congenital high arched feet
Introduction
Introduction to congenital high arch The eleipescavus, also known as the claw-shaped foot, is a common deformity characterized by a higher vertical arch. A small part is a congenital disease, most of which is caused by a disease after 3 years of age. basic knowledge The proportion of illness: 0.001% Susceptible people: seen in children Mode of infection: non-infectious Complications: progressive degeneration of the corpus callosum
Cause
Congenital high arch foot cause
(1) Causes of the disease
The cause of high arch foot is still unknown.
(two) pathogenesis
1. Bentzon believes that the cause is the weakness of the tibialis anterior muscle, and the muscle strength of the tibia is strong. The first metatarsal bone is pulled to make the foot prosthetic. In order to compensate for the function of the tibialis anterior muscle, the extensor muscle contraction causes the metatarsophalangeal joint to extend back and forth. Toe flexor contraction causes interphalangeal joint flexion. Some scholars believe that the imbalance between the strong tibialis anterior muscle and the weak anterior tibialis anterior muscle leads to the appearance of high arched foot. However, most patients with high arched foot have no anterior tendon softening.
2. Duchenne believes that due to the loss of function of the internal muscles (interosseous muscles and sacral muscles), the extensor and flexors of the feet appear contracture and claw-foot deformity occurs, most commonly in patients with polio, starting in the foot, external Muscle spasm, after the external muscle strength gradually recovered, while the internal muscle atrophy, fibrosis, although the nerve's dominating function recovered, the internal muscle of the foot lost function due to contracture, resulting in the formation of high arch.
3. When the gastrocnemius tendon is stretched, the function of the long toe flexor of the plantar toe is compensated for by the foot, and the joint between the toes is flexed, and the forefoot is drooping to form a high arch.
4. Muscles may be fibrotic and contracture for some reasons, and may also be deformed by claw-shaped feet.
5. Some unexplained high arches often have a family history, so it is believed that genetic factors are involved in the onset, but lack of genetic evidence.
In short, the cause of high arch foot is still unknown. In some cases, the forefoot is a primary malformation. Sometimes there are claw-shaped toes and occasional varus. Therefore, each patient should be examined in detail to understand the cause of the disease:
1 Ask family members whether they have a similar medical history (including parents, brothers, sisters, etc.);
2 detailed examination of the nervous system and foot;
3 check the muscles and remove the sputum;
4 spinal examination, including X-ray, CT or MRI examinations;
5 lines of lumbar puncture or myelography.
Prevention
Congenital high arch prevention
The etiology of this disease is complicated, so it is extremely difficult to prevent. Therefore, the diagnosis of this disease should pay attention to find out its cause, and whether the identification is secondary or primary, in order to take correct treatment for this disease, in children. After some neuromuscular diseases occur, it should be actively checked to prevent the occurrence of this disease is more important.
Complication
Congenital high arch and foot complications Complications carcass progressive degeneration
The skin of the plantar head may have sputum formation.
Symptom
Congenital high arch and foot symptoms Common symptoms First metatarsophalangeal joint pain... Palmoplantar keratosis excessive striate in the middle of the ball area... Horseshoe varus foot can not bend and varus claw toe ulcer
Depending on the degree of arch height increase, whether it is accompanied by other deformities of the foot, the high arch foot is usually divided into four types.
Simple high arch
Mainly the forefoot has a fixed plantar deformity, and the first and fifth metatarsal are evenly loaded. The medial lateral arch of the foot is consistently increased, the heel remains neutral, or has a mild valgus.
Inverted high arch
This type only has the plantar flexion of the first and second metatarsal bones in the medial aspect of the forefoot, which increases the medial longitudinal arch. The outer longitudinal arch is still normal. When the weight is not heavy, the fifth metatarsal is easily lifted to the neutral position, and the first metatarsal is unable to passively extend to the neutral position due to the fixed plantar flexion, and has an internal rotation deformity of 20 to 30°. The initial foot is more normal. When standing and walking, the pressure on the first metatarsal bone is significantly increased. In order to alleviate the pressure of the first metatarsal head, the patient often takes a weight in the varus posture and a fixed varus deformity in the posterior foot. The patient has a claw-shaped toe, the first metatarsal head protrudes to the sole of the foot, the soft tissue of the sole weight-bearing area is thickened, and the corpus callosum is formed and painful.
Follow-up type high arch
Common in polio, spinal cord bulging. Mainly caused by paralysis of the triceps of the calf, which is characterized by the calcaneus in the state of extension, and the forefoot is fixed in the flexion position.
High flexion
More secondary to congenital clubfoot surgery. In addition to the fixed plantar flexion deformity of the forefoot, the posterior foot and ankle joint also have obvious plantar flexion deformity. The clinical manifestations of each type of high arch foot are not consistent, but the forefoot has a fixed plantar flexion deformity. The early toe of the toes is more normal. As the disease progresses, the toes are retracted backwards, the toes joints are flexed, the metatarsophalangeal joints are excessively stretched, and the claw-toed deformities are deformed. In severe cases, the toes cannot touch the ground. Due to the deformity of the metatarsophalangeal joint, the subtotal dislocation of the metatarsophalangeal joint causes the proximal phalangeal base to press on the dorsal side of the humeral head, which will aggravate the plantar flexion deformity of the humerus, resulting in thickening of the skin at the weight, corpus callosum formation, and even ulceration.
Examine
Congenital high arch examination
X-ray performance, the X-ray lateral radiograph of the foot when standing, the performance of the high arch and foot deformity is the most typical, the articular surface of the front and rear ends of the first wedge of the normal foot is almost parallel; when the high arch is sufficient, most of the apex of the forefoot is The first wedge bone, so the bone is wide and narrow, the joint surface of the front and rear ends loses the parallel relationship, forming an angle to the sacral surface. In less cases, the apex of the forefoot is located on the scaphoid, and the back of the foot often has a hard bony. The bulge, secondly, the normal talus and the axis of the first metatarsal are in a straight line, while in the high arched foot the two are at an angle.
Diagnosis
Diagnosis and diagnosis of congenital high arch
Diagnostic criteria
X-ray examination, the positive side X-ray of the foot should be taken under load-bearing conditions. The distal and proximal articular surfaces of the normal foot are parallel to each other, while the high arched foot has a plantar flexion deformity, which occurs mostly in the first wedge-ankle joint, so that the equal line of the distal and proximal articular surfaces converges on the temporal side. M'eary measures the angle between the central axis of the talus and the central axis of the first metatarsal. When the arch is normal, the two lines are continuous. If the angle can be measured, it indicates that the arch is increased.
Hibbs measures the angle formed by the central axis of the calcaneus and the central axis of the first metatarsal. The normal value is 150-175°. The angle of the high arch deformity is reduced. In addition, the positive position measurement of the heel angle, if <20 ° indicates hind foot varus deformity.
Differential diagnosis
According to the abnormal gait of the child, the increase of the longitudinal arch with the claw-toe deformity, and the increase of the M'eary angle and the decrease of the Hibbs angle by X-ray examination, the diagnosis of high arch foot can be made. However, high arch-foot deformities caused by multiple neuromuscular diseases should be further examined to look for primary diseases or potential pathogenic factors, such as electromyography, head or spinal CT or MRI. Defining the cause is important for judging the prognosis.
