Static foot deformities are degenerative diseases of the skeleton that seriously impair its supporting functions.Normally, the load is not evenly distributed over the entire area of the sole, but is located along the main points and axes - from the tubercle of the heel along the outer edge to the toes.This structure ensures the formation of the arch of the foot - a group of bone formations and soft tissues that have absorbent properties.
Therefore, damage to this formation leads to the development of a fairly common disease - flat feet.When mentioned, people usually imagine a longitudinal variant of the pathology, which causes the arch of the foot to fall 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 appears mainly in mature and elderly women, it is often an acquired condition.It is associated with wearing uncomfortable or ill-fitting shoes, which over time contribute to the displacement of the bones of the front part of the foot.The result of hallux valgus is persistent 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 from the median axis.In this case, bending can also occur at the joint - then the direction of the angle between the bones is assessed.The development of transverse flat feet corresponds precisely to this mechanism, eventually leading 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:
- The first and main symptom is the curvature of the first metatarsophalangeal joint with the formation of an open angle from the outside.The formation of pathology occurs gradually, but progresses irreversibly.In the later stages of the disease, the deformity of the big toe reaches such severity that the angle at the joint becomes almost 90 degrees.
- Another important sign is the formation of a characteristic "bone" located on the inner edge of the foot, where normally the head of the metatarsal bone protrudes slightly.Its appearance is associated with a compensatory deviation of this bone inward under the force of gravity.
- The last manifestation is a hammer-shaped curvature of the second finger, 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 of the foot, discomfort in walking, the appearance of dense corns on the sole under the middle toes.
Mechanism of formation
Like other degenerative diseases of the skeleton, transverse flatfoot goes through two stages in its development.In the first stage, only functional changes occur in the soft tissues, leading to a decrease in their supporting and elastic properties.And in the second stage, deformations of the joints or bones themselves have already formed:
- The precipitating factor is always improper loading of the forefoot due to wearing ill-fitting shoes - especially those with narrow toes and heels.
- This leads to chronic soft tissue damage - the ligaments and muscles that hold the base of the toes and metatarsals in an elevated position.
- Repeated trauma causes the forefoot to gradually collapse, 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 normally experiences maximum load, and therefore the force of pathological pressure on it is maximum.Its capsule gradually stretches, causing 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 progress of hallux valgus is associated precisely with 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 injury leads to the development of deforming arthrosis of the first metatarsophalangeal joint, which causes a loss of functional abilities of the joint.
Further help tactics depend on the severity of the changes - in the early stages, conservative measures are sufficient, and already in advanced cases, only surgery will eliminate the persistent deformity.
Conservative treatment
Valgus deformity of the big toes can be eliminated using traditional methods only if the functionality of the joint is fully preserved.This is explained by the condition of the ligaments and muscles, whose damage at an early stage is reversible.In this case, assistance is provided in three successive stages:
- 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 using various orthopedic tools.Usually this period lasts at least 6 months, necessary for the adaptation of soft tissues.
- In the second phase, the active phase begins, which includes special training techniques to strengthen the leg muscles.To achieve this, physical therapy courses, massage sessions and physiotherapy procedures are combined simultaneously.
- The last period is indefinite, since hallux valgus is an incurable disease.Therefore, the patient consolidates the results of the treatment for the rest of his life and is engaged in preventing the progression of the disease.
The choice of tools and methods for therapy is completely individual - taking into account the age of the patient, accompanying diseases, as well as the characteristics of the curvature itself.
Passive procedures
The first stage of treatment is the most difficult for the patient, since the fixation of the leg rarely occurs without the patient noticing.The restoration of the normal anatomical structure of the arch of the foot is much more difficult and more visible than the development of pathology.For these purposes, the following tools are used in orthopedics:
- The standard to start helping is to completely get rid of shoes or boots that have a narrow toe box.Now the patient should only use loose, wide or open-toed shoes.Individual tailoring of orthopedic boots is considered ideal, but it is extremely rare that patients can afford such a luxury.
- For small deformities, a special bandage made of adhesive plaster is used, which is applied to the back of the leg.It is fixed in such a way that during walking the external and internal deviation of the metatarsal bones is excluded.
- 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 stiffness of which is chosen depending on the degree of deformation.
The wearing of support devices should be almost constant - during the first month it is recommended to remove them no more than 2 hours during the day.
Active procedures
The transition to the second stage is determined individually - after the doctor has evaluated 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 introduced gradually to prepare the joints and surrounding soft tissues for the upcoming load.Warm-up and distraction procedures are done, which can be used on foot.They include lasers, magnets, paraffin or ozokerite applications, ultrasound therapy.
- After a few days, massage sessions are added, which begin with the surface heating of the tissues.Gradually, the specialist should switch to warming up the actual leg muscles, which play an important role in eliminating curvature.
- When the unpleasant symptoms completely disappear, the patient moves on to independent physical exercises.It is not recommended to include many exercises in the program at the same time, so as not to cause muscle fatigue.It is better to gradually increase the load, allowing the soft tissues to adapt to the work being done.
To achieve the full effect, the listed activities must be performed every day to prevent the return of pathological processes.
Surgical treatment
Indications for surgery must always be justified, as long-term rehabilitation is required after their performance.Therefore, they are not performed on patients in the early stages of hallux valgus, in whom the curvature of the toe can be corrected naturally.Surgical intervention is required only in case of irreversible changes in the joint or surrounding tissues:
- When there are signs of transverse flatfoot fixation - that is, the front arch of the foot is deformed both during load tests and in the resting position.This conclusion comes after an X-ray examination that evaluates the location of the heads of the metatarsal bones.
- With pronounced curvature in the first metatarsophalangeal joint, accompanied by continuous dislocation between the bones that form it.The absolute indicator in this case is an additional curvature of the adjacent joint, which leads to a change in the position of the second finger.
- Even with initial signs of arthrosis in the first metatarsophalangeal joint, which indicates irreversible damage to the surrounding soft tissues.Muscles and ligaments are firmly fixed in a vicious position, so it will not be possible to carry out 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.
Ligament operations
This surgical treatment option is more suitable for those patients who do not yet have signs of direct damage to the joint tissues.Therefore, the main mechanism of deformation in them becomes the pathological pulling of the muscles 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 (movement) of tendons attached to the first metatarsal bone.It is the pathological contraction of the muscle that leads to a gradual increase in the deviation between it and the phalanx of the finger.Therefore, the ligament is removed or partially separated and attached to a new place - in the area of the outer edge of the metatarsal bone.Changing the point of application of 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 with "soft" deformation, when the displaced bones can easily return to their original place.
According to the results of observations, all operations on ligaments are still temporary in nature - without correction of pathological factors, displaced tendons quickly stretch again.
Joint operations
If there is pronounced curvature in the joints, orthopedic interventions are required to eliminate bone tissue defects.To do this, resections are performed - the 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 for eliminating the deformity is the Schede-Brandes osteotomy.This intervention includes two manipulations - the removal of the pathological growth on the first metatarsal bone (bones) and the resection of a triangular fragment at its base.After fusion of the bone tissue, the deformed finger returns to its normal position.
- Less commonly used are operations in which resection of both areas is performed in the area of the metatarsal head.Due to the massive damage, the risk of developing complications that will not allow the fragments to heal properly is very high.
- In advanced cases of the disease, palliative forms of intervention are performed - not the restoration of mobility, but the elimination of pathological displacement.For this purpose, arthrodesis is performed - removal and closure of 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 tendon, which eliminates improper muscle retraction.
Combined operations
Performing complex manipulations is a priority in modern orthopedics, which leads to an increase in the frequency of combined interventions.Typically, a combination of gentle bone resection and displacement of one of the ligaments that moves the thumb is performed:
- The modified Schede-Brandes operation involves the removal of standard sections of the metatarsal bone - resection in the area of the head and base.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.Moreover, in one operation it is possible not only to return the metatarsal bone to its original place, but to give the remaining structures the correct position.
- In severe cases, interventions are combined to simultaneously eliminate deformities in the first and second metatarsophalangeal joints.
This type of operation is characterized by greater severity - a large volume of destruction requires a long recovery and increases the rehabilitation period.
recovery
The end of conservative and surgical treatment is the beginning of the recovery period, which continues in such patients throughout their lives.Without following special recommendations, the disease can return, reminding itself again with unpleasant symptoms:
- First of all, all patients must wear special orthopedic insoles with additional Seitz support.They will not only ensure the correct position of the foot while walking, but will create additional support for its arches.
- You should also pay attention to your shoes - completely exclude from your wardrobe any boots or shoes with a narrow front.
- You should take care of your weight - maintaining a normal body weight significantly reduces the load on the arches of your feet.
- Regular daily preventive exercises keep the muscles in normal tone, which prevents displacement of the metatarsal bones.
The main difficulties for patients arise with the physical therapy program, since the last 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.