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THE INTROVERSION OR FLATFOOT: PRESSING INWARD IN CHILDREN
One of the issues that parents are most curious and worried about is introversion or flatfoot. Turkey Medicals Co-ordinator, “For this simple but important subject which is of interest to Orthopedics,” we ask our dear teacher Prof. Dr. who is a Pediatric Orthopedist at Istanbul Bahcesehir MedicalPark Hospital.
1- What do we understand when my teacher says Don’t press inward? Are there different types of inward pressing?
There are four types of inward pressure are defined in children who are brought in:
Type 1: They are deformities in the foot. In this case, the foot is introverted from the comb bones in the foot, it is a congenital problem, usually its treatment is surgically possible.
Type 2: There is a completely inward pressing on the leg. Actually, the foot is normal. This is a problem that can be corrected by the age of adolescence. The typical feature of these children is that they can sit on their knees and spread their legs to the sides, which we call W sitting. It does not require surgical treatment except in very special cases.
Type 3: Standing is the inward pressing of the base. In this case, there is no curve on the inner side of the foot, and when viewed from behind, the inner side of the heel is closer to the ground, and bending outwards is observed. Sometimes even the outer edge of the heel rises into the air. This condition, popularly known as Deceleration, is evaluated after the child walks independently.
It is not necessary to do anything only in children whose foot curve has not been formed and whose heel is smooth. Most of the time, it is a condition that resolves on its own. The use of special shoes is unnecessary.
Type 4: Lack of foot curve in inward presses, along with Type 2: in the clinical picture, which is seen in the form of introversion of the leg of the type and introversion of the tibia along with the o-leg, is dramatic for many families. However, even in such cases, spontaneous recovery is often possible. During the child’s natural development period, that leg improves, and accordingly, other problems decrease and improve over time.
2- Teacher, as far as I understand, most of the time there is no need to worry and it resolves on its own. So when and in what cases is treatment needed?
Conditions that are bending at the heel along with the absence of a curve may be a serious flatfoot that requires treatment. This distinction should preferably be made by an orthopedic specialist experienced in foot and pediatric orthopedics. If it is decided that treatment is needed, specially made shoes or insoles can be used until the age of four. After the age of four, if there is a severe flatfoot condition according to the examination on the X-rays, it may need to be corrected by surgery.
3- Flat Feet are also another problem… Is flat feet a bad disease?
It is definitely not a bad disease. But it is a problem that reduces the quality of life throughout life. There used to be a legend that flatfoot men wouldn’t enlist. Congenital flat feet that need to be operated very severely (which is very rare), except for flat feet, those who can do military service. Those with flat feet stay away from sports activities a little. In childhood, for this reason, they become a little calmer, they lag behind their peers in activities. After adulthood, foot and leg pains begin, they are pains that increase with standing. Work conditions, standing work and extra pounds are also other factors that increase their pain. Deforming of shoes and problems with wearing shoes last a lifetime, premature calcification may occur at an older age. If necessary, problems for the future can be eliminated with simple surgeries performed in childhood.
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