What is the foot bracket and why is it so important?

Bracket leg or "Genu Varum" is a term used to describe a condition where the knees are wide apart when standing straight and the legs appear bowed. In young children, it is normal for the feet to be slightly arched until about two years of age, as the bones and joints are still growing and forming. But if this condition continues after the normal age of growth or occurs in adults, it can be a sign of a structural or functional problem that needs to be investigated and treated.

The importance of identifying and treating clubfoot is not just because of the appearance of the feet. This angle change in the knee joint causes the pressure of the body weight to be unevenly distributed between the inner and outer parts of the knee. As a result, over time, the cartilage of the inner part of the knee is put under more pressure and the risk of arthritis, chronic pain, and movement limitation increases. Also, changes in the walking pattern may cause pain in the back, hips and even ankles.

Cleft foot can have various causes: from genetic factors and bone growth problems to metabolic diseases such as rickets or childhood injuries. In some people, being overweight or using inappropriate shoes for a long time can also aggravate this condition. Early diagnosis and timely action can prevent the development of deformity and complications.

One of the important points is that a braced leg does not always mean the need for surgery. In many cases, correcting the condition can be done with targeted exercises, using medical insoles and teaching the correct way to stand and walk. In the meantime, physiotherapy plays a key role. A detailed and personalized physiotherapy program can not only improve the appearance of the leg, but also prevent joint problems in the future by strengthening the muscles supporting the knee, improving flexibility and correcting the movement pattern.

In the rest of this article, we will examine all aspects of clubfoot — from the causes and methods of diagnosis to non-surgical treatments, home exercises, and the need for surgery — in simple but scientific language so that you can make the most informed decision for the health of your feet and joints or your loved ones.

Reasons and risk factors of clubfoot

Cleft foot can be the result of a combination of genetic, environmental and structural problems in the musculoskeletal system. Knowing these reasons helps to be able to advance the treatment path in a targeted way and prevent the development of the complication.

• Genetic factors and heredity: genetics play an important role in the formation of the leg structure and the angle of the knee joint. If there is a history of club feet or similar problems such as crossed knees in your family, the probability of this condition occurring in the next generations is higher.
• Normal growth in childhood: In infants and young children, clubfoot is a normal stage of development. Usually, by the age of 18 to 24 months, the legs gradually become straighter. But if this condition continues after 2 to 3 years old or its intensity increases, it needs a specialized evaluation.
• Metabolic and nutritional diseases: lack of vitamin D and calcium can cause soft bones (rickets), which is one of the common causes of club feet in children. This deficiency causes the structural weakness of the bones and makes them susceptible to deformation.
Joint and bone problems: Diseases such as early arthritis, ligament injuries or fractures around the knee can cause or aggravate clubfoot by changing the pressure and balance on the joint. In some cases, Blount's disease (Blount's disease), which is a developmental disorder of the leg bone, is involved.
• Mechanical factors and lifestyle: overweight puts more pressure on the knee joints and can change the angle of the leg. Also, continuous use of inappropriate shoes, sports activities with a lot of pressure on the knee or standing for a long time on hard surfaces can aggravate the problem.
• Weakness of the supporting muscles: Weakness in the thigh, hip and leg muscles makes the knee joint unable to withstand daily pressures well, and this muscle imbalance can eventually change the shape of the leg.

Understanding these factors helps the physiotherapist to adjust the treatment plan based on the root cause of the problem. For example, if the clubfoot is caused by muscle weakness, treatment will focus on strengthening the muscles. If the main cause is metabolic disease, medical intervention and nutritional modification are also necessary.

Symptoms and symptoms of bracket leg

In addition to the special appearance of the legs, the bracket foot brings a set of symptoms and functional problems, which are necessary to know for timely diagnosis and effective treatment. In this position, there is a considerable distance between the knees when standing with the legs together, even when the ankles are together. This distance is the main sign and characteristic of the parenthesis foot, but the story does not end here.

• Change in the appearance of the legs and knees. The most obvious symptom is the outward curvature of the leg, starting from the knee. This curvature is usually seen in both legs, but may be more severe in one leg. In severe cases, the change in shape causes disturbance in the person's walking and movement pattern.
2. Pain and pressure in the knee joint over time, due to the unbalanced distribution of body weight, more pressure is placed on the inner part of the knee joint. This continuous pressure can cause chronic pain, inflammation and even premature arthritis in this area. 3. Early leg fatigue People with clubfoot usually experience rapid leg and knee fatigue during long walks or physical activities. The reason for this is the excessive use of some muscle groups to compensate for the deviation. 4. Balance and walking problems Deviation of the legs can change the body's center of gravity and cause abnormal walking or limping. In children, this problem may appear as a delay in starting to walk or unwillingness to run and active games. 5. Local sensitivity and swelling In advanced cases or when mechanical pressure is high, the inner part of the knee or leg may be sensitive to touch, red or swollen.
• Secondary problems in the back and pelvis due to changes in the movement pattern, extra pressure is transferred to the hip joints and spine and can cause or aggravate back pain or hip pain.

It is very important to pay attention to these symptoms, because in the early stages, the braced foot responds more easily and quickly to non-surgical treatments, especially physical therapy. If these signs are ignored, the risk of developing deformity and long-term complications increases.

Methods for diagnosing bracket foot

Accurate diagnosis of clubfoot, especially to determine its severity and cause, is the key to choosing the best treatment plan. Sometimes this condition is seen in children in a natural and temporary way and it is corrected by itself, but in some cases, the underlying causes or the severity of the deformity require specialized intervention. In the following, we will review the steps and common methods of diagnosis:

• Primary clinical examination: a doctor or physiotherapist can detect the presence of deviation by observing the position of the legs when standing, walking and sitting. Measuring the distance between the knees (Intercondylar Distance) while the ankles are stuck together is one of the simplest and most practical tests. In adults, a distance of more than a few centimeters can be a sign of deformity.
• Evaluation of medical history: The doctor reviews the patient's history to determine possible factors such as rickets, old injuries, joint diseases or hereditary background. In children, it is also important to ask about the time of the start of walking and movement patterns.
Gait Analysis: By carefully observing the gait, it is possible to evaluate the degree of deviation, its effect on other joints, and the movement compensations of the body. This method helps to design a more accurate physiotherapy correction program.
• Medical Imaging: Radiography (X-ray): provides a clear image of the leg and knee bones and determines the angle of deviation. It is also useful for diagnosing bone problems such as arthritis, old fractures or changes due to metabolic diseases. MRI: may be requested if ligament or soft tissue damage is suspected. Bone density scan (DEXA): in cases of suspected osteoporosis or structural weakness.
Functional tests of muscles and joints: the physiotherapist may evaluate the strength of the muscles around the knee, hip and wrist by performing stretching and resistance movements. Muscle weakness or imbalance can play a role in creating or aggravating clubfoot.
• Evaluation of underlying diseases: Sometimes, clubfoot is a symptom of systemic diseases such as rheumatoid arthritis or metabolic disorders. In these cases, it is necessary to perform a blood test or refer to the relevant specialist.

Correct diagnosis not only prevents unnecessary treatments, but also prevents the progression of deformity and determines the optimal treatment path. In many cases, the combination of clinical examination and simple imaging can provide enough information to start treatment.

Physiotherapy's role in correcting the brace foot

Physiotherapy is one of the most effective and safest ways to improve clubfoot, especially in early stages and mild to moderate cases. The main goal of this approach is to correct the movement pattern, strengthen the supporting muscles and prevent the progression of deformity. Unlike surgical methods that are invasive and have a long recovery period, physical therapy is a non-surgical and low-risk method that can make significant changes with a regular and scientific program.

• Targeted strengthening exercises in the bracket leg, usually certain muscles such as the inner thigh muscles (Vastus Medialis) and hip muscles become weaker. The physiotherapist corrects this weakness with resistance exercises such as corrective squats, glute bridge, and exercises with sports bands. Strengthening the stabilizing muscles of the knee and hip reduces the pressure on the joint and improves the alignment of the legs.
2. Stretching exercises and release of soft tissue shortening or excessive stiffness in structures such as the iliotibial band (IT band) or hamstring muscles can exacerbate the deformity. Stretching techniques and deep tissue massage (Deep Tissue Massage) help to release these areas and increase flexibility. 3. Correcting the walking pattern and daily movements of the physiotherapist with Gait Analysis and teaching correct walking techniques will reduce inappropriate pressure on the knee. Also, the movements of sitting, standing up and lifting objects are taught to the patient in a modified form. 4. Use of auxiliary devices and orthosis In some cases, corrective shoes or medical insoles (orthotic insoles) are prescribed in order to evenly distribute the forces and correct the angle of the foot. These tools create better results along with therapeutic exercises. 5. Balance and proprioception exercises can disrupt balance and motor coordination. Exercises such as standing on one leg, working with a balance board or soft balls improve joint proprioception and motor control.
• Prevention of secondary injuries by modifying forces and movement patterns, physiotherapy reduces the risk of knee arthritis, hip and back pain in the long term.

Physiotherapy is not only effective for children and adolescents with active growth, but also in adults it can reduce symptoms and slow or stop the progression of deformity. The key to success is consistency in doing exercises and specialized supervision.

Home exercises for braces

Doing corrective exercises at home is one of the most effective and least expensive ways to help improve your clubfoot. These exercises, if performed regularly and correctly, can help improve movement patterns, increase flexibility, and strengthen key muscles. However, before starting, it is necessary to select the movements with the opinion of the physiotherapist and teach them their correct technique to avoid injury.

1. Corrective Squat

• Open your feet shoulder-width apart, with the tips of your toes facing forward.
• When lowering, keep the knees in line with the toes and do not allow them to move outward too much.
• 10 to 15 repetitions, 2 to 3 sets per day.

2. Glute Bridge

• Lie on your back, knees bent and feet on the floor.
• Raise the pelvis slowly so that the body forms a straight line from shoulder to knee.
• Hold for 10 seconds and then lower.
• 10 to 12 repetitions, 2 sets.

3. Iliotibial Band Stretch (IT Band Stretch)

• Stand next to the wall, put the problem foot behind the other foot.
• Bend the body towards the wall to feel the stretch in the outer part of the thigh.
• Hold for 20 to 30 seconds, repeat 2 to 3 times.

4. Resistance Band Side Walk

• Tie the sports band above the knees or around the wrists.
• In a half-squat position, step to the side.
• 10 steps to each side, 2 sets.

5. Single Leg Balance

• Stand on one leg and try to keep your balance.
• You can increase the challenge by closing your eyes or standing on a soft surface.
• 30 seconds, 3 times for each leg.

Important points:

• Do the exercises slowly and with control.
• If you experience abnormal pain or swelling during exercise, stop exercising and consult a physical therapist.
• For better results, do the exercises 4 to 5 days a week.

Home exercises are most effective when they are done along with a specialized physiotherapy program. The goal is to strengthen the stabilizing muscles and correct the movement pattern, not just temporarily relieve symptoms.

When does a braced leg need surgery?

Treatment of clubfoot in many cases can be managed with non-surgical methods such as physical therapy, corrective exercises and lifestyle changes. But in some situations, foot deviation is so severe or progressive that only surgical intervention can improve the condition. Diagnosing the need for surgery should be done based on detailed orthopedic examination, imaging and functional evaluation. Cases in which surgery is usually recommended:

1. Severe and fixed deviation: when the angle of deviation of the foot is much higher than normal and is not corrected by training or braces.
2. Rapid progression of deformity: If the deformity worsens in a short period of time and increases the risk of abnormal pressure on the knee and wrist joints.
3. Persistent pain and functional impairment: when pain limits daily activities such as walking or exercise and conservative treatments have been ineffective.
4. Secondary damage to the joints: constant pressure of the braced leg can lead to early knee or wrist arthritis. In this case, surgery is necessary to prevent further destruction of the joint.
5. Cosmetic reasons in severe cases: In some patients, the appearance of the leg has a negative effect on self-confidence, and surgery is performed with the aim of correcting the appearance.

Types of common leg surgeries:

• Osteotomy: Cutting and changing the angle of the bone to place the foot in the correct alignment.
• Osteotomy with fixation: use of screws, plates or rods to hold the bone in the corrected position.
• Knee axis correction surgery: in cases where the deviation has caused a lot of pressure on the knee joint.

Convalescence period and the role of physiotherapy after brace foot surgery:

After surgery, physiotherapy plays a key role in returning foot function. Specialized exercises help to reduce swelling, restore range of motion, strengthen muscles and prevent the return of the deviation. Usually, the rehabilitation program lasts a few weeks to a few months and includes a combination of stretching, strength, balance and proper walking training.

In short, brace foot surgery is a specialized decision that is performed only in special circumstances and after trying non-surgical methods. The choice of the best method depends on the severity of the deviation, age, general health status and the goals of the patient.

Last word

Although in many cases, clubfoot seems like a simple problem, ignoring it can have long-term consequences such as knee pain, early arthritis, and impaired walking patterns. Knowing the causes and risk factors, timely diagnosis and choosing the appropriate treatment method is the key to prevent these complications.

Frequently asked questions about the brace leg and the role of physiotherapy in it

1. Does clubfoot in children correct itself?

In many children under 2 years of age, clubfoot is a natural development process and gradually corrects as they grow older. But if the deviation continues or worsens after the age of 3, it should be checked by a doctor or physiotherapist.

2. When is the best age to start treatment for club feet?

The earlier the treatment is started, the better the chance of improvement. In children and adolescents, corrective exercises and aids work much more effectively. Physiotherapy can also prevent the development of problems and complications in adults.

3. Can exercise correct the leg brace?

Yes, targeted strengthening and stretching exercises designed by a physical therapist can be effective in correcting or reducing the deviation. Unplanned sports or wrong exercises may worsen the condition.

4. How effective are medical shoes or insoles?

Insoles and medical shoes balance the pressure on the knee and ankle and reduce pain. But alone, they usually do not correct the structural problem and must be used in conjunction with a physical therapy program.

5. When do we need surgery?

If clubfoot is severe, causes chronic pain, or causes premature damage to the knee joint, surgery (corrective osteotomy) may be the solution. Physiotherapy before and after the operation is necessary for the success of the treatment.

6. Is leg brace surgery only cosmetic?

No. This problem can cause a change in pressure in the joints, knee pain, early arthritis and walking disorder.

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