Deformity of the big toe: treatment

Static deformities of the foot are degenerative diseases of the skeleton that seriously disrupt its supporting functions.Usually, the load is not evenly distributed over the entire area of the sole, but is located along the main points and axes - from the heel to the heel along the outer edge to the toes.This structure provides the formation of the arch of the foot - a set of bone formations and soft tissues that has shock-absorbing properties.

Accordingly, damage to this formation leads to the development of a fairly common disease - flat feet.When it is mentioned, people usually imagine a longitudinal variant of the pathology, which causes the arch of the foot to drop along the inner edge.But the transverse form of the disease, which is accompanied by a characteristic curvature of the big toe, also refers to flat feet.

This type of pathology occurs mainly in mature and elderly women, and is often an acquired condition.It is associated with wearing uncomfortable or ill-fitting shoes, which over time contributes to misalignment of the bones in the forefoot.The result of hallux valgus is constant unpleasant symptoms that accompany a person both when wearing familiar shoes and when walking normally.

Concept

In orthopedics, valgus deformity is the deviation of any segment of the musculoskeletal system outward from the median axis.In this case, distortion in the joints can also occur - then the direction of the angle between the bones is assessed.The development of transverse flat feet corresponds precisely to this mechanism, which ultimately leads to irreversible damage to the metatarsophalangeal joint of the first toe.

Although this condition often develops over decades, patients seek help in the later stages.Therefore, it is necessary to indicate the characteristic features inherent in hallux valgus:

1. The first and main symptom is the distortion of the first metatarsophalangeal joint with the formation of an angle open to the outside.The formation of pathology occurs gradually, but progresses irreversibly.In the later stages of the disease, the deformity of the thumb reaches such severity that the angle in the joint becomes almost 90 degrees.
2. The next important sign is the formation of a characteristic "coke", located on the inner edge of the foot, where the head of the metatarsal bone usually protrudes slightly.Its appearance is associated with a compensatory deviation of this bone inward under the force of gravity.
3. The last manifestation is a hammertoe deformity of the second toe, also caused by pathological pressure from the adjacent joint and surrounding soft tissues.

Hallux valgus is characterized by the appearance of additional (non-permanent) signs - pain in the front part of the foot, gait disturbance, the appearance of thick calluses on the foot under the middle toes.

Mechanism of formation

Like other degenerative diseases of the skeleton, transverse flatfoot goes through two stages in its development.At the first stage, only functional changes occur in soft tissues, leading to a decrease in their supporting and elastic properties.And at the second stage, deformations of the joints or bones themselves are already formed:

• The trigger is always improper loading of the forefoot due to wearing ill-fitting shoes - especially those with narrow toes and heels.
• This leads to chronic damage to the soft tissues - the ligaments and muscles that hold the base of the toes and metatarsal bones in an elevated position.
• Repetitive trauma leads to a gradual drop in the forefoot, after which the maximum load begins to fall on the midfoot.
• In this case, there is a deviation of the peripheral metatarsal bones in opposite directions.
• The first metatarsophalangeal joint usually experiences the maximum load, and therefore the force of pathological pressure on it is maximum.Its capsule gradually stretches, leading to further inward displacement of the metatarsal bone.
• The stability of the joint decreases, which leads to the formation of subluxation of the phalanx of the first finger.The progression of hallux valgus is precisely related to the continuous and slow progress of this process.
• Deformed soft tissues - ligaments and muscles - are fixed in this position over time, which explains the irreversibility of the curvature.
• Chronic damage leads to the development of deforming arthrosis of the first metatarsophalangeal joint, which leads to the loss of the functional capabilities of the joint.

Further help tactics depend on the severity of the changes - in the early stages, conservative measures are sufficient, and in advanced cases, only surgery will remove the persistent deformity.

Conservative treatment

Valgus deformity of the big toes can be eliminated with traditional methods only if the functionality of the joint is fully preserved.This is explained by the condition of the ligaments and muscles, the damage of which is reversible at an early stage.In this case, the aid is provided in three successive stages:

1. First, the patient is prescribed passive treatment methods, which include fixing the finger in the correct position.The joint is artificially returned to its normal configuration, which is carried out with the help of various orthopedic devices.Usually this period takes at least 6 months, necessary for soft tissue adaptation.
2. In the second stage, the active phase begins, which includes special training techniques to strengthen the foot muscles.To achieve this, physiotherapy courses, massage sessions and physiotherapy procedures are combined at the same time.
3. The final period is indefinite, since hallux valgus is an incurable disease.Therefore, the patient consolidates the results of the treatment until the end of his life and is concerned with preventing the progression of the disease.

The choice of means and methods of therapy is completely individual - the age of the patient, concomitant diseases, as well as the characteristics of the curvature itself are taken into account.

Passive procedures

The first stage of treatment is the most difficult for the patient, because the fixation of the leg rarely happens unnoticed by the patient.Restoring the normal anatomical structure of the arch of the foot is much more difficult and noticeable than the development of pathology.For these purposes, the following means are used in orthopedics:

• The standard for starting help is to completely get rid of shoes or boots that have a narrow toe box.Now the patient should wear only loose shoes, wide or open in front.Individual tailoring of orthopedic boots is considered ideal, but extremely rarely patients can afford such a luxury.
• In case of slight deformities, a special plaster bandage is used, which is applied to the back of the leg.It is fixed in such a way that external and internal deviation of the metatarsal bones is excluded when walking.
• A more convenient and reliable option is orthopedic fixation of the leg - the treatment in this case is much more effective.For this purpose, different types of orthoses or bandages are used, the hardness of which is chosen depending on the degree of deformation.

Wearing support devices should be almost constant - during the first month it is recommended to remove them for no more than 2 hours during the day.

Active procedures

The transition to the second stage is determined individually - after a doctor's assessment of the symptoms, as well as an X-ray examination.The lack of progression of the disease, as well as at least a slight positive dynamic, allows us to start an active fight against the deformity.The following methods are used for this:

• First, physical therapy procedures are gradually introduced to prepare the joint and surrounding soft tissues for the upcoming load.There are warming and dissipating treatments that can be used on the foot.These include laser, magnet, applications with paraffin or ozokerite, ultrasound therapy.
• After a few days, massage sessions are added, which begin with surface heating of the tissues.Gradually, the specialist should move on to warming up the actual muscles of the foot, which play an important role in eliminating the curvature.
• When the unpleasant symptoms disappear completely, the patient switches to independent physical exercises.It is not recommended to include many exercises at once in the program, so as not to cause muscle fatigue.It is better to increase the load gradually, allowing the soft tissues to adapt to the work being done.

To achieve a full effect, the listed activities must be carried out daily to prevent the return of pathological processes.

Surgical treatment

Indications for surgery must always be justified, as long-term rehabilitation is necessary after their operation.Therefore, they are not performed on patients in the early stages of hallux valgus, where the curvature of the toe can be corrected naturally.Surgical intervention is necessary only in case of irreversible changes in the joint or surrounding tissues:

1. When there are signs of fixed transverse flatfoot - ie.the forefoot arch deforms both during stress testing and at rest.This conclusion appears after an X-ray study evaluating the location of the metatarsal heads.
2. With pronounced curvature in the first metatarsophalangeal joint, accompanied by persistent dislocation between the bones forming it.The absolute indication in this case is additional distortion of the adjacent joint, which leads to a change in the position of the second finger.
3. Even with initial signs of arthrosis in the first metatarsophalangeal joint, which indicates irreversible damage to the surrounding soft tissues.The muscles and ligaments are firmly fixed in a vicious position, so it will not be possible to make a correction in a conservative way.

The choice of intervention method depends entirely on the individual characteristics of the course of the disease - it is usually performed on the most affected component of the arch of the foot.

Link operations

This option of surgical treatment is more suitable for those patients who do not yet have signs of direct damage to the joint tissues.Therefore, the leading mechanism of deformation in them becomes the pathological muscle adhesion associated with a change in the position of the arch of the foot.To correct it, the following intervention options are used:

• The first type of operations includes all forms of transposition (shifting) of the tendons attached to the first metatarsal bone.This is the pathological contraction of the muscles, which leads to a gradual increase in the deviation between it and the phalanx of the finger.Therefore, the ligament is removed or partially split and fixed in a new place - in the area of the outer edge of the metatarsal bone.Changing the point of application of the muscle force allows you to gradually return it to its original place.
• The second type of operation involves the creation of various types of connections - the creation of an artificial transverse arch of the foot.All metatarsal bones are fixed in the correct position, after which a part of another ligament or a synthetic prosthesis is sewn to them.But this option is possible only in "slight" deformity, when the displaced bones can be easily returned to their original place.

According to the results of the observations, all operations on the ligaments are still temporary in nature - without correction of the pathological factors, the displaced tendons are quickly stretched again.

Joint operations

If there is a significant curvature in the joint, orthopedic interventions are needed to remove bone tissue defects.To do this, resections are performed - removal of certain areas of the affected bone.This method makes it possible to artificially return the joint to its normal position.The following options are currently used for such operations:

• The main method of eliminating the deformity is the Schede-Brandes osteotomy.This intervention includes two manipulations - removal of the pathological growth of the first metatarsal bone (ossicles) and resection of a triangular fragment at its base.After the fusion of the bone tissue, the deformed finger returns to its normal position.
• Operations in which both areas are resected in the area of the metatarsal head are less commonly used.Due to massive damage, the risk of developing complications that will not allow the fragments to heal properly is too high.
• In advanced cases of the disease, palliative forms of interventions are performed - not restoring mobility, but removing pathological displacement.For this purpose, arthrodesis is performed - cutting and closing the joint cavity between the metatarsal bone and the phalanx.

Nowadays, these interventions are rarely performed in isolation - they are usually combined with simultaneous plastic surgery of the tendons, which eliminates improper muscle traction.

Combined operations

Performing complex manipulations is a priority in modern orthopedics, which leads to an increase in the frequency of combined interventions.A combination of gentle bone resection and repositioning of one of the ligaments that moves the thumb is usually performed:

• The modified Schede-Brandes operation involves removal of standard sections of the metatarsal bone - head and base resection.In addition, the abductor pollicis muscle is transposed on its outer surface, the pressure of which leads to subluxation in the joint.
• It is also possible to perform an osteotomy in combination with the formation of an artificial arch.In addition, with one operation it is possible not only to return the metatarsal bone to its original place, but also to give the correct position to the other structures.
• In severe cases, interventions are combined to simultaneously remove deformities in the first and second metatarsophalangeal joints.

This type of operation is characterized by the greatest severity - a large volume of destruction requires long healing and increases the rehabilitation period.

Recovery

Completion of conservative and surgical treatment is the beginning of the recovery period, which in such patients lasts until the end of their lives.Without following special recommendations, the disease can return, reminding itself again with unpleasant symptoms:

1. First of all, all patients are required to wear special orthopedic insoles with additional Seitz supports.They will not only ensure the correct position of the foot when walking, but will create additional support for its arches.
2. You should also pay attention to your shoes - completely exclude boots or shoes with a narrow front from your wardrobe.
3. You should take care of your own weight - maintaining a normal body weight significantly reduces the load on the arches of the feet.
4. Regularly performing preventive daily exercises keeps the muscles in normal tone, which prevents displacement of the metatarsal bones.

The main difficulties for patients arise with the physical therapy program because most recent patients do not even know the exercise technique.Therefore, to perform them correctly, you must first study with an instructor in individual or group form.