What is arch placement in shoes? Orthopedic shoes

, (don’t worry, not for long), and we’ll talk about a topic that always arouses keen interest. And above all, not professional, but personal. After all, many of you have children, and many are planning to have them, and some have already faced the issue of choosing children’s shoes, and some will face it.

And the luckiest of all are those who are asking questions right now:

• What should be the right children's shoes?
• Why do children develop flat feet, and how to avoid it?
• Is it true that a baby’s first shoes should be “orthopedic”?
• Should a child wear shoes at home?
• What kind of house shoes should a child have?
• Do children's shoes have to have arch support?

The topic is a pressing one: very often very little ones are prescribed orthopedic shoes, and orthopedic doctors often contradict each other. One diagnoses a 2-year-old child with flat feet and sends him for orthopedic shoes, the other says that your baby is absolutely healthy and advises the mother to drink motherwort and the child to run, jump and enjoy a carefree childhood. One says that children's shoes must have arch support, the other categorically disagrees with this.

As you remember, I am not an orthopedic doctor, so in order to understand this issue, I suggest you, as usual, use logic.

Have you turned it on? Then let's figure it out together.

How is a child's foot formed?

We already talked about what a foot is. If you forgot, read here. Let's see how it develops.

So, the first thing you need to understand is that a child is born with a flat foot. Remember, dear mothers, what your children’s feet looked like when they didn’t even walk under the table.

As you can see, the place that will later become the longitudinal arch is now filled with fat. And it is right. After all, what is a vault? This is a spring that springs when we walk in order to absorb shock loads and not “bomb” the joints of the legs and spine. Why does such a baby need a spring? After all, he doesn't walk yet. Logical?

Let's remember one more important point: The arched shape of the arches is supported by the muscles of the lower leg and foot. But the muscles are not yet developed, since our baby does not yet walk, run, or jump. And when he stands on his feet and takes his first steps, the fat pad of his feet will be very useful to him.

• Firstly, it increases the area of ​​support and increases the stability of our hero, so that he understands that walking, it turns out, is fun! And you will see more, and you will feel more, and you don’t need to call your mother, you can stomp on her. First along the wall, then in short dashes, and now “the bull is walking, swinging.” 🙂
• Secondly, plantar fat is needed for shock absorption, while there is no full-fledged spring yet.

Such a voluminous fat pad persists in children until the age of 3, and then begins to gradually dissolve. By the age of 5, the longitudinal arch appears, and at the age of 7-10 we already see a foot that is quite similar to an adult. And the complete formation of a person’s foot ends at about 20-21 years old, in girls - 2-3 years earlier. This means that by this age, ossification of all cartilaginous structures of the foot occurs.

But until the baby begins to walk confidently, he will go through a difficult school of balancing act. Once he is on his feet, he rests more on the outer arches of his feet. This is called "foot varus." It occurs in children up to about 1.5 years of age.

As your baby learns to walk, he tries to maintain his balance by spreading his legs wide apart. In maintaining balance, it is precisely the same fat pad that we talked about above, which he begins to rely on, that helps him. It turns out that the feet roll inward. This is called hallux valgus. This is what it looks like:

This condition is usually observed at 2-4 years of age. Further, as the muscular-ligamentous apparatus of the feet strengthens, the shape of the legs is usually leveled: the lower leg, knees and thigh line up in one line. And if normally the angle of valgus deviation of the calcaneus at 3 years is 5-10 °, then by 7 years it is 0-2 °.

So, we draw conclusions:

1. All children under 5 years old have flat feet.

2. Valgus placement of feet up to 4-5 years of age is a normal option

Therefore, if your two or three year old child has been diagnosed with flat feet, know that everything is going according to plan and there is nothing to worry about. And there is absolutely no need to run for orthopedic shoes. So what did the doctor prescribe? Are you a mother or what? It’s better to concentrate your attention on strengthening the muscles of your little one’s feet and legs, and you will all be happy: the parents, the baby, and his feet. 🙂

Back to the past

In the 60s of the last century, employees of the Leningrad Institute of Prosthetics named after. Albrecht conducted a study in which about 5,000 children participated. They assessed the “maturation” of the arches of the feet.And look what happened: at 2 years old, flat feet were detected in 97.6% of children, and at 9 years old it remained in only 4% of those observed.Of course, if this study were conducted today, the figures would be more dismal.

I sometimes think: if you remove all computers, gadgets, phones now, what will the children do? What about adults?I wonder if jump ropes are on sale now, or are they already a rarity? Do modern children know the game “dodgeball”? Do they play badminton?

In my childhood I remember myself exclusively with my knees smeared with brilliant green. We didn’t sit at home, especially on the weekend. We were running and jumping all the time, so the diagnosis of “flat feet” was not left in my childhood memory.

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How are the muscles of the arches of the feet trained?

Have you ever seen Adam and Eve wearing shoes in paintings? Do you think God felt sorry for them to make some boots? Or did he not have enough imagination for this?

Nothing like this!

It’s just that the foot, in order to be healthy and happy, must work. And for this you need to walk more, barefoot and on an uneven surface, so that the muscles of the foot and lower leg contract, trying to maintain balance on it, train and fulfill their great mission: to maintain the health of our spring. If you walk on a flat, hard surface all the time, and besides, put your foot in shoes, its muscles will weaken, they will no longer hold the arches, and they will begin to flatten.

Conclusion:

It is necessary to create conditions for the child so that the muscular-ligamentous apparatus of the foot works as much as possible. If possible, let the child, at least at home, walk barefoot.

True, orthopedic doctors disagree on this issue. Some say that children should wear shoes at home, others say that they should run barefoot at home whenever possible.

I am inclined to the second opinion.

• Firstly, based on my pediatric experience. In children from large families Flat feet are much less common. 🙂
• Secondly, a normal child who has a problem in his butt, he doesn’t just walk around the apartment. He sits on his knees, assembling some kind of pyramid, crawls, plays with a car, dances, squats and does a lot of other movements that help the foot form. But shoes only interfere with this.

If the floor is cold, then put warm socks on your baby. Now they even come with non-slip soles. For those children who are taking their first steps, ordinary thin booties are ideal (if for some reason they do not want to walk barefoot).

• Thirdly, from my personal experience. Previously, our parents had never even heard of orthopedic shoes, and we walked around the house either in ordinary soft slippers or barefoot. And they were healthier.

What else is needed to train the muscles of the foot?

1. If funds and space allow, purchase a wall bars and a soft mat nearby in case of a fall. Let the child master it from the age of 2-3 years.
2. Buy a bicycle and let your child pedal: at home barefoot or in socks, outside in shoes with soft soles.
3. Buy it at an orthosalon or at your own pharmacy, massage Mat and place it in the place where the child most often runs. Something like this:

1. There is also an economy one. option: find a piece of fabric in your “bins”, put it on the floor, scatter beads or buttons over it. You can give your baby the task of collecting beads into a box with his toes.
2. And you can do this:

6. Find foot exercises on the Internet and do them with your child. Remember how the teacher used to say in physical education: “We walk on our toes, now on our heels, on the inside of the foot, on the outside.” And it's a great muscle workout!

Write, comment, share your experience.

By the way, I posted the correct answers to the test on drugs for. See bottom of page.

With love to you, Marina Kuznetsova

What are orthopedic shoes and why are they needed? Doctor's opinion. Article by orthopedic doctor Nikolai Ivanovich Bunyakin

The child’s foot experiences heavy loads from the moment he stands on his feet (with an average weight of 10 kg by the age of 1 year, all support is on the feet, which is only 4% of the body surface). The structure of the foot is quite complex and is represented by 26 bones connected to each other by joints and ligaments. Its formation occurs on average up to 4 years - until the age when its bones retain their cartilaginous structure.

In the absence of rational shoes (with a rigid sole and a bend line at the level of the metatarsophalangeal joint, fixation of the talocalcaneal joint due to the rigid rear part with lateral tibia and alignment of the longitudinal-transverse arch of the foot with the help of an instep support), flat feet are formed, and subsequently - planovalgus foot deformity . This leads to loss of the “spring” function of the foot, rapid fatigue, and pain in the legs after long walking. As a result, spasm of the blood vessels in the legs occurs, circulatory disorders and the development of various complications in older age. The absence of the “spring” function of the feet also affects the condition of the cartilaginous surfaces of the knee, hip joints and the entire spine. Thus, all children's shoes, without exception, must meet certain requirements.

Here are the standards for “correct” children's shoes:

1. Children's and teenagers' shoes must take into account all factors for the healthy development of the foot. For this purpose, hygienic and environmentally friendly materials must be used.

2. For the health and full development of the foot, the design of the shoe must match the anatomical and physiological structure of the child’s foot.

3. In children's and adolescent orthopedic shoes, it is very important to use anatomically correct shapes during their manufacture - the shoes should not pinch or restrict the finger in the toe. And the main sole of the shoe should have a flexible, moisture-absorbing insole. At the very top, where the insole is in direct contact with the foot, a non-hard surface with an antibacterial coating is desirable. It should be noted that the insole with antibacterial properties performs several functions: it ensures air circulation in the shoe and absorbs sweat.

4. For children's and adolescent shoes, it is very important to use rigid forms in the heel area to prevent and treat the bending of the foot inward (flatfoot) and outward (clubfoot).

Shoes made without taking these aspects into account provoke the occurrence of foot and leg diseases.

There are special orthopedic children's shoes that fit the foot tightly, especially in the upper part of the heel and shin. A rigid heel with side shanks eliminates the formation of valgus (most often) and varus placement of the heel bone. A rigid sole with an insole-support helps form the correct arch of the foot. Fastenings on the front of the boots or sandals that open wide make them easy to put on and hygienic.

- in the presence of planovalgus or contralateral- adductovarus placement of the foot; children are recommended to wear preventive children's shoes with a removable insole-instep support. This insole allows you to use an individual approach to form it taking into account the deformation of the foot. The rigid forefoot of the shoe prevents the formation of transverse flatfoot and lateral (valgus or varus) deviation of the forefoot. High-top shoes are also recommended as a way to stabilize the talocalcaneal and ankle joints. Fixation forms the correct development of the articular surfaces and prevents further deformation. An individually selected removable orthopedic insole correctly shapes the arch of the foot.
- in cases of lack of active extension of the foot(“dangling” foot), with peripheral paresis of the peroneal nerve and in the cases listed above, there is a need for additional rigid fixation using a functional splint inserted into the shoe. Orthopedic shoes with a large opening most fully meet this goal. The use of tape-type fasteners allows even complete fixation of the foot and facilitates the use of shoes.

Winter orthopedic shoes, unlike the well-known “farewell to youth” shoes, and indeed all winter shoes on store shelves, allow you to feel confident on slippery roads, reduce the risk of sprained ligaments of the foot, fractures of the ankle joint and foot bones. Such injuries are the most common in winter period of the year.

Thus, all shoes, especially children's ones, should be orthopedic, i.e. meeting the requirements of stability, unloading and arch formation. And since each foot, like fingerprints, has its own characteristics, the approach to solving these problems should be as individual as possible.

Doctor Bunyakin Nikolai Ivanovich

How to choose orthopedic shoes?

Leg and posture problems are common in children. They are often associated with foot pathology: the child’s body weight puts pressure on the narrow part of the foot, the foot cannot withstand the pressure and becomes deformed. This is facilitated by getting on your feet early, heavy weight, hidden rickets in areas of sun deficiency, for example in Moscow. Deformation of the feet shifts the axis of the child's body - problems arise in the legs and spine. According to medical examination data, every fourth child in Russia has problems with their legs. Orthopedic children's shoes are a tool for preventive treatment. In a set of measures, it can prevent or correct many problems of the musculoskeletal system, for example, such as flat feet, clubfoot, valgus varus, X-shaped and O-shaped legs, hip problems, spinal problems, etc. Children's orthopedic shoes fix the foot and form correct posture.

This primarily applies to orthopedic sandals with an open or closed toe. Orthopedic children's sandals (“sandals”) have the opportunity to prevent and correct problems, because they are on the child's leg most of the day. Now it has become fashionable to call shoes orthopedic. Even slippers called “orthopedic” appeared on sale. Having an instep support alone is not enough. This is the illusion of protection. Shoes for children should have a set of orthotic positions that work together. Therefore, first we will understand what children's orthopedic shoes are.

The word "Orthopedics" translated from Greek means "proper training." This word has different interpretations, which causes confusion when buying children's shoes. In Russia, orthopedic shoes most often mean special shoes for correcting foot pathologies. Abroad, this term is interpreted in in a broad sense: since the shoes contain an element of “correct training”, then they are orthopedic. Therefore, the word "Orthopedic" ("Orthopedic") can be written on a box with shoes that have a low back, a sole without a slope, but with arch support. Most likely, the benefits of such shoes will be questionable, and the money will be wasted.

If we interpret children's orthopedic shoes in a broad sense, then the best guide for buyers will be the classification according to which orthopedic shoes are conventionally divided into three groups:

1. Standard or preventive orthopedics - shoes with three main elements: a high back, an instep support (simple), a sloped sole. In Russia, most shoe models from Kotofey, Antelope, Shalunishka and others meet these criteria. Attention: the instep support is low and sometimes wrinkles (disappears). These shoes are optimal in price and suitable for prevention, but are of little use for treating flat feet.

2. Reinforced orthopedics or shoes with therapeutic correction. Shoes have a higher or reinforced heel, orthopedic instep support(higher, wrinkle-resistant) and an orthopedic sole (does not bend at the heel). Usually these are conveyor belt Turkish shoes: “Miniman”, “Tashi-orto”, “Orsetta”, “Rabit”, etc. These shoes are used in the treatment of individual problems or the threat of their occurrence. Attention: some models may have a simple instep support or a simple sole to reduce cost.

3. Special orthopedics or orthopedics self made. These are ideal shoes for prevention and treatment, formation of correct foot and posture. Complex orthopedics are done individually and are not sold in stores. You can buy less complicated shoes. In retail sales it is sometimes referred to as a complete orthotic, implying more advanced features such as an anti-valgus position. Distinctive feature: in models with an open nose there is an anti-valgus frame surrounding the foot. Shoes are made to order in orthopedic salons; several models are produced by the Perseus company. For a number of European companies, such shoes are made by hand at different types foot orthopedic specialists in Turkey.

Important details:

Orthopedic shoes High Quality may have kid (to reduce sweating) or antibacterial insoles, massage insoles, reinforced soles or special quality leather.

Of course, an orthopedic doctor should give recommendations on choosing orthopedic shoes, but parents buy shoes, and they must clearly understand what they are paying for and how the purchased shoes will help in a particular situation.

The first size range (from 19 to 25 sizes and from 12 to 16.5 cm in the insole) is very important for a child. It covers the most critical period of formation of the axial skeleton (up to 3-4 years). The next size range from 25(26) to 29(30) also cannot be ignored, because... At this age, the formation of the child’s foot is still ongoing.

Prices for orthopedic shoes vary greatly, so it is better to rely on relative prices - shoes of the second group are approximately twice as expensive as the first, and shoes of the third group are twice as expensive as shoes of the second and four times more expensive than shoes of the first group.

If orthopedic shoes are sold below the prices of their group, for example, during sales and promotions, it is advisable to start trying on them. And vice versa, if shoes from a well-known brand are expensive, but do not have the minimum orthopedic positions of the first group, you need to think about the consequences.

The length of the shoe along the inner insole should not exceed the length of the foot by more than 1 cm (two sizes). The reserve is necessary to correct the growth of the leg in the right direction. There is a rule: if shoes are needed for treatment, then the supply should not exceed one size (half a centimeter). For preventive purposes, orthopedic shoes can be purchased with a reserve of two sizes (one centimeter), provided that the foot circumference is good. However, in children with narrow feet (usually girls), a reserve of 1 cm is often very large.

Orthopedic children's shoes are considered everyday home shoes and are worn constantly, starting from the first steps. While these shoes are on the child’s foot, they fight problems and form a beautiful foot and posture. Shoes are changed as your feet grow, usually every 3-6 months.

The shape of a child's foot changes with age, so shoes must be selected anew each time. In this case, you should comply Golden Rule choosing children's shoes: you should start trying on shoes that the mother likes, and you need to buy the shoes that suit the child. The child's health is more important than ambitions.

And yet, we must remember that orthopedic children's shoes are not a panacea, but one of the conditions for maintaining healthy feet, along with massage, physiotherapy or hygiene.

Answers to frequently asked questions

- Which shoes are better to buy, with Velcro or with buckle?
- The buckle “locks” the foot into a closed-toe shoe and prevents the foot from growing when the shoe becomes too small. As a result, signs of wearing small shoes develop: curling of the toes, ingrown nails, deformation of the toes, etc. “Velcro” is safe for the child’s feet. When the shoe gets too small, the toes press into the toe of the shoe, the foot arches and the Velcro comes undone. Frequent unfastening of the Velcro signals that it is time to change shoes.

- Does everyone need to wear orthopedic shoes?
- Orthopedic shoes are very important for a child’s first steps; they fix the foot, increase the area of ​​support for the leg and redistribute the body load. Kids learn to walk faster and without health consequences. Orthopedic shoes form a right angle with the plane of the floor, which forces the child to stand and walk straight. In this way, the axis and balance of the body are built, and correct posture is formed for life. The formation of an “aesthetic foot” is also of no small importance, especially for girls. The internal shape of orthopedic shoes corresponds to the shape of the correct foot and gives the foot a beautiful outline - it “collects” splayed toes, and, if possible, reduces congenital broad-footedness and high instep.

- Which brand of shoes is better to buy?
- Children's orthopedic shoes are available for different types of feet: standard, narrow and wide feet; for high and low lifts; on convex and flat heels. No single company is able to produce this entire range of products. Therefore, children's orthopedic shoes are selected not by brand, but by foot.

- What positions should you wear in the right shoes?
- In children's shoes, it is desirable to have 5 main positions:
1. The presence of an instep support (instep support) - a special cushion under the insole of the shoe. The purpose of this position is the prevention and treatment of flat feet.
2. The presence of a cushion along the upper edge of the heel of the shoe. Necessary for soft anatomical fixation of the ankle.
3. Reinforced back of the shoe (top of the shoe) 5-7 cm high. Serves to fix the ankle joint. Ensures the movement of the foot in a straight direction and prevents the curvature of the legs.
4. Sloped sole. There is a special orthopedic sole (often used in Turkish shoes). It has unique properties - it is elastic along its entire length like a leaf spring, almost does not bend in the transverse direction and does not allow the foot to do so. Provides elasticity and ease of gait, “straightens” the foot, relieves tone (forces the heel to drop).
5. Lift regulators in open shoes (straps - fasteners) or a 1 cm raised toe in closed shoes (eliminates pressure on the fingertips and deformation of the nails).

- Where can you buy orthopedic shoes?
- Purchasing children's orthopedic shoes is not a problem. Shoes of the first and second groups can be bought in any department of children's shoes. Some firms, such as Minimen and Orthopedia, have their own departments. Shoes of the third group are usually sold in orthopedic stores or made to order. Some scientific developments are used in the creation of physiological shoes by Chicco (Italy). Developments from the Valencia Institute of Biomechanics are used in shoes of Spanish brands: Garvalin, Agatha Ruiz De La Prada, Biomecanics. Superfit® (Superfit) - children's shoes, which are created in Austria, at the oldest shoe factory in Europe “Legero” and a number of others.

It should be said that during the crisis, the sale of children's orthopedic shoes decreased significantly. This suggests that parents began to save on shoes, allow their children to walk around the house without shoes, or buy cheaper, non-orthopedic shoes. This is a bad trend. The crisis will end sooner or later, and the time to prevent problems will be irretrievably lost. Entire generations of Russians may grow up with various deviations in the skeletal system. This is bad for the children themselves, because... they experience discomfort and fatigue; for parents who will inevitably face complications in later life; for the state, which will need to incur additional costs for the treatment of sick children, i.e. problems that might not have existed.

The article was prepared by the website grechpatent.info based on the experience of selling orthopedic shoes from different companies and scientific publications domestic and foreign authors. Original article on the website grechpatent.info

Many parents are concerned about the question: Are “instep supports” needed in children’s shoes? Most of them are sure that high-quality children's shoes must have an inner arch lining or, as it is also called, “underliner” or “instep support”.

Let's figure it out.

What is an instep support?

SupineAtorus( from lat. Supino -overturn) is an orthopedic product designed to support the longitudinal arch of the foot and raise the inner edge of the heel while keeping it flat.

From the definition it is clear that an instep support is a special orthopedic product that should be individually selected by a doctor if a child has a foot deformity. To a healthy child With a normally developing foot, an instep support is absolutely not needed; it only prevents the muscles of the foot from developing naturally.

Many manufacturers' children's shoes contain an arch lining - an "arch," which is advertised by them as a necessary element that ensures the prevention of longitudinal flat feet in children.

A properly designed arch support supports the arch only when there is full support on one foot and does not interfere with the muscles working independently the rest of the time. If the layout is rigid and high enough, it can, on the contrary, negatively affect the child’s foot, because the longitudinal arch of the foot, constantly resting on the support, stops working. As a result, the muscles of the foot that support the arch weaken, which leads to the development of longitudinal flatfoot.

The habit of many parents to buy shoes for their child to grow into is very dangerous, because... The location of the display and its height depend on the size of the shoe. Thus, harsh and high placements, often placed in the wrong places, can provoke serious developmental disorders of the longitudinal arches of the foot in a healthy child and lead to flat feet.

The world's leading manufacturers of children's shoes in the design of shoes do not use separate local linings, but a profiled footprint, the anatomical shape of which is ensured by moderate linings of the outer and inner arches and the heel recess. The height of the pads should be such as not to interfere with the inner arches of the foot performing their spring function. This shape of the footprint promotes the correct position of the foot in shoes, raising the anterior part of the calcaneus, and, consequently, the process of forming arches, which is a means of preventing static deformities of the feet*.

In children's shoes TM KOTOFEY, all instep supports have the correct location and height, and new models have a profiled anatomically shaped footprint.

We pay special attention

foot health

our little customers -

Your children!

Sincerely , KOTOFEY

Orthopedic shoes are intended for anatomically and functionally impaired limbs. Helps correct initial unstable deformities, prevents their progression, and creates support when standing and walking. The main indications for the use of orthopedic shoes: flat feet, clubfoot, hollow foot, heel foot, curvature of the fingers, unequal foot sizes, foot stumps, shortened limb length, vascular diseases (endarteritis), the presence of an orthopedic apparatus, a prosthesis. A referral to order orthopedic shoes is received from a doctor. In an orthopedic workshop or in the medical department of a prosthetic company, a measurement, outline, print or, in difficult cases, a cast is taken. Measurements are taken from both socked feet by a prosthetic technician. Orthopedic shoes must match the shape and size of the affected foot, be light enough, elastic, durable and not deformable during wear. The inner surface of orthopedic shoes should be smooth, without rough seams; Painful areas of the foot inside the shoe are released by squeezing out - “unblocking” the depressions over the sores, deformed toes, and bone protrusions. The upper of any orthopedic shoe is made from soft types of leather (chrome, cowhide, calf leather); for heels, sometimes for the sides of shoes they use hard leather (shaft). Leather, duralumin, cork, felt, rubber, and plastics are used for insoles. Pulls (artificial traction) are made of elastic materials to act as “external muscles”. The more complex the deformation, the more precise manufacturing or selection of orthopedic shoe lasts is required. The issuance of orthopedic shoes is carried out by a doctor; the patient must walk in orthopedic shoes for at least half an hour. Here the patient should receive the necessary instructions on foot hygiene and orthopedic shoes.

For deformities of the toes (hammertoes, hallux valgus) and mild flat feet, you can use corrective products - instep supports and inserts (Fig. 1 and 2), placed in ordinary shoes, which thus turn into simple orthopedic ones. Such shoes can also be made in a factory. The most common insert orthopedic product for shoes is an instep support - an insole that lifts the inner edge of the foot. With pronounced flat feet, in addition to the arch support and arch support in orthopedic shoes, the heel is placed 2-3 cm inward. The toe is widened over the standing toes and raised. For clubfoot (Fig. 4, b), shoes are made with rods and cork braids on the outer edge of the sole. If the deformity is fixed, the boot must accurately follow its contours, for which orthopedic shoes must be made from a cast (a plaster negative or from a foot print in plaster paste), a wide toe is made, and a varus block is repeated. Well-made orthopedic shoes promote stability achieved result conservative or surgical treatment of foot deformities. In case of a hollow foot, if the deformation is pliable, traction is used, they provide support to the foot along the edges and thereby contribute to the constant correction of the foot under the influence of the patient’s weight. With a fixed hollow foot, a steep arch is placed, and depressions are made under the heads of the 1st and 5th metatarsal bones, where there are always depressions. For equine, drooping feet, use traction (Fig. 4, a); sometimes it is useful to increase the boot on the healthy leg with a double heel. To equalize the length of the legs, use braids under the heel. In case of congenital shortening of the foot, an insert is made into the toe of the shoe; in case of amputation defects of 1 toe and the entire forefoot, orthopedic shoes are equipped with a springy metal plate, and a felt insert is made into the shoe with a blank in the form of an envelope - an insert shoe - to compensate for the defect and fill it. In case of paralysis, limited movement of the foot, or ankylosis of the foot at an angle of about 100°, it is necessary to make it easier to carry the sore, weakened leg over the support so that its toe does not catch on the ground; To do this, leave about 2 cm of its length uncompensated or even simply raise the heel for healthy legs; if necessary, to compensate for a slight shortening of the limb (2-5 cm), a braid is made under the heel; when shortened to 18 cm, a cork braid in the form of a “wedge” is made under the entire footprint. For large shortenings, the use of shoes with a “double footprint” or an orthopedic device is indicated. There are also prosthetics for shortened limbs. They are used if it is possible to place the knee joint at the appropriate level.

Orthopedic shoes are designed for pathologically altered feet. It should be light, durable, comfortable, and a cosmetic bag. Its purpose is to maintain the corrected position of the foot, record the result of treatment, compensate for existing foot defects, and compensate for shortening. Orthopedic shoes must match the size and shape of the foot.
To make the last, measurements are taken from both feet in their corrected position. The length of the foot, the circumference in the area of ​​the heads of the metatarsal bones, at the level of the navicular bone, through the ankle joint and calcaneal tubercle, and the circumference above the ankles are determined. Make an imprint and outline of the foot.
To make a complex orthopedic O., a negative is made by applying a plaster sleeve (see Plaster technique). Until the bandage hardens, the foot is held in the corrected position. After hardening, the plaster negative is cut. A plaster positive is made from a negative (cast). If it is necessary to reflect the smallest details of the shape of the foot, then an impression is made. The foot is lowered into a plaster mixture. Once the plaster has hardened, it is cut. The negative is molded and the positive is cast.

For the upper of orthopedic shoes, soft leather is used - chevro, suede or more durable - chrome, cowhide, calf leather. Painful areas should be relieved of pressure using appropriate indentations. The insole is made of soft material - cork, felt, sometimes from porous rubber or plastic. The heel can be moved to the side, lengthened, or raised on one side.
When ordering an orthopedic O., some special technical terms are used: internal lateral support - an insert made of thick leather, mounted into the O. from its inner side, with a height of 3.5 cm (low) to 10 cm (high); side corset - an insert made of a stiffer material that grips the ankle joint; pronator - an insole that raises the outer edge of the foot; instep - an insole that raises the inner edge of the foot and its arch; fascicles - heads of metatarsal bones; helenok - the underarch of the foot; lining - an elevation on the inner surface of the foot, pressing on any part of the foot; recess - a notch that creates free space between any part of the foot and the corresponding part of the foot; berets - a rigid side splint mounted in the O.
Orthopedic shoes and instep supports are manufactured at prosthetic factories, orthopedic clothing factories, and in workshops with special equipment as prescribed by the attending physician and the doctor of the medical department of the enterprise.
Shoes for limb shortening. The degree of shortening is determined by measurements and placing flat boards under the sole in such a quantity that the anterior superior iliac spines are at the same level when the patient is in an upright position. Shortening, which is compensated by plantar flexion of the foot, is measured by placing wedge-shaped boards - braids - under the heel. When shortening to 2 s., a cork is inserted under the heel into the usual O. If the shortening is within 2-5 cm, orthopedic shoes with a brace under the heel are prescribed. When shortening 6-18 cm, a wedge-shaped plug is placed under the entire footprint, but higher under the heel than under the toes. When shortening over 18 cm, an O. with a double trace or a device is prescribed.

The insole in O. is made according to the relief of the sole with the lining of the arch and a recess for the heel. When limiting movements in the joints, leave a shortening of 1.5-2 cm to avoid touching the toe when walking.
Shoes for toe defects after amputation at the level of the Lisfranc and Chopard joints. Defects of individual phalanges or all fingers except the thumb do not require orthopedic shoes. If there is a defect in the thumb, the sole of the O. is strengthened with a metal plate. With practically healthy stumps of the foot, the O. blank has the envelope type. A metal plate is placed in the sole along the entire footprint. The defect is filled with cork or felt. The toe is with one or two finger bends, the arch is filled with lining. To prevent the stump of the foot from slipping forward, a rigid front valve is used.
After the Pirogov operation, special devices are prescribed.
Shoes for equine feet. The vicious position of the foot at an angle of up to 100° is compensated by increasing the height of the heel in normal O. or by an inset brace under the heel. When pes equinus is within 100-110°, a brace is prescribed under the heel of the sore leg. To equalize the length of the limbs, you need to place a braid under the heel of the healthy leg.
For equine feet with an angle of 110 to 130°, orthopedic shoes with a cork along the footprint or with rigid ankle boots are prescribed, and over 130° - orthopedic shoes with rigid ankle boots or splints.
Shoes for internal clubfoot (pes varus) are made with a wide toe and a last made in the valgus position. In the case of a fixed, under-corrected deformity, the O. is made from an impression. Equation is compensated by a cork braid. The heel on the inside continues to the head of the first metatarsal bone, on the outside to the base of the fifth metatarsal bone, preventing adduction of the forefoot. For elastic rolling, the cork is placed up to the metatarsophalangeal joints, and the anterior section is filled with a soft lining. The area of ​​support of the foot is increased using the cork pronator.

Internal lateral support is used to maintain the correction of the heel and foot. For fixed non-straightened deformity - a lateral corset. The heel should fit tightly around the heel. The shaped heel, slanted outward, extends from the outside to the middle of the calf.
Shoes for flat feet. For flat feet of the 1st and 2nd degrees - an instep support inserted into a regular arch, made of cork, leather, felt, rubber, plastic, metal with leather and other materials. In case of flat feet of the first degree, the inner part of the heel is raised with an instep support up to 5 mm, and the anterior outer part - up to 8 mm. In case of II degree flat feet, the arch is placed in instep supports. With longitudinal and transverse flatfoot they lay out both vaults.
For flat feet of the third degree, orthopedic O. is prescribed using an individual block or plaster negative; instep support - taking into account the topography of the plantar surface. Laying out the arches is impractical, since flat feet are fixed. The heel is placed inward, its height is 2-4 cm. For transverse flatfoot, an instep support is prescribed with placement in the forefoot behind the heads of the metatarsal bones. This pad has a fan-shaped shape; it tapers toward the middle of the foot, and the edges are flat.
For hallux valgus, O. is done with the alignment of the arches and adduction of the anterior section. A small allowance is made for the thumb. The heel should fit snugly around the heel. In the area of ​​the head of the first metatarsal bone, the block is made wider, the skin is pressed in from the side of the workpiece and the sole.
For hammertoes and claw toes, O. is prescribed with a raised or high hard toe with arches laid out and a recess in the insole for the fingertips. With a heel spur, arch placement is prescribed to increase the area of ​​support and unload the heel. Depending on the location, the spurs make indentations in the insole or heel. In case of a hollow foot and the first degree of deformity, an insole without arch lining is prescribed, in which the anterior-inner edge is raised by 5-8 mm, and the posterior-outer edge by 5 mm. In the second degree, when equalization and adduction of the foot appear, measurements should be taken after achieving a possible correction, and in O. an internal rigid shank, extended to the fascicles, is prescribed; the top of the boot is strengthened in the front-inner section (with a hard side). In severe forms of pes cavus, O. is made from a plaster cast, and a pronator and arch alignment are prescribed. With significant heel varus, the heel is moved outward and internal lateral support is prescribed.
For paralyzed foot drop (no more than 130°), it is recommended to use a rigid system without metal devices, with a bilateral tibia, internal or posterior. If the sagging is over 135°, O. is done with a rigid corset, splints and rubber hoes to support the foot in the correct position. For accompanying deformities, corrective parts are added. To prevent deformities of the foot skeleton, metal splints with a hinge in the ankle joint and a metal plate in the sole are used.
For calcaneal foot, O. is prescribed with metal splints that limit dorsiflexion without limiting plantar flexion. The foot is placed in an equinus position. When shortening, use a braid for the heel made of cork without laying out the longitudinal arches. If there is no shortening, braids under both heels. Under the bunches - felt, felt for better rolling. The ankle boots should cover the lower third of the shin.
In case of swelling of the foot in the sole of the foot, allowance for internal dimensions is provided. Shoe rubber is placed in the upper part of the vamp.

Posted by Lizaveta Tue, 10/13/2015 - 00:00

Description:

Children with Down syndrome have increased joint mobility, which is caused by hyperelasticity of the ligaments. In the process of movement, in this case, walking, the child’s muscles develop, which becomes a stabilizing factor, that is, the muscles take on the role of joint stabilizers. Orthopedic doctors who are not familiar with these features have a desire to prescribe splints or high shoes for the child to fix the ankle. At first glance, this should help the child when walking, since the foot and ankle will be more stable in this case.
The author of the article draws the attention of adults raising a child with Down syndrome to such important questions as: what can strengthen the foot and prevent the occurrence of flat feet, what is “properly selected shoes” and what are their properties.

Publication date:

01/01/12

Children with Down syndrome have increased joint mobility, which is caused by hyperelasticity of the ligaments. In the process of movement, in this case, walking, the child’s muscles develop, which becomes a stabilizing factor, that is, the muscles take on the role of joint stabilizers. -----At doctors orthopedists who are not familiar with these features, there is a desire to prescribe splints or high shoes for the child to fix the ankle. At first glance, this should help the child when walking, since the foot and ankle will be more stable in this case.

But, as we all know from our own experience, muscles develop in the process of movement, and limiting them with the help of various devices or special shoes prevents this. Thus, the use of high-top boots may provide temporary relief when walking, but makes the problem of joint stability more pronounced. In addition, many children refuse to wear such shoes at all.
What to do? Orthopedic doctors say that in most cases, in the absence of significant orthopedic problems, it is enough to use the right shoes.

What can strengthen the foot and prevent flat feet from occurring:

1. Varied physical activity. Child with early childhood spends a lot of time on the stairs of the gymnastics corner, donated by smart, caring parents for his own birth, runs a lot, jumps, swims, rides a bike a lot, skis in winter, that is, leads a NORMAL lifestyle for a child.
2. Walking barefoot on a variety of surfaces, requiring instantaneous tension-relaxation reactions of different muscle groups. (To avoid falling, injecting yourself, etc.) There is also a positive effect from massaging the plantar surfaces with pebbles, cones, etc.
3. Properly selected shoes that will help support the foot in an optimal position while walking on a uniformly flat, hard surface.

Thus, if a child spends most of his time in a city apartment and does not have access to outdoor games, properly selected shoes remain the only obstacle to the development of functional flat feet.

What is “the right footwear”?

If we are not talking about existing disorders, it does not have to be “orthopedic” or have any features other than those listed below.

1. Heel. If the heel is raised, the muscles that support the arches of the feet are more actively involved when walking and, accordingly, develop better.
2. The rigid heel does not allow the heel to “fall” inward, which ensures even distribution of the load on the muscles.
3. A little support for the longitudinal (inner) arch of the foot (soft insole-instep support), as a rule, indicates that the shoes are of high quality, but in no case should they cause discomfort to the child. If it is not possible to choose an instep support that is comfortable for the child, it is better to abandon it completely.
4. The foot should not “ride” inside the shoe.

The properties of “good” shoes have been discussed many times, but here are a few additions.

Backdrop. Mechanical properties heel counters are determined mainly by the characteristics and shape of the rigid element inserted into almost all types of shoes. Those. Most types of shoes have stiffness in the heel area. In practice, the heel of a preschool shoe can be bent by applying slight pressure with the thumb. But its dimensional stability is also important. When bending any side of the backdrop up to 20-30 degrees. creases should not form on the shoes, and when the pressure stops, the shape of the heel should be completely restored.

The height of the hard heel in ordinary (non-therapeutic) shoes is a fairly constant value for each size, which is calculated so that its upper edge along the side surface is just below the ankles.

When trying on low shoes/sandals, you need to pay attention to the fit of the upper contour of the heel to the back of the foot. The better the match between the shape of the heel and the foot, the better. This is especially important if the child has a “narrow heel”. One of the universal solutions is to use a soft upper edging or lining in the heel area of ​​the shoe. By creasing the soft material, the shoe adapts to the foot.

Arch support. Regarding the instep support - in short, the layout of the longitudinal arch is simply an evolutionary stage in the development of shoes. Those. the manufacture of ordinary shoes with arch lining does not classify them as orthopedic, but serves to increase comfort due to a more complete fit to the entire plantar surface of the foot. But the height and geometry of the underarched space are very different in both adults and children (children are also relatively lower), in addition, this surface of the foot is not intended for heavy loads. Therefore, in order not to disturb biomechanics, in shoes for children preschool age if the vault is laid out, it should be soft (for example, like foam rubber or a little harder).

Sole. The sole has also been discussed several times. The elasticity of the sole is one of its most important qualities. If you hold it with one hand back shoes, and bend the toe part upward with the other, then the shoes should bend relatively easily along the roll line (the line of the metatarsophalangeal joints). In practice, in shoes with elastic soles and the right size, a child can stand on his toes without the toes resting on the toe part of the shoe (or not extending beyond the edge of the insole in open-toed shoes).

When buying shoes, in addition to choosing the size, it is advisable check whether it violates biomechanics. Walking in shoes should ideally be no different from walking barefoot, i.e. from heel to toe, no shuffling, no tucking in, stable (no stumbling, no tucking), no increased rotation of the feet.

If a child says that shoes are not comfortable for him, then this is most likely true. You shouldn’t compromise aesthetic preferences at the expense of functionality. Just try on different shoes.

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