Deformation of the foot with a displacement of the big toe and a protruding bone is one of the most common orthopedic pathologies.Initially, the disease manifests itself as a cosmetic defect and does not cause any particular problems, but if not treated, it progresses with age.The feet quickly tire when walking, pain begins, the problem of choosing shoes arises, and it becomes increasingly difficult to correct the defect even with surgery.So start treatmenthallux valgus (valgus of the foot)is necessary as soon as the first signs of the disease appear.
Causes of hallux valgus
It is a multifactorial disease that develops due to 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 feet
- inflammatory processes (mainly arthritis: psoriatic arthropathy, gout, rheumatoid arthritis)
- congenital biomechanical instability of the legs
- hyperelasticity syndrome, connective tissue dysplasia
- neuropathy of various origins
- deformity of the knee and hip joints
External provoking factors:
- foot and ankle sprains, joint damage and foot bone fractures
- wearing anatomically incorrect high-heeled shoes with narrow toes
- occupational risks: prolonged carrying of heavy objects, prolonged standing
Hereditary predisposition to Hallux valgus in itself is not considered a cause of the development of the disease, but is an increased risk factor that is almost always triggered by negative external factors.
What happens with hallux valgus
Valgus deformity- not only an aesthetic defect that causes women a lot of inconvenience due to the limitations in choosing shoes (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 some time pass into an irreversible stage.What happens to the legs?
- Spreading the foot, changing the anatomical shape, reducing the curve.
- Shifting of the first metatarsal bone and increasing the angle between it and the second metatarsal bone.
- Deviation of the big toe at an angle to the first metatarsal bone, the head of which is in the form of a convex lump (therefore Hallux valgus is often called lumps or lumps).
- Subluxation of the metatarsophalangeal joint, resulting in rotation of the sesamoid bones.
- Violation of biomechanical indicators: reduced indicators of motor and support functions.
- Changes in the bone, cartilage tissue and the whole joint.First of all, the area of the head of the first metatarsal bone suffers: the tissues become more sensitive, the bones become inflamed and painful, bursitis may develop and the cartilage is destroyed.The lumen of the joint space narrows, a focal cyst with local osteoporosis develops.
Hallux valgus symptoms
The disease does not develop in a week or a month;from the beginning of a clearly visible pathology (at stage I, the toe deviates from the normal position by 20-30 °) to the third degree of hallux valgus (the big toe deviates by more than 40 ° and is usually superimposed on the second) can take more than a decade.
External manifestations of the disease:
- Deviation of the big toe to the side (outward from the inner surface of the foot) and prominence of the bone.
- Hammer-shaped foot (the 2nd and 3rd toes are deformed and become hammer-shaped, i.e. they fold at the joints).
- Fatigue in the legs, pain that often worsens in the evening and at night.
Diagnosis
The diagnosis is made on the basis of data obtained during an external examination and an X-ray of the leg.In order to understand the causes of the development of the disease, the orthopedist collects an anamnesis (during the conversation he asks the patient about his profession, hereditary diseases, previous injuries, lifestyle, habits), gives a referral for laboratory tests and consultations 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.
Hallux valgus treatment methods
In the initial stage of the disease (hallux valgus 1 degree), conservative treatment is prescribed: gymnastics, wearing individual orthopedic insoles to prevent flat feet, massage, foot baths and medications.Wearing elastic retainers (first metatarsal head protectors) called valgus splints is also recommended.In case of inflammation, physiotherapeutic treatment is prescribed: magnetotherapy, electrophoresis, paraffin therapy, etc., pain relievers.
The orthopedist, if necessary, will give recommendations for changes in lifestyle and nutrition.For example, many patients have to go on a diet to lose excess weight and not provoke disease.It is also recommended to limit excessive physical activity, often walk barefoot on the ground and small stones, use orthopedic mats, buy safe shoes that do not press the toes, due to which the leg does not bend and the center of gravity of the whole body does not move.
However, all conservative methods can only slow down the course of the disease, but not get rid of it forever.That is why surgical treatment is prescribed in difficult cases.More than 100 different proprietary methods have been developed for the treatment of hallux valgus.All are based on distal angular and proximal osteotomies with reconstruction of the foot to correct the deformity.To perform surgery, the first metatarsophalangeal joint is exposed through a skin incision.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 deviation of the finger, but also lengthen or shorten the bone if there is a 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 for surgical correction of hallux valgus:
- Corrective osteotomy of the first metatarsal bone (chevron, wedge-shaped, SCARF+Akin (with resection and rotation), lapidus arthrodesis.
- Osteotomy with bioresorbable implants.
The final choice of treatment method can be made only after examination and determination of the degree of deformation and individual clinical and X-ray picture.
After a 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, the cartilage is not destroyed and the joint is not deformed.The patient can live a full life, play sports, walk, run, wear comfortable shoes.