Foot deformity with displacement of the big toe and protuberant bone is one of the most common orthopedic pathologies.At first, the disease manifests itself as a cosmetic defect and does not cause any special problems, but if left untreated, it progresses with age.The legs quickly get tired when walking, pain begins, the problem of choosing shoes arises, and correcting the defect becomes more and more difficult even with surgery.Therefore, start treatment.hallux valgus (valgus foot)necessary as soon as the first signs of the disease appear.
Causes of hallux valgus
This is a multifactorial disease that develops due to a hereditary predisposition, other diseases of the musculoskeletal system, neurological pathologies and metabolic disorders, and external factors.
Internal reasons:
- hereditary predisposition to hallux valgus
- transverse and longitudinal flat foot
- inflammatory processes (mainly arthritis: psoriatic arthropathy, gout, rheumatoid arthritis)
- congenital biomechanical instability of the feet
- hyperelasticity syndrome, connective tissue dysplasia
- neuropathy of various origins
- deformation of the knee and hip joints.
External provoking factors:
- Injuries with sprains of the foot and ankle ligaments, joint damage and fractures of the bones of the foot.
- wearing anatomically incorrect high-heeled shoes with narrow toes
- Occupational hazards: prolonged transportation of heavy objects, prolonged standing.
The hereditary predisposition to hallux valgus alone is not considered the cause of the development of the disease, but it is an increased risk factor that is almost always triggered by negative external factors.
What happens with hallux valgus?
Valgus deformity- not just an aesthetic defect, which causes a lot of inconvenience to women due to restrictions in the choice of footwear (the disease is much more common in women than in men).Changes occur in the entire musculoskeletal system of the foot, which gradually progress and after a while enter an irreversible stage.What's wrong with your foot?
- Extending the foot, changing the anatomical shape, reducing flexion.
- Displacement of the first metatarsal bone and increase in the angle between it and the second metatarsal bone.
- Deviation of the big toe at an angle relative to the first metatarsal bone, the head of which takes the shape of a protruding lump (hence hallux valgus is often called lumps or bunions).
- Subluxation of the metatarsophalangeal joint, leading to rotation of the sesamoid bones.
- Violation of biomechanical indicators: decrease in indicators of motor and support functions.
- Changes in bone, cartilage and throughout the joint tissue.First of all, the head area of the first metatarsal suffers: the tissues become more sensitive, the bones become inflamed and painful, bursitis can develop, and the cartilage is destroyed.The lumen of the joint space narrows, focal cystosis with local osteoporosis develops.
Symptoms of hallux valgus
The disease does not develop in a week or a month;From the onset of clearly visible pathology (in stage I, the toe deviates from the normal position by 20 to 30°) to the third degree of hallux valgus (the big toe deviates by more than 40° and usually overlaps the second) more than a decade can pass.
External manifestations of the disease:
- Deviation of the big toe to one side (outward from the inner surface of the foot) and protrusion of the bone.
- Hammer-shaped foot (the second and third toes are deformed and acquire the shape of a hammer, that is, they bend at the joints).
- Leg fatigue, pain, which often intensifies in the afternoon and evening.
Diagnosis
The diagnosis is made based on the data obtained during an external examination and an x-ray of the foot.To find out the reasons for the development of the disease, the orthopedist collects a history (during the conversation, he asks the patient about his occupation, hereditary diseases, previous injuries, lifestyle, habits), refers him for laboratory tests and consults with other specialists.The fact is that hallux valgus can be caused by autoimmune and systemic diseases (for example, rheumatoid arthritis), metabolic disorders, and neurological disorders.After an examination, during which concomitant diseases are often diagnosed, treatment is prescribed.
Treatment methods for hallux valgus.
At the initial stage of the disease (hallux valgus grade 1), conservative treatment is prescribed: gymnastics, use of individual orthopedic insoles to prevent flat feet, massage, foot baths and medications.It is also recommended to use elastic fixators (protectors of the head of the first metatarsal bone), which are called valgus splints.Physiotherapeutic treatment is prescribed for inflammation: magnetotherapy, electrophoresis, paraffin, etc., analgesics.
The orthopedist, if necessary, will give recommendations on changes in lifestyle and nutrition.For example, many patients need to switch to diet foods to lose weight and not cause illness.It is also advisable to limit excessive physical activity, frequently walk barefoot on the ground and small stones, use orthopedic mats, buy safe shoes that do not squeeze the toe, so the leg does not bend and the center of gravity of the entire body does not move.
However, all conservative methods can only slow down the course of the disease, but not eliminate it forever.Therefore, in difficult cases, surgical treatment is prescribed.More than 100 different patented methods have been developed for the treatment of hallux valgus.All are based on distal and proximal angular osteotomies with reconstruction of the foot to correct the deformity.To perform the surgery, the first metatarsophalangeal joint is exposed through an incision in the skin.The surgeon then cuts the bone and places it in the functionally correct position.With the help of osteotomy, you can not only correct the deformity due to the deviation of the finger, but also lengthen or shorten the bone if there is concomitant pathology.As a result, it is possible to achieve a long stage of compensation or completely eliminate the pathology, maintain or restore the functions of the joint.
Basic methods of surgical correction of hallux valgus:
- Corrective osteotomy of the first metatarsal (chevron, wedge-shaped, SCARF+Akin (with resection and rotation), Lapidus arthrodesis.
- Osteotomy using bioabsorbable implants.
The final choice of the treatment method can only be made after examination and determination of the degree of deformation and the individual clinical and radiological picture.
After corrective osteotomy, the supporting function is restored, pain disappears, calluses and calluses do not form, soft tissues do not swell, all components of deformation are eliminated: the finger returns to its anatomically correct place, cartilage is not destroyed, and the joint is not deformed.The patient can live a full life, play sports, walk, run and wear comfortable shoes.