A modern approach to the treatment of scoliosis with skewed pelvic bones by correcting asymmetric mobile planovalgus deformity of the feet

Introduction. The treatment of combined pathology of posture and feet remains an urgent problem of the child population.

Target. To study the effectiveness of using an individually made wedge-shaped corrective heel pad for each foot in the treatment of grade I-II scoliosis with pelvic bone distortion due to asymmetric mobile flat-valgus deformity of the feet for 3 years.

Object and methods. A comparison group and a main group were formed from 39 children and adolescents aged 3 to 15 years with grade I-II scoliosis with skewed pelvic bones and mobile flat-valgus deformity of the feet; patients underwent orthopedic examination every 6 months, radiography of the spine with pelvic bones, photoplantography, measurement of the pronation angle of the calcaneus, the study of quality of life indicators.

Results. There was a decrease in clinical symptoms in 54.2 % of patients of the main group with regression of the II degree of scoliosis to the I degree, the pronation angle of the calcaneal bones decreased by 4.25 ± 0.78 ° with the preservation of minimal asymmetry after 3 years, a decrease in the difference of the iliac crests by 3 .64 ± 1.59 mm and the angle of scoliotic deformity of the spine on radiographs by 5.22 ± 1.36°. Correlation analysis showed a statistically significant strong and moderate direct relationship between the pronation angle of the left calcaneus and the angle of scoliotic spinal deformity on radiographs in the 1st and 3rd years of the study, as well as with the difference in the iliac crests throughout the study. The quality of life of patients of the main group with correction of the asymmetry of foot hyperpronation improved by 15.5 %, in the comparison group by 2.9 %.

Conclusions. The results of the study confirmed the effectiveness of the use of individual wedge-shaped corrective heel pads for each foot in the treatment of grade I-II scoliosis with skewed pelvic bones due to asymmetric mobile flat-valgus deformity of the feet.

1. Baranov A.A., Albittskiy V.Yu. The state of children's health in Russia, the priorities of its preservation and strengthening. Kazan Medical Journal. 2018;99(4):698–705. (In Russ).

2. Batrshin I.T., Sadovaya T.N. Different height of the lower extremities with pelvic distortion and frontal deformity of the spine. Spinal surgery. 2007;2:31–39. (In Russ).

3. Dudin M.G., Pinchuk D.Yu. Idiopathic scoliosis. Lecture, part I. "Paradoxes". Orthopedics, traumatology and reconstructive surgery of children. 2014;1:70–77. (In Russ).

4. Dudin M.G., Pinchuk D.Yu. Idiopathic scoliosis in children and adolescents.Part 2. Pathogenesis. XI Congress of the Russian Association of Vertebrologists (RASS) with the Educational Course of the Society for Scoliosis Research (SRS Worldwide Course – 2021) "Spine Surgery: results of 10 years of experience and updates": Collection of abstracts. XI Congress of the Russian Association of Vertebrologists (RASS) with the Educational Course of the Society for Scoliosis Research (SRS Worldwide Course 2021), Nizhny Novgorod, 02-05 June 2021. Nizhny Novgorod: Association of Vertebrologists (RASS). 2021:48-49. (In Russ).

5. Burwell R.G., Dangerfield Р.Н. Pathogenesis of progressive adolescent idiopathic scoliosis. Platelet activation and vascular biology in immature vertebrae: an alternative molecular hypothesis. Acta Orthopacdica Belgica. 2006;72(3):247–260.

6. Vitenzon A.S., Skoblin A.A., Alekseenko I.G. Changes in the function of the muscles of the trunk and lower extremities in idiopathic scoliosis of the II-III degree. Spinal surgery. 2007;3:31–35. (In Russ).

7. Sadovaya T.N., Sadovoy M.A. Work experience of a specialized children's vertebrological district outpatient center. Diagnosis, prevention and correction of disorders of the musculoskeletal system in children and adolescents: tez. dokl. All-Russian conf. with internat. participation. Moscow, 2002:151-153. (In Russ).

8. Anosov V.S. et al. Dynamic photoplantography with computer analysis in the diagnosis and treatment of longitudinal flat feet in children. The journal of GSMU. 2005;3:151–155. (In Russ).

9. Bleck E.E., Berzins U.J. Conservative management of pes valgus with plantar flexed talus. Clin. orthop. 1977;122:85–93.

10. Gatskan O.V. Formation of flat feet, its prevention and treatment in various forms. Trends in the development of science and education. 2020;65(part 1):60-65. (In Russ).

11. Coleman S.S. Complex foot deformities in children. Philadelphia, 1983:395.

12. Helfet A.J. A new way of treating flat feet in children. Lancet. 1956;1:262.

13. Parshikov M.V., Popov A.V., Zorya V.I., Sergeeva V.V. Treatment of static diseases of the feet. Russian medical journal. 2000;1:18–21. (In Russ).

14. Konyukhov M.P., Lapkin Yu.A., Yanov A.N. Tactics and principles of treatment of congenital deformities of the feet in children. Optimal technologies of diagnosis and treatment in pediatric traumatology and orthopedics, errors and complications: mater. symposium. detsk. traumat.orthopedist of Russia. Volgograd, 2003:329-334. (In Russ).

15. Vinderlich M.E., Shchekolova N.B. Patent RU 2802506 C1 RF. Method of treatment of grade 1 and 2 scoliosis with pelvic distortion in children and adolescents: No. 2023112537. 12.05.2023. (In Russ).

16. Dubrovin G.M., Bakurskaya E.S., Borovleva A.V. Results of treatment of mobile flat-valgus deformity of feet in children. Bulletin of Modern Clinical Medicine. 2019;3:28–33. (In Russ).

17. Kulikov A.G., Zaytseva T.N., Pyzhevskaya O.P., Ivanova E.R. Scoliosis in children: new approaches to solving an important medical and social problem. Medical and social expertise and rehabilitation. 2016;4:178–181. (In Russ).

18. Sheveleva N.I., Dubovikhin A.A. Problems of conservative treatment of patients with flat feet. Kazan Medical Journal. 2018;99(4):665–670. https://doi.org/10.17816/KMJ2018-665 (In Russ).