Плоскостопие

Плоскостопие – это заболевание, которое сопровождается уплощением поперечного и/или продольного сводов стопы. Состояние стоп отражает состояние всего организма. Плоскостопие может развиться в любом возрасте: детском, юношеском, взрослом и старческом. Говоря о плоскостопии необходимо прежде всего говорить о несостоятельности соединительной ткани, которая проявляется в различные периоды жизни при сочетании нескольких неблагоприятных факторов: пола, возраста, эндокринных нарушений, наследственной предрасположенности, физической нагрузки.

Функционирование стопы происходит по принципу пружинящих сводов. Классически выделяют два свода: продольный и поперечный. Оба они имеют костную и мягкотканые составляющие в виде связок и мышц.

При стоянии человек опирается на три точки – пятку, область головок первой и пятой плюсневой костей.

При ходьбе происходит сложное скоординированное движение различных мышц, суставов как стоп, так и вышележащих отделов опорно-двигательного аппарата. Происходит движение голени, бедра, таза, позвоночника, верхних конечностей. В целом каждый шаг – это есть часть осанки и походки (по которым мы можем узнать человека издали). При плоскостопии из-за уплощения сводов площадь опоры возрастает, больше нагружаются внутренний край стопы, основания 2-го, 3-го, 4-го пальцев; возникает деформация стопы Стройная система движений нарушается, могут появиться боли в колене, тазобедренном суставе, позвоночнике.

По причине развития плоскостопия выделяют:

  • Врожденное плоскостопие – при неполноценности костного и мышечно-сухожильного компонентов стоп. Этот вид плоскостопия трудно диагностировать, так как до 6-7 лет у детей плоская стопа это физиологическая норма.
  • Паралитическое – при параличе мышц, поддерживающих своды стопы. Возникает как следствие, например, полиомелита.
  • Статическое – в результате длительной нагрузки на стопы при стоянии. Этот вид плоскостопия наиболее распространен (80% всех случаев). Встречается лиц стоячих профессий (парикмахеры, хирурги, продавцы), с избыточной массой тела (ожирение, беременность, климактерический период), в период роста организма, в старческом возрасте, при ношении неудобной обуви.
  • Травматическое – плоскостопие, возникающее после переломов лодыжек, пяточной кости, предплюсневых костей.

Как заподозрить плоскостопие?

При 1-й степени появляются утомляемость, боли в мышцах стоп и голеней, избыточная потливость, мозоли и трещины стоп. Болезненные точки расположены по центру продольного свода со стороны подошвы и тыла, под лодыжками. Деформации стоп нет.

При 2-й степени боли захватывают область голеностопного сустава и голени. Появляются начальные признаки деформации стоп.

При 3-й степени патологические изменения затрагивают коленные и тазобедренные суставы, появляется головная боль, компенсаторный сколиоз. Отмечается резко выраженная  деформация стопы.

При деформации стоп увеличивается их размер: пациентам приходится покупать обувь на размер больше, выбирать более широкую обувь в переднем отделе. Обувь изнашивается неравномерно – больше с наружной, либо с внутренней стороны. [рисунок]

Осложнения плоскостопия:

  • вальгусное отклонение большого пальца стопы
  • молоткообразная деформация других пальцев стопы
  • неврома Мортона
  • подошвенный фасциит, пяточная шпора
  • болезнь Келлера II
  • деформирующий артроз коленных, тазобедренных суставов
  • остеохондроз, сколиоз
  • хронические головные боли

Лечение плоскостопия

Существует два варианта лечения плоскостопия: консервативное и оперативное. К мероприятиям консервативного характера относятся:

  • подбор удобной и практичной обуви: каблук 2-4 см, достаточно широкий нос, подметка из упругого материала
  • использование ортопедических ортезов стоп, ортопедической обуви
  • массаж и самомассаж стоп, в том числе с помощью специальных ортопедических ковриков, мячей, валиков
  • физиолечение, грязевые аппликации,
  • комплекс специальных упражнений (лечебная физкультура) для профилактики и лечения плоскостопия:

— ходьба босиком по неровной поверхности и песку,

— ходьба на пятках и на цыпочках,

— ходьба на наружном крае стопы,

— захватывание с пола и перекладывание пальцами стоп легких предметов (карандаша, носка, камешка, веревочки и т.п.)

— катание ровной палки по полу в течение 5-10 мин

Все упражнения должны выполняться пациентами с упорством и терпением, ежедневно, в течение 2-3 лет, а лучше постоянно. Это помогает улучшить кровообращение,  укрепить мышцы, сухожилия и связки стоп и голеней, участвующие в поддержании сводов стоп.

При оперативном лечении плоскостопия необходим учет многих индивидуальных особенностей пациента, без которого операция может быть неудачной. Для оперативного лечения продольного и поперечного плоскостопия предложено множество вариантов. Выбрать оптимальный способ доктор сможет только после полноценного обследования.

Статья предназначена для информирования пациентов о заболевании и о тактике его лечения. Пожалуйста, не занимайтесь самолечением. Для консультации обратитесь к специалистам.

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