Foot deformity with displacement of the big toe and protruding bone is one of the most common orthopedic pathologies.At first, the disease manifests itself as an aesthetic defect and does not cause any particular problems, but if left untreated, it progresses with age.The legs quickly get tired when walking, pain begins, the problem of choosing shoes arises, and it becomes more and more difficult to correct the defect even by surgical intervention.So start the treatmenthallux valgus (foot valgus)necessary from the appearance of the first signs of the disease.
Causes of hallux valgus
This is a multifactorial disease that develops due to a 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 flat foot
- inflammatory processes (mainly arthritis: psoriatic arthropathy, gout, rheumatoid arthritis)
- congenital biomechanical instability of the feet
- 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 damage and fractures of the bones of the foot
- 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 the 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 just an aesthetic defect, which causes a lot of inconvenience to women due to restrictions 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 foot, which gradually progress and after a while enter an irreversible phase.What happens to the foot?
- Foot spreading, modification of anatomical shape, reduction of curvature.
- Displacement of the first metatarsal bone and increase in the angle between it and the second metatarsal bone.
- Deviation of the big toe at an angle from the first metatarsal bone, the head of which takes the form of a protruding bump (this is why Hallux valgus is often called a bump or bunion).
- Subluxation of the metatarsophalangeal joint, which causes 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 suffers: the tissues become more sensitive, the bones become inflamed and injured, bursitis may develop, and the cartilage is destroyed.The lumen of the joint space narrows, focal cystosis develops with local osteoporosis.
Symptoms of hallux valgus
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 (outwards from the inner surface of the foot) and protrusion of the bone.
- Hammer-shaped foot (the 2nd and 3rd toes deform and become hammer-shaped, i.e. they bend at the joints).
- Fatigue in the legs, pain which often intensifies in the evening and night.
Diagnosis
The diagnosis is made based on data obtained during an external examination and an 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), directs him for laboratory tests and consultations with other specialists.The fact is that hallux valgus can be caused by autoimmune and systemic diseases (eg rheumatoid arthritis), metabolic disorders and neurological disorders.After an examination, during which concomitant diseases are often diagnosed, treatment is prescribed.
Methods for treating 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 (protectors of the head of the first metatarsal), called valgus splints.In case of inflammation, physiotherapeutic treatment is prescribed: magnetotherapy, electrophoresis, paraffin therapy, etc., painkillers.
The orthopedist, if necessary, will give recommendations on lifestyle and nutrition changes.For example, many patients need to switch to diet foods in order to lose 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 safety shoes that do not squeeze the toe, thanks 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 for the treatment of hallux valgus have been developed.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 an incision in the skin.Next, the surgeon cuts the bone and places it in the functionally correct position.With the help of osteotomy, you can not only correct deformity due to deviation of the finger, but also lengthen or shorten the bone in case of concomitant pathology.Due to this, it is possible to carry out a long stage of compensation or completely eliminate the pathology, maintain or restore the functions of the joint.
Basic methods of surgical correction of hallux valgus:
- Corrective osteotomy of the first metatarsal (chevron, wedge, SCARF+Akin (with resection and rotation), arthrodesis of the lapidus.
- Osteotomy using bioresorbable 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 picture.
After corrective osteotomy, the supporting function is restored, the pain disappears, corns and calluses are not formed, 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 fully, play sports, walk, run and wear comfortable shoes.