Deformation of the foot with displacement of the big toe and the protruding bone is one of the most common orthopedic pathologies.The disease initially appears as a cosmetic defect and does not cause any particular problem, but if not treated, it progresses with age.The feet get tired quickly while walking, the pain starts, the problem of choosing shoes arises and it becomes more and more difficult to correct the defect even with surgery.Therefore, start the treatmenthallux valgus (valgus of the 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 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 legs
- hyperelasticity syndrome, connective tissue dysplasia
- neuropathy of various origins
- deformation of the knee and hip joints
External provoking factors:
- injuries with sprained ligaments of the foot and ankle, joint injuries and fractures of the bones of the foot
- wearing anatomically incorrect high-heeled shoes with narrow toes
- occupational hazards: holding heavy objects for a long time, standing for a long time
Inherited predisposition to Hallux valgus itself is not considered the cause of the development of the disease, but is an increasing risk factor that is almost always triggered under negative external factors.
What happens with hallux valgus?
Valgus deformity- not only an aesthetic defect, which causes women a lot of inconvenience due to limitations in the choice of shoes (the disease is much more common in women than in men).Changes occur in the entire musculoskeletal system of the leg, which gradually progress and after some time enter an irreversible stage.What happens to the leg?
- Spreading the foot, changing the anatomical shape, reducing the flexion.
- Displacement of the first metatarsal bone and an increase in the angle between it and the second metatarsal bone.
- Deviation of the big toe at an angle with the first metatarsal bone, the head of which takes the form of a protruding bump (therefore, Hallux valgus is often called a hump or hump).
- Subluxation of the metatarsophalangeal joint, which leads to rotation of the sesamoid bones.
- Violation of biomechanical indicators: decrease in indicators of motor and support functions.
- Changes in bones, cartilage tissue and the entire 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 hurt, bursitis can develop and the cartilage is destroyed.The lumen of the joint space narrows, focal cystosis develops with local osteoporosis.
Hallux valgus symptoms
The disease does not develop in a week or a month;from the beginning of a clearly visible pathology (in 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 usually overlaps the second) can last more than a decade.
External manifestations of the disease:
- Deviation of the big toe to the side (to the outside from the inner surface of the foot) and the extension of the bone.
- Hammer-shaped foot (the 2nd and 3rd toes are deformed and become hammer-like, that is, they bend at the joint).
- Leg fatigue, pain, which often intensifies in the evening and at night.
Diagnosing
The diagnosis is established on the basis of the data obtained during the external examination and X-ray of the foot.To find out the reasons for 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 reference 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 accompanying diseases are often diagnosed, treatment is prescribed.
Hallux valgus treatment methods
In the initial stage of the disease (grade 1 hallux valgus), conservative treatment is prescribed: gymnastics, individual wearing of 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.For inflammation, physiotherapeutic treatment is prescribed: magnetotherapy, electrophoresis, paraffin therapy, etc., pain relievers.
Orthopedics, if necessary, will give recommendations for changes in lifestyle and nutrition.For example, many patients have to switch to diet food in order to lose excess weight and not provoke diseases.It is also advisable to limit excessive physical activity, often walk barefoot on the ground and small stones, use orthopedic mattresses, buy safe shoes that do not squeeze the toe, 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.Therefore, in difficult cases, surgical treatment is prescribed.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 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 correct functional 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 accompanying pathology.As a result, it is possible to achieve a long compensation phase or completely eliminate the pathology, preserve or restore joint functions.
Basic methods of surgical correction of hallux valgus:
- Corrective osteotomy of the first metatarsal bone (chevron, wedge-shaped, SCARF+Akin (with resection and rotation), Lapidus arthrodesis.
- Osteotomy using bioabsorbable implants.
The final choice of the treatment method can be made only after examination and determination of the degree of deformation and an individual clinical and radiological appearance.
After the corrective osteotomy, the supporting function is restored, pain disappears, corns and calluses do not form, soft tissues do not swell, all components of the deformity are eliminated: the finger returns to its correct anatomical place, the 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.