Demian Y. Flexible flat foot and its orthopedic treatment of children with hypermobility of the joints

Thesis for the degree of candidate of medical sciences (specialty 14.01.21 “traumatology and orthopedics". - State institution "Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine", Kyiv, 2019. The thesis is devoted to the improvement of diagnostics and increasing the effectiveness of treatment of flexible flat feet of children with hypermobility of the joints on the basis of clinical and radiological data, biomechanical studies, conservative and surgical treatment. The sample of subjects for the diagnosis and treatment of flexible flat foot was 81 people, among them 37 boys and 44 girls (p <0.01). The age of the patients of the main group (n = 81) ranged from 3 to 18. The study was conducted in three stages. It has been found that the main risk factor in the occurrence of orthopedic pathology in patients with connective tissue dysplasia is precisely the hypermobility of the joints (according to Beighton criteria 8-9 points), which was diagnosed in all patients, in the future it should be taken into account when deciding the tactics of further treatment. In the course of the study, a base of quantitative radiometric indicators of the forms of the feet of patients has been formed. Reliable has been ascertained: a decrease in the heel- tibia (r = 0.65, p,00.05), metatarsal-ramming (r = 0.84, p˂0.05), ramming - heel angle (r = 0 , 54, p˂0.05) an increase in the angle of inclination of the heel bone (r = 0.88, p0.05). On the basis of ergonomic research, it has been found that the use of soft insoles improves the main indicators of foot support ability of patients with flexible flat foot on the background of severe hypermobility of joints. In cases of symptomatic flexible foot of children with hypermobility of joints, a clear algorithm of actions of conservative treatment (the use only of soft insoles, exercise therapy for 6 months). Surgical intervention was applied only in case of ineffectiveness of the conservative treatment of this pathology. The use of the technique of subtalar arthroreuse in the treatment of this group of patients allows for effective correction of foot deformities, to achieve a lasting effect on pain and improve the function of walking.