of the distal metatarsus in combination with valgus deviation of the first finger, the development of deforming arthrosis of the first metatarsophalangeal joint and limitation of movements in this joint, as well as the occurrence of hammer-shaped deformity of the II-V fingers Causes: weakness of the ligamentous apparatus congenital / hormonal changes § ill-fitting shoes.

Treatment of transverse flatfoot Operations on the tendons of the muscles of the 1st finger (mm. extensor et flexor hallucis longus, t. Adductor ü transposition of the tendon of the long flexor of the 1st finger to the tendon of the long extensor ü Adductorothenotomy Operation of Schede-Brandes - resection of osteochondral exostosis of the head of the 1st metatarsal bone, resection base of the main phalanx of the 1st finger McBride's operation - cutting off the tendon of the adductor of the 1st finger from the base of the main phalanx and suturing it to the head of the 1st metatarsal bone

Hammer-shaped deformity of the fingers Ø with transverse flat feet Ø with children's cerebral palsy Ø poliomyelitis (with flat-valgus foot) Ø myelodysplastic hollow foot

Exostoses of the heads of the I and V metatarsal bones Subluxation valgus deviation