Physiotherapy approach in children with flat feet

Spušteno stopalo je jedna od najčešćih deformacija stopala koja je u mnogo slučajeva zanemarena, iako može uzrokovati razna bolna stanja. Normalan anatomski položaj svoda stopala je narušen te ga je potrebno korigirati. Kod male djece vrlo je lako zamijeniti masne naslage na tabanima s deformacijom, stoga je važno utvrditi je li uistinu riječ o spuštenom stopalu. Kod procjene položaj stopala koriste se razne metode i postupci kojima se utvrđuje iskrivljenje, uglavnom plantografija ili pedobarografija. Svako odstupanje mora biti zabilježeno kako bi se lakše odredila terapija. Prije fizioterapijske intervencije potrebno je napraviti detaljnu procjenu koja obuhvaća subjektivni i objektivni pregled, inspekciju i palpaciju stopala, te procjenu hoda kojom se analizira stav i obrazac hoda. Zatim slijede mjerenja koja uključuju mjerenja opsega pokreta u zglobovima i manualni mišićni test. Nakon procjene, potrebno je provoditi vježbe jačanja, istezanja te koordinacije i balansa. Vježbe jačanja služe za jačanje mišića i ligamenata te je za njih karakteristično svladavanje otpora vlastitog tijela ili vanjskog opterećenja. Vježbe istezanja pomažu uspostavljanju, održavanju i poboljšanju pokretljivosti zglobova i skraćenih mišića. Vježbe koordinacije i balansa sudjeluju u realizaciji kretnje svake strukture. Koristi se i kinesio taping koji služi smanjuju boli, poboljšanju cirkulacije te stabilizacije zglobova i poboljšanju funkcije mišića. S obzirom da je deformacija spuštenih stopala sve češća kod djece koriste se preventivne mjere u ranom djetinjstvu poput ortopedskih cipela ili uložaka.Flat feet is one of the most common deformities of the foot, which is neglected in many cases, although it can cause various painful conditions. The normal anatomical position of the foot arch is disturbed and needs to be corrected. In young children it is very easy to mistake fatty deposits on the soles with deformities, so it is important to determine whether it is really a flat feet. There are various methods and procedures which are used to assess the position of the feet and to determine the distortion: mainly plantography or pedobarography. Any discrepancy must be noted to help recommend therapy. Prior to the physiotherapy intervention, a detailed assessment should be made which includes subjective and objective examination, inspection and palpation of the feet, and gait assessment to analyze posture and gait pattern. This is followed by measurements that include measurements of range of motion in the joints and a manual muscle test. After the assessment, it is necessary to perform exercises of strengthening, stretching and coordination and balance. Strengthening exercises serve to strengthen muscles and ligaments and are characterized by overcoming the resistance of your own body or external load. Stretching exercises help establish, maintain and improve the mobility of joints and shortened muscles. Coordination and balance exercises participate in the realization of the movement of each structure. Kinesio taping which reduces pain, improves circulation and stabilizes joints and improves muscle function is also used. As deformity of flat feet is becoming more common in children, preventive measures are used in early childhood such as orthopedic shoes or insoles