Foot deformity with displacement of the big toe and protruding bone is one of the most common orthopedic diseases.The disease initially manifests itself as a cosmetic defect and does not cause any particular problems, but it progresses with age if left untreated.When walking, the legs quickly tire, pain occurs, the problem of choosing shoes arises, and even with an operation it becomes increasingly difficult to correct the defect.Therefore, start treatmentHallux valgus (foot valgus)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, as well as external factors.
Internal reasons:
- Hereditary predisposition to hallux valgus
- Transverse and longitudinal flatfoot
- inflammatory processes (mainly arthritis: psoriatic arthropathy, gout, rheumatoid arthritis)
- Congenital biomechanical instability of the feet
- Hyperelasticity syndrome, connective tissue dysplasia
- Neuropathy of different origins
- Deformation of the knee and hip joints
External provoking factors:
- Injuries with sprained ligaments of the foot and ankle, joint damage and fractures of the foot bones
- Wearing anatomically incorrect shoes with high heels and narrow toes
- Occupational risks: carrying heavy objects for long periods of time, standing for long periods of time
The hereditary predisposition to hallux valgus in itself is not considered to be the cause of the disease, but represents an increased risk factor that is almost always triggered by negative external factors.
What happens with hallux valgus?
Valgus deformity- not just an aesthetic defect that causes great inconvenience to women due to restrictions in the choice of shoes (the disease occurs much more often in women than in men).Changes occur in the entire musculoskeletal system of the foot that progress gradually and after some time reach an irreversible stage.What happens to the foot?
- Spreading the foot, changing the anatomical shape, reducing flexion.
- Displacement of the first metatarsal and increase in the angle between it and the second metatarsal.
- Deviation of the big toe at an angle to the first metatarsal bone, the head of which takes the form of a protruding lump (hence, hallux valgus is often called a lump or bunion).
- Subluxation of the metatarsophalangeal joint of the big toe, resulting in rotation of the sesamoid bones.
- Violation of biomechanical indicators: decreased indicators of motor and supporting functions.
- Changes to bones, cartilage tissue and the entire joint.First, the area of the head of the first metatarsal suffers: the tissue becomes more sensitive, the bones become inflamed and painful, bursitis can occur and cartilage is destroyed.The lumen of the joint space narrows, resulting in focal cystosis with local osteoporosis.
Hallux valgus symptoms
The disease does not develop within a week or a month;More than a decade can pass from the beginning of a clearly visible pathology (in stage I, the toe deviates by 20-30° from the normal position) to third-degree hallux valgus (the big toe deviates by more than 40° and is usually above the second).
External manifestations of the disease:
- Deviation of the big toe to the side (from the inner surface of the foot to the outside) and protrusion of the bone.
- Hammer-shaped foot (the 2nd and 3rd toes are deformed and become hammer-like, i.e. they bend at the joints).
- Leg fatigue, pain that often increases in the evening and at night.
diagnosis
The diagnosis is made based on the data of an external examination and an x-ray of the foot.In order to find out the reasons for the development of the disease, the orthopedist takes an anamnesis (during the conversation he asks the patient about his profession, hereditary diseases, previous injuries, lifestyle, habits), refers him for laboratory tests and carries out consultations with other specialists.The fact is that hallux valgus can be caused by autoimmune and systemic diseases (e.g. rheumatoid arthritis), metabolic disorders and neurological disorders.After an examination, during which concomitant diseases are often diagnosed, treatment is prescribed.
Treatment methods for hallux valgus
At the initial stage of the disease (hallux valgus grade 1), conservative treatment is prescribed: gymnastics, wearing individual orthopedic insoles to prevent flat feet, massage, foot baths and medications.It is also recommended to wear elastic fixators (protecting the head of the first metatarsal bone), called valgus splints.In case of inflammation, physiotherapeutic treatment is prescribed: magnetic therapy, electrophoresis, paraffin therapy, etc., painkillers.
If necessary, the orthopedist will make recommendations for changing your lifestyle and diet.For example, many patients have to switch to diet food in order to lose excess weight and not cause illness.It is also advisable to limit excessive physical activity, often walk barefoot on the ground and small stones, use orthopedic mats, purchase safe shoes that do not squeeze the toe, as a result of which the leg does not bend and the center of gravity of the entire body does not move.
However, all conservative methods can only slow down the progression of the disease, but cannot eliminate it forever.Therefore, in difficult cases, surgical treatment is prescribed.More than 100 different proprietary methods have been developed to treat hallux valgus.All are based on distal angle and proximal osteotomies with reconstruction of the foot to correct the deformity.For the operation, the first metatarsophalangeal joint of the big toe is exposed through a skin incision.The surgeon then cuts through the bone and places it in the functionally correct position.With the help of osteotomy you can not only correct deformities due to finger deformity, but also lengthen or shorten the bone if there is an accompanying pathology.This makes it possible to achieve a long compensation period or completely eliminate the pathology, maintain or restore joint functions.
Basic methods of surgical correction of hallux valgus:
- Corrective osteotomy of the first metatarsal (chevron, wedge-shaped, SCARF+Akin (with resection and rotation), Lapidus arthrodesis.
- Osteotomy with bioabsorbable implants.
The final choice of treatment method can only be made after examination and determination of the degree of deformation as well as an individual clinical and radiological picture.
After corrective osteotomy, the supporting function is restored, pain disappears, corns and calluses do not form, soft tissues do not swell, all deformation components are eliminated: the finger returns to its anatomically correct place, the cartilage is not destroyed and the joint is not deformed.The patient can lead a full life, play sports, walk, run and wear comfortable shoes.