Static foot deformities are degenerative diseases that seriously disrupt the supporting functions of the skeleton.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 heel tubercle along the outer edge to the toes.This structure ensures the formation of the arch of the foot - a set of bone joints and soft tissues with shock-absorbing properties.
Accordingly, 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.However, the transverse form of the disease, accompanied by the characteristic curvature of the big toe, also applies to straight feet.
This type of pathology mainly occurs in adult and elderly women, it is often an acquired condition.This is associated with wearing uncomfortable or ill-fitting shoes that over time contribute to the displacement of the bones of the forefoot.The result of hallux valgus is constant unpleasant symptoms that accompany a person both when wearing familiar shoes and during normal walking.
Concept
In orthopedics, valgus deformation is a deviation of any segment of the musculoskeletal system from the central axis.In this case, the curvature can also occur in the joints - then the direction of the angle between the bones is evaluated.The development of transverse flatfoot follows exactly this mechanism, resulting in irreversible damage to the metatarsophalangeal joint of the first toe.
Although the condition often develops over decades, patients seek help in the later stages.Therefore, it is necessary to mention the characteristic features of hallux valgus:
- The first and main symptom is the curvature of the first metatarsophalangeal joint with the formation of an open angle to the outside.The formation of pathology occurs gradually, but progresses irreversibly.In the later stages of the disease, the deformity of the thumb is so severe that the angle in the joint is almost 90 degrees.
- The next 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 compensatory deviation of this bone inward under the force of gravity.
- The latest manifestation is the hammer-shaped curvature of the second finger, which is caused by the pathological pressure of the adjacent joint and the surrounding soft tissues.
Hallux valgus is characterized by the appearance of additional (non-permanent) symptoms - pain in the forefoot, gait disturbance, the appearance of dense corns on the heel under the middle toes.
Formation mechanism
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 soft tissues, which leads to a decrease in their supporting and elastic properties.In the second stage, deformations of joints or bones are already formed:
- The trigger factor is always improper loading of the forefoot due to wearing ill-fitting shoes - especially shoes with narrow toes and heels.
- This leads to chronic damage to the soft tissues - the ligaments and muscles that hold the base of the toes and metatarsals in place.
- Repeated trauma causes a gradual lowering of the anterior arch, after which the maximum load begins to fall on the middle of the foot.
- In this case, there is a deviation of the peripheral metatarsal bones 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 stretches and causes the metatarsal bone to move further inwards.
- The stability of the joint decreases, which causes subluxation of the phalanx of the first finger.The progression of hallux valgus is precisely related to 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 damage leads to the development of deforming arthrosis of the first metatarsophalangeal joint, which leads to the loss of functional capabilities of the joint.
The subsequent tactics of assistance depend on the severity of the changes - conservative measures are sufficient in the early stages, and in advanced cases, only surgery will eliminate permanent deformation.
Conservative treatment
Valgus deformity of the big toes can be eliminated by 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 is reversible at an early stage.In this case, assistance is provided in three successive stages:
- First, the patient is prescribed passive treatment methods that involve fixing the finger in the correct position.The joint is artificially restored to its normal configuration using various orthopedic devices.Usually this period takes at least 6 months, which is necessary for adaptation of soft tissues.
- In the second stage, the active stage begins, which includes special training methods to strengthen the leg muscles.To achieve this, physiotherapy classes, massage sessions and physiotherapy procedures are combined at the same time.
- The last period is uncertain, because hallux valgus is an incurable disease.Therefore, the patient combines the results of the treatment until the end of his life and is engaged in preventing the development of the disease.
The choice of means and methods for therapy is completely individual - the patient's age, accompanying diseases, as well as the characteristics of the curvature itself are taken into account.
Passive procedures
The first stage of treatment is the most difficult for the patient, because the fixation of the leg rarely occurs without the patient noticing.Returning the normal anatomical structure of the arch of the foot is much more difficult and noticeable 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 with a narrow toe box.Now the patient should only use loose shoes that are wide or open in front.Custom tailoring of orthopedic boots is considered ideal, but it is extremely rare for patients to be able to afford such a luxury.
- For small deformations, 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 the external and internal deviation of the metatarsal bones during walking is excluded.
- A more convenient and reliable option is orthopedic fixation of the foot - in this case, the treatment is more effective.For this purpose, various types of orthoses or bandages are used, the stiffness of which is selected depending on the degree of deformation.
Wearing support devices should be almost constant - during the first month, it is recommended to remove them no more than 2 hours a day.
Active procedures
The transition to the second stage is determined individually - after the doctor evaluates the symptoms, as well as X-ray examination.The absence of disease development, as well as at least a slight positive dynamics, allows to start an active fight against deformity.The following methods are used for this:
- First, gradual physical therapy procedures are applied to prepare the joint and surrounding soft tissues for the upcoming load.Warm-up and distraction procedures that can be used on the leg are performed.These include applications with laser, magnet, paraffin or ozokerite, ultrasound therapy.
- After a few days, massage sessions are added, starting with the surface heating of the tissues.Gradually, the specialist should move on to warming up the actual muscles of the foot, which play an important role in eliminating curvature.
- When unpleasant symptoms completely disappear, the patient goes to independent physical exercises.In order not to cause muscle fatigue, it is not recommended to include more than one exercise in the program.It is better to gradually increase the load, allowing the soft tissues to adapt to the work being performed.
To achieve the full effect, the listed activities should be carried out daily to prevent the return of pathological processes.
Surgical treatment
Indications for surgery should always be justified, since long-term rehabilitation is required after their implementation.Therefore, in patients with early stages of hallux valgus, where the curvature of the toe can be corrected naturally, it is not performed.Surgical intervention is required only if there are irreversible changes in the joint or surrounding tissues:
- When there are signs of a fixed transverse flatfoot - that is, the front arch of the foot is deformed both during load tests and at rest.This result appears after an X-ray examination that evaluates the location of the heads of the metatarsal bones.
- It is accompanied by an open curvature in the first metatarsophalangeal joint, with continuous dislocation between the bones that form it.In this case, the absolute indicator is the additional curvature of the adjacent joint, which causes a change in the position of the second finger.
- Even with initial signs of arthrosis in the first metatarsophalangeal joint, it indicates irreversible damage to the surrounding soft tissues.Muscles and ligaments are reliably fixed in a bad position, so it will not be possible to make a correction in a conservative way.
The choice of the 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 patients without signs of direct damage to joint tissues.Therefore, the leading mechanism of deformation in them becomes pathological muscle tension associated with a change in the position of the arch of the foot.To fix this, the following intervention options are used:
- 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 muscles that causes the deviation between it and the phalanx of the finger to gradually increase.Therefore, the ligament is removed or partially torn and attached to a new place - in the region of the outer edge of the metatarsal bone.Changing the point of application of muscle force allows it to gradually return to its original position.
- The second type of operation involves the creation of different types of ligaments - 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 are easily returned to their original place.
According to the results of observations, all operations on the ligaments are still temporary - the displaced tendons are quickly re-stretched without correcting the pathological factors.
Joint operations
If there is a significant curvature in the joint, orthopedic interventions are required to eliminate the defects of the bone tissue.For this, resections are performed - removal of certain areas of the affected bone.This method allows you to artificially restore the joint to its normal state.Currently, the following options are used for such operations:
- The main method for removing the deformity is Schede-Brandes osteotomy.This intervention includes two manipulations - removal of pathological growth in the first metatarsal bone (ossicles) and resection of a triangular piece at its base.After the fusion of bone tissue, the deformed finger returns to its normal position.
- Less commonly used are operations in which both regions are resected in the region of the metatarsal head.Due to massive damage, there is a very high risk of developing complications that will not allow the fragments to heal properly.
- In advanced cases of the disease, forms of palliative intervention are carried out - they do not restore mobility, but eliminate the pathological displacement.For this purpose, arthrodesis is performed - cutting and closing the joint space between the metatarsal bone and the phalanx.
Nowadays, these interventions are rarely performed in isolation - they are usually combined with tendon plastic surgery at the same time, which eliminates improper stretching of the muscles.
Combined operations
In modern orthopedics, performing complex manipulations is a priority, which leads to an increase in the frequency of combined interventions.Typically, a combination of gentle bone resection and replacement of one of the ligaments that move the thumb is performed:
- The modified Schede-Brandes operation involves the removal of standard parts of the metatarsal bone - resection of the head and base.In addition, the abductor pollicis muscle is transferred to its outer surface, its pressure causes subluxation in the joint.
- It is also possible to perform an osteotomy along 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 also to give the correct position to the remaining structures.
- In severe cases, interventions 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 increases the rehabilitation period.
Recovery
Completion of conservative and surgical treatment is the beginning of the recovery period, which lasts until the end of life in such patients.Without following special recommendations, the disease may return, reminding itself again with unpleasant symptoms:
- First of all, all patients are required to wear a special orthopedic insole with additional Seitz supports.They will not only ensure the correct position of the foot during walking, but also create additional support for its arches.
- You should also pay attention to your shoes - completely remove narrow-fronted boots or shoes from your wardrobe.
- You should pay attention to your weight - maintaining a normal body weight significantly reduces the load on the arches of your feet.
- Regularly performing daily preventive exercises keeps the muscles in normal tone, which prevents displacement of the metatarsal bones.
The main difficulties for patients arise with the physical therapy program, because most of the end patients do not even know the exercise technique.Therefore, to perform them correctly, you must first study with an instructor individually or in a group.