Corrective plaster casts in the first months of life lead to guidance of growth
Foot exercises for coordination and muscle strengthening is very important
Insoles, splints, etc. are also used
Acquired foot deformities
Insoles, splints, etc. are used to provide support or relief
Aim for normal weight! Determination of BMI (body mass index, body mass index) or body composition by means of electrical impedance analysis and, if necessary, participation in a medically supervised weight loss program.
BMI ≥ 25 → participation in a medically supervised weight loss program.
Special therapy
Hacked foot (pes calcaneus)
Fitting of an orthopedic shoe
If necessary, muscle replacement surgery or arthrodesis (surgical joint fusion) may be indicated
Suspended foot (pes cavus, pes excavatus)
Provision of a special shoe (raised shaft, inner shoe).
In the case of local injury to the peroneal nerve, surgical reconstruction is possible
Stabilization of the foot can be achieved by joint fusion, for example, by arthrodesis, arthrorisis (joint locking; surgery to reduce joint mobility in one direction by forming a stop lock, usually by a bone chip) or tenodesis (dislocation of a tendon)
Hollow foot (pes cavus, pes excavatus)
Conservative therapy with orthopedic treatment:
Orthopedic insoles: under feeding the instep; if necessary, sensomotoric insoles.
Inner shoes in children, orthopedic custom shoe in adults (in extreme cases).
Operative therapy is indicated, if necessary, a surgical tendon transfer; in adults, if necessary, the dorsal wedge osteotomy with extension of the Achilles tendon or an arthrodesis is indicated
Clubfoot (pes equinovarus, supinatus, excavatus et adductus)
Ponseti technique with redressing plaster casts, beginning in the first days of life; the pointed foot is corrected by percutaneous (“through the skin”) Achilles tendon transection
Residual deformities can be treated from the 6th month of life by surgical intervention on the soft tissues
At the beginning of walking may need to be adapted insoles and special anti-varus shoes (shoes to correct the varus position, ie joint malposition in which the joint axis is lateral (“bent from the center of the body”))
In the course of development, further follow-up operations may be required
An early therapy is to strive for
Buckling flatfoot
Playful foot gymnastics should be performed in children
If necessary, an insole supply with heel and supination wedge is required
At the age of 8-12 years, if the findings are pronounced, a surgical arthrorhise (joint locking) or arthrodesis (joint fusion) may be required
In adulthood, arthrodesis or calcaneus lengthening osteotomy may be indicated
Flatfoot (pes planus)
Corrective plaster treatment start immediately after birth in pes planus congenitus.
A recommendation for injection of corticosteroids cannot be made.
Surgical correction of talonavicular dislocation with long postoperative follow-up.
After completion of growth, residual deformities may require arthrodesis
Sickle foot (pes adductus)
Primarily, the sickle foot should be redressed manually, if necessary with thighplaster bandage, -night positioning shells, insoles.
In infants who lie on their stomachs and have only a slight deformity, lower leg foam rings are sufficient
Surgical therapies such as osteotomy (surgical cutting) of the metatarsalia (metatarsal bones) occur rarely
Pes equinus (pointed foot)
Pes equinus is stretched with physiotherapy, and a below-knee standing cast can redress the pointed foot
A heel elevation is needed for contracted pointed foot
Surgical therapy consists of Achillotenotomy (severing of the Achilles tendon) with several months of plaster treatment or, alternatively, arthrodesis (joint fusion)
In case of prolonged immobility, a pointed foot prophylaxis with a foot board should be performed
Splayfoot (pes transversoplanus)
If symptoms are acute, the foot should be immobilized; antiphlogistics (anti-inflammatory drugs) may need to be used
An insole supply is regular
To the foot bedding
If painful: shell-shaped insoles, possibly anti-pelotte for painful splayfoot in the final stage.
If not painful: try with sensorimotor or proprioceptive insoles.
If conservative therapy is not successful, Weil surgery (intra-articular diaphyseal oblique osteotomy) may be indicated
Accompanying toe deformities must be surgically eliminated
Aim for normal weight! Determination of BMI (Body Mass Index, body mass index) or body composition by means of electrical impedance analysis and, if necessary, participation in a medically supervised weight loss program.
BMI ≥ 25 → participation in a medically supervised weight loss program.
Nutritional medicine
Nutritional counseling based on nutritional analysis
Nutritional recommendations according to a healthy mixed diet taking into account the age. This means, among other things:
Daily total of 5 servings of fresh vegetables and fruits (≥ 400 g; 3 servings of vegetables and 2 servings of fruit).
Once or twice a week fresh sea fish, i.e. fatty marine fish (omega-3 fatty acids) such as salmon, herring, mackerel.