Поражение мышечно-связочного аппарата приводит не только к плоскостопию. Полная противоположность этого заболевания – полая стопа. При такой патологии пациенты отмечают сложности подбора обуви в связи с «высоким подъемом», изменение формы пальцев и быструю утомляемость при физических нагрузках.
Что это такое
Стопа человека состоит из 26 костей, соединенных связками и мышцами. Мягкие ткани обеспечивают прочность, возможность изменять конфигурацию при нагрузке, перераспределение давления на отдельные участки.
Стопа имеет два продольных и один поперечный свод. В проекции подошвы они начинаются и заканчиваются из 3 основных точек опоры: головки первой и пятой плюсневых и пяточная кость.
Увеличение кривизны продольного свода приводит к росту его высоты, контакт с опорой в средней части подошвы отсутствует. Это и называют полой стопой. Вся опора приходится на пальцы ног и пятку. Средняя часть не нагружена.
Почему развивается такая деформация
Образование высокого свода стопы возникает вследствие различных причин. Существует гипотеза, что перераспределение мышечного тонуса связано с патологией нервной системы или травмами. Среди наиболее распространенных этиологических факторов называют такие болезни и состояния:
- детский церебральный паралич;
- полиомиелит;
- врожденные нейропатии;
- мышечные дистрофии;
- наследственные патологии мозжечка;
- тяжелые ожоги;
- последствия переломов костей ступни.
У каждого пятого пациенты полая деформация возникает на фоне неврологического благополучия и при отсутствии травм в анамнезе. В таком случае предполагают наследственную предрасположенность, которую чаще ассоциируют с длиной связок.
В МКБ 10 полая стопа имеет шифр Q66.7. 
Виды и стадии
По локализации наибольшей деформации выделяют три вида полой деформации:
- Передний. Опора идет на кончики пальцев, стопа находится в вынужденно разогнутом положении. Пятка приподнята.
- Задний. Слабость икроножных мышц приводит к подошвенному сгибанию. Основная опора идет на пятку, она опускается ниже других отделов. Часто этот вид деформации сочетается с вальгусной установкой, которая происходит из-за контрактуры длинного разгибателя мышц ступни.
- Средний. У пациента укорочен подошвенный апоневроз или есть контрактуры мышц ступни.
Ортопеды указывают, что заболевание имеет 2 стадии:
- Изменить конфигурацию стопы можно за счет воздействия на мягкие ткани.
- Деформации носят стойкий характер, избавиться от них можно только путем хирургического вмешательства.
Выделение стадий позволяет понять, когда пациенту можно рекомендовать консервативные методы лечения, а в каких случаях они окажутся неэффективными.
Симптомы и осложнения
Обычно пациенты с полой стопой обращаются к врачу с такими жалобами:
- Боли в области голеностопных суставов, утомляемость после нагрузки.
- Боли в области центра подошвы, особенно после ношения неудобной обуви.
- Образование плотных мозолей на ногах – в области основания 1 и 5 пальцев.
- Сложности с подбором обуви – пациент отмечает, что может удобно чувствовать себя лишь в моделях с высоким подъемом, шнуровкой, чтобы отрегулировать пару по высоте. С трудом переносит обувь без каблука (когда средняя часть ступни не находит опоры и «провисает»).
- Привычка неправильно ставить ногу – с опорой на наружный край. О такой особенности свидетельствует неравномерный износ подошвы обуви.
При осмотре врач обратит внимание на следующие признаки:
- Изменение конфигурации стопы: отсутствие контакта с опорой среднего отдела, когтеобразные или молоткообразные пальцы, характерное расположение мозолей.
- Чтобы оценить стадию заболевания, травматолог-ортопед пропальпирует ступни, потянув кверху пятку и стараясь разогнуть пальцы ноги. Если деформация не является стойкой, она проходит от надавливания на первую плюсневую кость со стороны подошвы при осмотре, опоре на пол. При подъеме ноги стопа снова принимает патологическую форму.
- В случае необратимой деформации в средней части стопы врач пальпирует плотный тяж мышечного сухожилия, в ряде случаев наблюдают фиксацию в патологическом виде даже измененной кожей.
- При возникновении полой стопы на фоне неврологической патологии состояние ног будет вписываться в общую картину заболевания: конская деформация с опорой на носки, паралитическая ступня с переразгибанием в области подошвы.
Если родители подозревают полую стопу у ребенка или подростка, они должен обратить внимание на расположение ног. Вальгусная деформация на фоне плоскостопия также приводит к нарушению опоры: малыш будет вставать на наружный край стопы. Если зафиксировать ступню на опоре, она приобретет типичный для плоско-вальгусной деформации вид.
При отсутствии лечения заболевание будет прогрессировать, разовьются осложнения:
- нарушается походка;
- беспокоят боли в ногах и спине;
- снижается устойчивость к физическим нагрузкам;
- возникает стойкая деформация пальцев.
Диагностика
Установить верный диагноз помогут:
- Беседа: выявление жалоб, уточнение их связи с какими-либо заболеваниями, семейный характер заболевания.
- Осмотр ног пациента, анализ походки.
- Рентгенодиагностика полой стопы позволит выявить увеличение высоты продольных сводов, костных изменений.
- Плантография: выполнение отпечатков стопы с оценкой, чтобы выявить степень и признаки патологии.
- МРТ и электромиография при неврологических заболеваниях.
При необходимости пациента направляют на консультацию невролога.
Полая стопа и военная служба
Пациента с болезнями стоп могут освободить от армии. Годность к военной службе при полой стопе определяют исходя из того, может ли призывник носить обувь установленного образца. Армейские сапоги или ботинки изготавливают для здоровых ног, использование особой обуви или стелек недопустимо. От службы освобождают призывников, у которых продольные своды фиксированы в патологическом положении. Так называемые скрученные ступни должны иметь:
- приведенный, распластанный и широкий передний отдел;
- характерные натоптыши под головками плюсневых костей;
- молотообразную или когтеобразную деформацию пальцев.
Если ношение военной обуви затрудненно, но грубых стойких изменений стопы нет, призывник может быть признан ограниченно годным к некоторым родам войск (категория Б).
Лечение полой стопы
При заболевании применяют консервативные и хирургические методы.
Если патологической фиксации стопы еще нет, ортопед может посоветовать исправление с помощью безоперационного лечения. Это поможет при полой стопе у ребенка, молодого человека без тяжелого неврологического заболевания.
Консервативное лечение
Массаж. Процедуры направлены на расслабление мышц, снятие болевого синдрома. Приемы зависят от локализации поражения, так как они связаны с нарушением работы различных групп мышц. При наиболее распространенном среднем виде выполняют поглаживание и разминание подошвы в области натянутого апоневроза, глубокое поглаживание в проекции плюснево-фалангового соединения и поверхностное со стороны тыла стопы.
Ортопеды рекомендуют изготовление стелек для полой стопы на заказ. Только так можно сконструировать приспособление, которое будет подходить конкретному пациенту. Стандартные модели стелек обычно оказываются неэффективными и неудобными.
Обувь для пациентов должна фиксировать голеностопный сустав, иметь жесткую пятку и небольшой широкий каблук. Дополнительно для фиксации предлагают ношение ортезов.
Комплекс ЛФК при полой стопе назначает врач. Перечень упражнений зависит от причины заболевания и направлен на его коррекцию. После освоения основных приемов пациент может повторять их дома.
Физиолечение также назначают симптоматически. Оно направлено на уменьшение болей, нормализацию мышечного тонуса. Среди методов терапии применяют: магнитолечение, электрофорез, парафиновые аппликации.
Хирургическая коррекция
При неэффективности консервативных методов коррекции полой стопы у взрослых или детей назначают операцию. Тактика хирурга зависит от локализации поражения, причины болезни. Ортопеды используют:
- Формирование анкилоза в суставе (артродез).
- Рассечение костей (остеотомия).
- Резекция части кости.
- Пересадки сухожилия.
- Рассечение плантарной фасции.
Заболевание возникает при травмах, нервных и мышечных заболеваниях. У части пациентов это состояние является вариантом нормы. Стойкие деформации с невозможностью подбора военной обуви при полой стопе – основание для освобождения от службы в армии.
Консервативное лечение рекомендовано лицам, у которых еще не сформировалась патологическая фиксация ступни.
Полая стопа – это патологическое увеличение продольного изгиба свода стопы. Приобретает деформацию по типу «арочный изгиб». Значительно влияет на качество передвижения, нарушения опорно-двигательного аппарата, болезненность, быструю усталость при активной ходьбе. Провокация изменений происходит на фоне заболеваний костно-мышечных структур, приводит к инвалидности.
Что такое и код по МКБ 10 полой стопы
Согласно международной классификации болезней МКБ-10 присвоен код Q66.7 — pes cavus.
Стопа является сложной структурой. Обеспечивает поддержку тела под воздействием внешних факторов, изменчивых массо-ростовых показателей. Приспосабливается при смене обуви, поверхности. Свод служит амортизатором во время движения. При нарушении в строении голеностопа, уплощении, повышении свода стопы возникают двигательные расстройства.
Анатомически при полой деформации наблюдается опущение плюсневой кости большого пальца ноги, ротация пяточной части внутрь — внешнее выкручивание стопы. Различают вариации скручивания:
- Задний тип – провоцируется слабостью трехглавой мышцы голени и повышения тонуса мышц-сгибателей, фактически формируется вальгусное положение ног, что очень часто можно наблюдать у детей из-за незрелости мышечной системы.
- Промежуточный — при слабости и укорочении подошвенных мышц.
- Передний — характеризуется преобладанием тонуса мышц-разгибателей с опорой на передний отдел стопы.
Причины появления и симптомы
Общепризнанных оснований для развития не существует. На долю неизвестного фактора приходится пятая часть всей патологии. Согласно изученным причинам, среди провоцирующих факторов нарушения строения, изменений кривизны свода, выделяют факторы:
- генетический триггер. Существует теория наследственной предрасположенности к определенной форме ног, склонность к экскавации свода;
- нарушение тонуса мускулатуры в сторону гипертонуса или паретической слабости, асимметрия сгибателей-разгибателей голеностопных мышц (вследствие чего формируются нарушения положения свода), укорочение подошвенного апоневроза (заболевание Ледероуза), смещение точек давления при ходьбе;
- при сопутствующей патологии костно-мышечных структур, слабости связочного аппарата нижних конечностей: полиомиелит, мускулатурная слабость с деформирующей дистрофией, при расщеплении срединного шва позвоночного столба (спинальная дизрафия) у детского (ребенок, подросток), взрослого населения;
- неврологические заболевания: сенсомоторная невропатия Шарко-Мари-Тута, паретическая атаксия по типу Фридрейх, ДЦП различной степени тяжести, полинейропатические нарушения, мозжечковая атаксия, сирингомиелия, при инфекционном менингите, энцефалите и менингоэнцефалите;
- онкологические новообразования доброкачественного или злокачественного характера, с локализацией в спинном мозге;
- при травмирующем факторе: переломы голеностопа, пяточной таранной кости, после массивных ожоговых поражений, обморожений (идет замещение соединительнотканных элементов на рубцовую ткань);
- идиопатическая невыясненная этиология, в общем сегменте заболевания достигает 15-22%.
Клиническая картина включает симптомы, проявления болезни:
- быстрая утомляемость при ходьбе на небольшие дистанции;
- болезненность, постоянно прогрессирующая в ступнях, голеностопном суставе. Носит колющий или простреливающий характер. Боль бывает постоянной, вялотекущей, временами обостряться (метеочувствительность, смена подъема обуви, хождение босиком);
- при прогрессировании идет видоизменение внешнего строения пальцев ног (молоткообразные, когтеподобные деформации, «пальцы веером», сплющивание фаланг под воздействием давящей силы);
- возникают атипичные мозоли, натоптыши, отличающиеся острой болезненностью. Особенность их локализации – у основания мизинца, на большом пальце;
- ограничивается подвижность с контрактурами голеностопной части нижних конечностей, возникает тугоподвижность стоп;
- у детей симптоматика выражена слабо. Присутствует вальгусное искривление стоп, незначительный дискомфорт при активных спортивных нагрузках (бег, игра с мячом). Скрытый период опаснее. Риск стойких деформаций, запущенных состояний значительно возрастает.
Рентгенодиагностика
Диагностический комплекс мероприятий при нарушении нормальной кривизны с экскавацией свода стопы включает плантографическое обследование. Основной метод для полой стопы — рентгенодиагностика. Выполняется рентгенологический снимок в двух проекциях – прямой и боковой.
На основании осмотра лечащего врача-ортопеда, заключении рентгенолога ставится окончательный диагноз экскавации сводов. На рентгенологическом снимке отчетливо определяются изменения и смещения костных структур, деформация ступни и нарушения мышечно-тканных составляющих.
Лечение полой стопы
Схема терапевтического воздействия, выбор методики лечения определяется согласно причине заболевания: генетические патологии, неврологические проблемы, мышечная слабость или гипертонус. При легких степенях поражения с небольшим отклонением угла при плантометрии (от 31 до 39) ограничиваются лечебным массажем, физиотерапевтическим воздействием, назначением индивидуального комплекса занятий ЛФК. При средней тяжести дополнительно подбирают корректирующие супинаторы, ортопедические стельки, специальную обувь с приподнятым внутренним краем, устойчивым плоским каблуком. В тяжелых случаях не обойтись без операции: остеотомия, частичная костная резекция, артродез, надрез фасции подошвы, трансплантация сухожилий.
Хирургическое лечение
Операция проводится комбинированная по Куслик, по Альбрехту, по Митбрейту или по Чаклину. Суть методов оперативной коррекции в фактическом иссечении части костной пораженной структуры, придания нормального положения ступням. Ушиваются раны, накладывают двухсторонний «гипсовый сапог». Следует стационарный или домашний реабилитационный период. В зависимости от разновидности вмешательства изменяется место резекции, вид удаленной кости или нескольких сразу костей. Длительность реабилитации и нахождение в гипсе от 5 до 10 недель.
Упражнения
Лечебная гимнастика подбирается совместно с лечащим врачом, когда имеется возможность проводить тренировки совместно с врачом-реабилитологом или самостоятельно дома. Физкультуре отводится главенствующая роль. Физическое воздействие помогает восстановлению нормальной ходьбы, помогает расслабить или привести в тонус различные группы мышц, в частности голеностопные. Длительное, системное выполнение упражнения для полой стопы оказывает исключительно положительный эффект.
Важным условием является предварительная консультация специалиста — ортопеда, невролога, терапевта и травматолога.
Массаж
Выполняют общий массаж подошв для улучшения микроциркуляции, нормализации нервных окончаний, снятия усталости, отечности после дневного времяпровождения, минимизации болевого синдрома с двусторонней локализацией, дискомфортных ощущений. Комбинируют с физиопроцедурами (электрофорез, парафиновые аппликации, иглоукалывание), наложением кинезиотейпов (двусторонний тейп используют для устранения гипертонуса, гипотонуса, выравнивания мышечной асимметрии, внешней замены сухожилий по типу псевдо связочного аппарата для временного облегчения дискомфортных ощущений).
В комплексе с народными методами терапии признаки деформаций исчезают.
Годен ли человек с полой стопой к военной службе
При прохождении медицинской комиссии на предмет пригодности к армии существует перечень заболеваний, исключающих призывника из ряда пригодных к служению в воинских частях. Наличие патологии в виде полой стопы (согласно проведенному исследованию плантометрии, подометрии, определении подометрического индекса кривизны свода) решается вопрос о непригодности. Стандартная воинская обувь не приспособлена для коррекции супинаторами, стельками, корректорами. Станет причиной усугубления состояния. Нагрузки и физические упражнения не могут быть применены и разработаны индивидуально – действует общий устав и распорядок.
Для подтверждения диагноза, снятия с воинского учета призывник обязан обратиться в лечебное учреждение к врачу-ортопеду, пройти диагностику с рентген-снимком, получить письменное подтверждение для военкомата. Документация заверяется, выдается военный билет о профессиональной непригодности к службе.
В человеческом организме стопа является важнейшим механизмом опорно-двигательной системы.
Это сложное анатомическое образование, которое состоит из большого количества элементов, в число которых входят и кости, и мышцы, и сухожилия.
Уникальный механизм действует как единое целое. Тем самым обеспечивая возможность человеку двигаться, опираясь на землю. Когда в данном комплексе возникает патология, то механизм стояния и движения нарушается.
Возникает перераспределение нагрузки при ходьбе, в результате чего ноги быстро устают, тяжелеют и болят.
Полая стопа – это такое изменение формы, при котором происходит патологическое увеличение свода. По своей сути данная патология является противоположностью плоскостопью, когда свод опущен и уплощён.
При ходьбе опора приходится на пятку и пальцы ног. А средняя часть ступни не несет никакой нагрузки и нависает над поверхностью подобно «мостику».
С течением времени пятка разворачивается внутрь и происходит серьезная деформация конечности.
Причины патологии
Причины по которым возникает полая стопа до конца не выявлены.
В тоже время многолетняя лечебная практика позволяет назвать некоторые факторы, которые способны спровоцировать развитие данного заболевания:
- В первую очередь надо назвать патологии нервно-мышечной системы. Это церебральный паралич, полиомиелит, дистрофия, опухоль спинного мозга.
- Неточно сросшаяся пяточная или таранная кость после перелома так же может вызвать патологическую деформацию стопы.
Стопа может изменить свою форму и после сильного ожога. - Встречаются случаи, когда данный процесс не беспокоит пациента, но является первым признаком заболевания спинного мозга.
Примерно в пятой части общего числа патологий причину болезни выявить не удается. Этот факт не оказывает влияния на тактику лечения и применяемые процедуры. Выбор делается в зависимости от фазы развития болезни.
Две стадии заболевания
Деформация стопы развивается постепенно, и специалисты выделяют в этом процессе две стадии.
На первой стадии происходит морфологические изменения мягких тканей. Когда стопа искривляется в результате деформации мышц, связочного аппарата, кожи, то эти изменения легко устранить.
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У детей младшего возраста полая стопа сложно выявляется из-за того, что клиническая картина болезни выражена слабо.
Но если этого не сделать, то деформация переходит в устойчивую фазу. И это влечет серьезные последствия для здоровья.
Как проявляется заболевание?
Первыми признаками возникновения и развития болезни проявляются в том, что человек начинает уставать при ходьбе. После прохождения привычной дистанции от дома до работы и назад, у него возникают боли в области голеностопа.
Возникают болезненные натоптыши, мозоли на мизинце и в основании большого пальца. Наблюдается явная, когтеобразная деформация пальцев.
Прежняя, хорошо разношенная обувь начинает казаться не удобной и некомфортной. При этом возникают трудности при выборе и покупке новой обуви.
Почему возникает болевой синдром в области позвоночника дорсалгия и как купировать боли в таком случае? На эти вопросы ответит наш материал.
Как себе помочь самостоятельно, если болит копчик при сидении? Методики, советы и различные подходы вы можете узнать изучив нашу статью.
Постановка диагноза — первый шаг к излечению
Для того чтобы поставить точный диагноз, используются несколько методов. Прежде всего, проводится визуальный осмотр стопы.
Плантография — основной метод
Самым простым и проверенным временем считается метод плантографии. Суть его сводится к тому, что на специальной бумаге отпечатывается след стопы. И уже по форме отпечатка определяется наличие болезни и степень ее развития.
Если на полученном изображении четко просматривается отпечаток пятки и пальцев, а между ними пустое пространство, то это явный признак полой стопы.
В том случае, когда метод плантографии не дает однозначной картины для постановки точного диагноза, больного направляют на рентгенологическое исследование.
По полученным снимкам можно сделать точный вывод о характере заболевания и назначить соответствующее лечение. Лечебная практика показывает, что при постановке диагноза больного нужно отправить на консультацию к неврологу.
Специалист назначает подробное неврологическое обследование.
Это нужно сделать потому, что полая стопа может оказаться признаком болезни позвоночника.
С помощью современной аппаратуры, при обследовании стопы, можно обнаружить заболевание нервно-мышечного аппарата. Если деформация стопы обнаружена впервые и в зрелом возрасте, то больного нужно направить к онкологу.
Это может быть признаком опухоли спинного мозга. Обследование с помощью магнитно-резонансной томографии позволяет оценить общее состояние организма и выявить многие болезни на стадии возникновения.
Лечение зависит от степени запущенности патологии
Конкретное лечение полой стопы назначается в зависимости от определенных обстоятельств:
- в первую очередь учитывается причина возникновения и развития болезни;
- второй момент, который влияет на тактику лечения, возраст больного;
- и третье важное обстоятельство – степень увеличения свода стопы.
Совокупность перечисленных факторов предполагает использование консервативного или хирургического способа лечения.
Главная цель консервативного метода лечения сводится к тому, чтобы укрепить костно-мышечные компоненты свода стопы. Хорошие результаты достигаются совместным использованием лечебной гимнастики и специальной ортопедической обуви.
ЛФК — основа основ
Комплекс специальных физических упражнений и физиологических процедур подбирается по рекомендации лечащего врача. Теплые ванночки, парафиновые аппликации и одновременная ручная коррекция деформации приводят стопу в нормальное состояние.
Выбор обуви
Для женщин очень важно подобрать комфортную обувь. От высоких каблуков нужно отказаться. Предпочтение нужно отдавать низкому каблуку и широкую платформу, которая способствует фиксации стопы в правильном положении.
Выбирать ортопедическую обувь необходимо под наблюдением лечащего врача. Туфли или ботинки должны быть с высоким верхом и широкой подошвой.
А так же иметь приподнятый внутренний край. Для того чтобы обеспечить поддержку свода стопы используются ортезы. Так называются специальные стельки, которые изготовляются по индивидуальному заказу.
Хорошо помогают брейсы. Они одеваются как носки и обеспечивают стабилизацию лодыжки и стопы.
Мозоли и натоптыши, которые всегда сопутствуют заболеванию, нужно либо срезать, либо подкладывать под них специальные подушечки для перераспределения нагрузки на стопу.
Основная задача в этом случае заключается в том, чтобы снять болезненные ощущения при ходьбе и купировать дальнейшее развитие болезни. Оно приносит положительный эффект больным в раннем возрасте и тем, кто не перенес неврологических заболеваний.
Хирургия, как крайняя мера
Если положительного результата после всех консервативных процедур и мероприятий не наблюдается, то для лечения приходится использовать хирургическое вмешательство.
Данный метод лечения используется в том случае, когда причиной возникновения полой стопы послужило неврологическое заболевание.
Хирургическое лечение включает в себя:
- артродез – создание неподвижного сустава;
- остеотомия – рассечение кости для придания ей правильной формы;
- пересадка сухожилия;
- рассечение подошвенной фасции.
На практике часто используются несколько методик одновременно.
Профилактические меры
Надо знать, что полая стопа имеет свойство передаваться от родителей к потомству. В обиходе, когда болезнь не развивается, это 
называется высокий взьем.
В медицине – высокий арочный свод. Но подобные факты могут и не привести к заболеванию. Особое внимание к стопе нужно проявить в том случае, если человек в раннем возрасте перенес полиомиелит.
В любом возрасте, человеку, который замечает у себя признаки полой стопы, нужно тщательно подбирать обувь. Она не должна быть тесной или слишком свободной.
Щадящие физические упражнения и регулярные гигиенические процедуры способствуют здоровому состоянию ног в целом, и стоп в частности.
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