The use of biogenic stimulants in the treatment of static flatfoot in children 
 

Danilov A. A., Shulga O. V., Talko M. A.

Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine

Kyiv Children’s Hospital No 2, Bila Tserkva, Ukraine

The aim was to investigate the effectiveness of combined use of biogenic stimulators and pharmaco-electro-kinesotherapy neuromuscular apparatus of the leg and foot in the complex treatment of patients with static longitudinal flatfoot (SLF), and explore, based on the analysis of literary sources, possible causes of this disease in the early stages of embryonic development.

Materials and methods. We observed 64 patients with pathology of the foot on the base of Kyiv Regional Children’s Hospital No 2. SLF diagnosed in all patients which was confirmed clinically and radiographically. The study group included 31 patients aged 14–18 years old, 21 of them with SLF of the I–II degree and 10 patients had SLF of the III–IV degree. The control group consisted of 33 patients of the same age with SLF, including 23 with SLF of the I–II degree, and 10 patients with SLF III–IV degree. During the survey there were used clinical and instrumental methods of research: plantography, X-rays of the foot in the lateral projection of the load foot, rheovasography, electromyography, ultrasound examination of the foot and lower leg muscles. Plantography results were evaluated by Shtriter’s method. Investigation of the structure and the diameter of the muscle was performed on the apparatus for ultrasound studies «ALOCA» with linear sensor and 5 MHz frequency. The patients in the control group received standard treatment — pharmaco-electrokinesitherapy of neuromuscular apparatus of the leg and foot. For the patients of the study group this therapy was supplemented by biogenic stimulator — placenta extract.

Results and discussion. According to X-ray examination the treatment led to a greater reduction in the navicular angle to the longitudinal arch in the study group (average parameters: in the study group, I–II degree — 4.90 (p<0.05), III–IV degree — 2.1 (p<0.05); in the control group, I–II degree — 2.90 (p<0.05), III–IV degree — 0.60 (p>0.05). Both in control and study groups treatment improved electromyographic pattern and significantly better parameters were registered in the study group: after treatment in the patients with the I–II degree of CPR bioelectrical activity of long and short flexors of the toes increased by 100 and 60 mV, respectively, and in the patients with SLF II–IV degree by 20 and 10 mV, respectively. In the control group the bioelectrical activity of these muscles in patients with SLF I–II degree increased by 40 and 30 mV, and in the patients with SLF III–IV degree by 10 and. 10 mV. The analysis of ultrasound results, after a course of therapy, showed a more pronounced increase in diameter of the foot and leg muscles in the study group as compared to the control one. Plantography parameters decreased in Shtriter’s index, but greater improvement in the studied parameters were registered in the study group. The analysis of the reovasografic data of the patients with SLF I–II degree showed improvement in reosistolic index in the control group and a significant improvement in the study group: by 0.17 and 0.33 units on the left foot, respectively, and 0.19 and 0.35 units on the right foot, respectively. The patients with SLF III–IV degree had no ignificant improvement of hemodynamic changes.

Conclusions. Clinical picture, terms of rehabilitation, X-ray data, ultrasound results, the indices of myography, plantography, rheovasography evidence the effectiveness of the biogenic stimulants for the treatment of SLF in children. Combined usage of the biogenic stimulators and pharmacoelectro-kinesitherapy is pathogenetically and sanogenetic reasonable and effective method for the treatment on the initial stages of SLF, however, requires further study. Patients with III–IV degree need operative treatment.

Key words: placenta extract, static longitudinal flat feet, mesenchyme, connective tissue dysplasia.

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