Henryk Kapnik

Henryk Kapnik – The angles of valgity of the first toe and varus deformity of the fifth toe in school age children from the physiotherapeutic, orthopedic, and ergonomic perspective. Fizjoterapia Polska 2001; 1(2); 135-142

Abstract
Background. The structure and efficiency of the foot is a subject of interest to specialists in various branches of science, from anthropology, through medical and pedagogical sciences, to sciences of physical culture, including specialists in the area of physiotherapy. The majority of the research is concentrated on the platypodia, while little attention is devoted to deformities of the toes. Work in the area of ergonomics is of particular importance in this respect. This research focuses on various aspects of foot structure, including proportions and shape, and in particular the anterior portion of the foot, where the functionality of footwear is of essential importance. Nevertheless, toe deformities are very frequently encountered. Various causes for this have been indicated; many authors, however, regard the primary cause to be non-physiological footwear. Goal of research. The purpose of this study is to present various ways of working up plantoconturograms of the foot, to specify the variability of the angles of the first and fifth toes in pre-school and school-age children, and to ascertain whether or not changes have taken place in respects to the forefoot in preschool and school-age children over the last 32 years.Material and methods. The research material consisted of plantoconturograms made in Cracow in 1984, in Radom, Katowice, and Cracow in 1994 and 1995, and in Katowice and Radom in 1999 and 2000. Over 3,500 children ranging in age from 3 to 15 years were tested. Direct measurements of the feet were made, as well as plantoconturograms. Various concepts are presented for marking the angles of valgity of the first toe and varus deformity of the fifth toe in orthopedics, anthropology, and ergonomics. A device developed by the author was used to work up the plantoconturograms. Analysis of results. The internal angles of the first and fifth toes are a better measure of valgity and varus deformity of the toes than the external angles previously used, which depend to a significant extent on the proportion of the width of the heel to the width of the forefoot and the distance between them. The internal angles are not dependent on the relation of these segments or their relative distance from each other, and are thus stable; moreover, from the ergonomic point of view they may serve as a basis for designing the bed of the last. The 1968 results revealed marked valgity of the first toe between ages 5 and 15, i.e. in the school years. This phenomenon is particularly evident in girls. The fifth toe is much more deformed; the largest degree of varus deformity in boys occurs at age 5, and in girls age 7. in comparison to nation-wide data from 1968, considerable improvement has been noted in respect to valgity of the first toe, and even more so in terms of varus deformity of the fifth toe. The least improvement was noted in 1984, somewhat more in the children tested in 1995, and the greatest improvement in 2000. Only slight differences were noted between the results recorded for boys and girls. Less deformity of both first and fifth toes was over the last 32 years. Discussion. The results of the author’s research are discussed in terms of the differences between the dimensions of the foot and the internal dimensions of the footwear used and purchased by children and youth. In general, children wear shoes that are too short; the differences between the dimensions of the foot and the shoe average ca. 1-1,5 cm, and reach as high as 5 cm. The percentage of children wearing shoes that are to some extent too short ranges from 60% to 95%, while 67-97% of the footwear purchased is too short. Almost half of adult women and men have differences of more than 5 mm in the dimensions of their feet. In children, asymmetrical feet are in from 30% to 60%.Results. The “internal angles” are a better measure of valgityof the first toe and varus deformity of the fifth toe, since they do not depend on the proportions of foot width, while at the same time they are useful in ergonomic practice for the needs of the footwear industry. The angle of the foot cannot be an objective measure of lateral platypodia, since it depends on the proportion of the width of the forefoot and heel and their relative distance from each other, which is not necessarily the direct result of the flattening of the lengthwice arch of the foot. In children of preschool age no changes have been noted in respect to the angles of the first and fifth toe. In children of school age there is a clear tendency to worsening of the valgity of the first toe and varus deformity of the fifth toe. The fifth toe is subject to much greater deformity than the first toe, and this deformity begins at a younger age. No obvious differences were discovered between the results for girls and boys. A certain tendency was noted for girls to have somewhat smaller angles of the first and fifth toes, i.e. they have more deformed toes than the boys. Over the last 32 years there has been a marked improvement in both the angle of valgity of the first toe and varus deformity of the fifth toe in children of preschool and school age.

Key words:
malformation of toes, valgity, varus deformity, schools-age children

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