Big toe deformity: treatment

Static foot deformities are degenerative diseases of the skeleton that severely impair its supporting functions.Normally, the load is not distributed evenly over the entire surface of the sole, but runs along the main points and axes - from the heel bump along the outer edge to the toes.This structure ensures the formation of the arch of the foot - a collection of bone formations and soft tissues with shock-absorbing properties.

Accordingly, damage to this formation leads to the development of a fairly common disease - flat feet.When we talk about this, we usually imagine a longitudinal variant of the pathology, which causes the arch of the foot to sink 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 disease.This is associated with wearing uncomfortable or ill-fitting shoes, which over time contribute to shifting of the forefoot bones.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 refers to the deviation of any segment of the musculoskeletal system from the central axis to the outside.In this case, there may also be curvatures in the joints - then the direction of the angle between the bones is assessed.It is precisely this mechanism that leads to the development of transverse flat feet, which ultimately leads to irreversible damage to the metatarsophalangeal joint of the big toe.

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

1. The first and most important symptom is the curvature of the first metatarsophalangeal joint with the formation of an angle that is open to the outside.The development of pathology occurs gradually, but progresses irreversibly.In the later stages of the disease, the deformity of the big toe reaches such a degree of severity that the angle in the joint is almost 90 degrees.
2. The next important sign is the formation of a characteristic “bone” on the inner edge of the foot, where the head of the metatarsal bone normally protrudes slightly.Its occurrence is associated with a compensatory inward deviation of this bone under gravity.
3. The most recent 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 forefoot, gait disturbances, the appearance of dense corns on the sole under the middle toes.

Education mechanism

Like other degenerative skeletal diseases, transverse flatfoot goes through two stages of its development.In the first stage, there are only functional changes in the soft tissues, which lead to a decrease in their supportive and elastic properties.And in the second stage, deformations of the joints or bones themselves are already forming:

• The trigger is always incorrect loading of the forefoot by wearing unsuitable shoes - especially with narrow toes and heels.
• This leads to chronic damage to the soft tissue – the ligaments and muscles that hold the base of the toes and metatarsals in an elevated position.
• Repeated trauma causes the anterior arch of the foot to gradually sink, whereupon the maximum load falls on the midfoot.
• This causes the peripheral metatarsal bones to deviate in opposite directions.
• The first metatarsophalangeal joint normally experiences the maximum load and therefore the force of pathological pressure on it is maximum.Its capsule gradually expands, causing further inward displacement of the metatarsal bone.
• The stability of the joint decreases, which leads to the formation of a subluxation of the phalanx of the first finger.The progression of hallux valgus is precisely associated with the continuous and slow course of this process.
• Deformed soft tissues - ligaments and muscles - become fixed in this position over time, which explains the irreversibility of the curvature.
• Chronic injuries lead to the development of deforming osteoarthritis of the first metatarsophalangeal joint, which leads to loss of functionality of the joint.

Further help tactics depend on the severity of the changes - in the early stages, conservative measures are sufficient, but in advanced cases only surgery can eliminate the permanent deformity.

Conservative treatment

A valgus deformity of the big toe can only be eliminated using conventional methods if the functionality of the joint is fully preserved.This is explained by the condition of the ligaments and muscles, the damage to which is reversible in the early stages.In this case, assistance is provided in three consecutive stages:

1. First, the patient is prescribed passive treatment methods, during which the finger is fixed in the correct position.The joint is artificially returned to its normal configuration, which is carried out using various orthopedic means.Normally this period lasts at least 6 months and is necessary for soft tissue adaptation.
2. In the second phase, the active phase begins, in which special training techniques are used to strengthen the foot muscles.To achieve this, physiotherapy courses, massage sessions and physiotherapy procedures are combined at the same time.
3. The last period is unlimited because hallux valgus is an incurable disease.Therefore, the patient consolidates the treatment results for the rest of his life and is committed to preventing disease progression.

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

Passive procedures

The first step in treatment is the most difficult for the patient, as fixation of the foot rarely occurs unnoticed by the patient.Restoration of the normal anatomical structure of the arch of the foot is much more difficult and noticeable than the development of pathology.For this purpose, the following means are used in orthopedics:

• The standard for beginning help is to completely get rid of shoes or boots with a narrow toe box.Now the patient should only wear loose shoes that are wide or open at the front.Custom-made orthopedic boots are considered ideal, but patients can rarely afford such a luxury.
• For smaller misalignments, a special bandage made of adhesive plaster is used, which is placed on the back of the foot.The fixation is carried out 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 foot - the treatment in this case is much more effective.For this purpose, various types of orthoses or bandages are used, the rigidity of which is selected depending on the degree of deformation.

Wearing support devices should be almost constant - in the first month it is recommended not to remove them for more than 2 hours a day.

Active procedures

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

• First, physiotherapeutic procedures are gradually introduced to prepare the joint and surrounding soft tissues for the upcoming load.Warming and distracting procedures are carried out that can be applied to the foot.These include laser, magnet, applications with paraffin or ozokerite, ultrasound therapy.
• After a few days, massage sessions begin with superficial warming of the tissue.Gradually, the specialist should move on to warming up the actual muscles of the foot, which play an important role in eliminating curvature.
• When the unpleasant symptoms have completely disappeared, the patient begins independent physical activity.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 increase the load gradually so that the soft tissues can adapt to the work being done.

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

Surgical treatment

The indication for surgical intervention should always be justified, as long-term rehabilitation is required after its implementation.Therefore, they are not performed on patients with early stages of hallux valgus, in whom the curvature of the finger can be corrected naturally.Surgical intervention is required only if there are irreversible changes in the joint or surrounding tissues:

1. If there are signs of a fixed transverse flat foot, i.e.h.a deformation of the anterior arch of the foot both during stress tests and in the resting position.This conclusion comes from an X-ray examination in which the position of the metatarsal heads was assessed.
2. With pronounced curvature in the first metatarsophalangeal joint of the big toe, accompanied by persistent dislocation between the bones of which it consists.The absolute clue in this case is an additional curvature of the adjacent joint, which leads to a change in the position of the second finger.
3. The first signs of osteoarthritis in the first metatarsophalangeal joint of the big toe indicate irreversible damage to the surrounding soft tissues.The muscles and ligaments are securely fixed in a malignant position, so conservative correction is not possible.

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

Ligament operations

This surgical treatment option is more suitable for patients who do not yet have any signs of direct damage to the joint tissue.Therefore, the leading deformation mechanism in them is pathological muscle traction associated with a change in the position of the arch of the foot.The following intervention options are used to resolve this:

• The first type of operations includes all forms of transposition (movement) of the 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 finger phalanx.To do this, the ligament is removed or partially split and attached to a new location - in the area of the outer edge of the metatarsal bone.If you change the point of application of muscle strength, you can gradually return it to its original place.
• The second type of operation involves the creation of various types of bindings - the creation of an artificial transverse arch of the foot.All metatarsal bones are fixed in the correct position, then a section of another ligament or a synthetic prosthesis is sewn to it.However, this option is only possible with “mild” deformation, when displaced bones can be easily returned to their original place.

According to observation results, all ligament operations are still of a temporary nature - without correction of pathological factors, the displaced tendons quickly expand again.

Joint Operations

With severe curvature of the joint, orthopedic interventions are required to eliminate bone defects.For this purpose, resections are carried out - the removal of certain areas of the affected bone.This method makes it possible to artificially return the joint to its normal position.Currently, the following options are used for such operations:

• The main method for eliminating deformity is the Schede-Brandes osteotomy.This procedure includes two procedures: the removal of the pathological growth on the first metatarsal bone (ossicle) and the resection of a triangular fragment at its base.After the fusion of bone tissue, the deformed finger returns to its normal position.
• Less common are operations in which a resection of both areas in the area of the metatarsal head is performed.Due to the massive damage, the risk of complications that prevent the fragments from healing properly is too high.
• In advanced cases of the disease, palliative forms of intervention are carried out that do not restore mobility but eliminate pathological shifts.For this purpose, arthrodesis is performed - removal and closure of the joint cavity between the metatarsal bone and the phalanx.

Nowadays, these procedures are rarely performed in isolation - they are usually combined with simultaneous tendon plasty, which eliminates maltraction of the muscles.

Combined operations

The performance of complex procedures is very important in modern orthopedics, which leads to an increasing frequency of combined procedures.Typically, a combination of gentle bone resection and relocation of one of the ligaments that move the thumb is performed:

• During the modified Schede-Brandes operation, standard sections of the metatarsal bone are removed - resection in the area of the head and base.In addition, the abductor pollicis muscle is displaced to its outer surface, the pressure of which leads to a subluxation in the joint.
• It is also possible to perform an osteotomy in combination with the formation of an artificial arch.In addition, in one operation it is possible not only to return the metatarsal bone to its original place, but also to give the remaining structures the correct position.
• In severe cases, procedures are combined to simultaneously eliminate 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 prolongs the rehabilitation period.

recreation

The completion of conservative and surgical treatment is the beginning of the recovery period, which lasts in such patients for the rest of their lives.Without adhering to special recommendations, the disease can recur and again manifest itself with unpleasant symptoms:

1. First, all patients must wear special orthopedic insoles with additional Seitz pads.Not only do they ensure the correct position of the foot when walking, but they also provide additional arch support.
2. You also need to pay attention to your shoes - completely exclude boots or shoes with a narrow front from your wardrobe.
3. You need to pay attention to your own weight - maintaining a normal body weight significantly reduces the stress on the arch of the foot.
4. Regular preventive daily exercises keep the muscles in normal tone, thereby preventing displacement of the metatarsal bones.

The main difficulties for patients arise from the physiotherapy program, since most patients do not even know the exercise technique.Therefore, to perform them correctly, you must first study with a teacher in an individual or group form.