Displacement of the big toe and deformity of the foot with a protruding bone is one of the most common orthopedic pathologies.At first, this disease manifests itself as a cosmetic defect and does not cause any special problems, but if it is not treated, it progresses with age.When walking, the legs get tired quickly, pain begins, problems arise with choosing shoes, and it becomes increasingly difficult to correct the defect even with surgery.So start treatmenthallux valgus (foot valgus)It is necessary as soon as the first signs of the disease appear.
Causes of hallux valgus
It is a multifactorial disease that develops due to hereditary predisposition, other diseases of the musculoskeletal system, neurological pathologies and metabolic disorders, external factors.
Internal causes:
- Hereditary tendency to hallux valgus
- transverse and longitudinal flat base
- 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 knee and hip joints
External inciting factors:
- foot and ankle sprains, joint injuries and broken bones of the foot
- wearing anatomically incorrect high heels with narrow toes
- occupational risks: carrying heavy objects for a long time, standing for a long time
Hereditary tendency to hallux valgus is not considered the cause of the development of the disease in itself, but it is almost always an increased risk factor triggered by negative external factors.
What happens with hallux valgus?
Valgus deformity- is not only an aesthetic defect, but also causes a lot of discomfort in women due to limitations in the choice of shoes (the disease is more common in women than in men).Changes occur in the entire musculoskeletal system of the foot, they gradually progress and after some time pass to an irreversible stage.What happens to the leg?
- Spreading the leg, changing the anatomical shape, reducing the bend.
- Displacement of the first metatarsal bone and an increase in the angle between it and the second metatarsal bone.
- The deviation of the big toe at an angle to the first metatarsal bone takes the form of a piece with a protruding head (therefore Hallux valgus is often called lumps or bunions).
- Subluxation of the metatarsophalangeal joint causing rotation of the sesamoid bones.
- Violation of biomechanical indicators: decrease in indicators of motor and support functions.
- Changes in bone, cartilage tissue and the entire joint.First of all, the head area of the first metatarsal bone suffers: the tissues become more sensitive, the bones become inflamed and painful, bursitis may 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 within a week or a month;It can take more than a decade from the beginning of 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 more than 40 ° and is usually placed on top of 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 the protrusion of the bone.
- Hammer-shaped foot (the 2nd and 3rd toes are deformed and become hammer-like, that is, they bend at the joints).
- Fatigue, pain in the legs, which often worsens in the evening and at night.
Diagnostics
The diagnosis is based on the data obtained during the external examination and X-ray of the foot.In order to find out the causes of the development of the disease, the orthopedist collects an anamnesis (during the conversation, asks the patient about his profession, hereditary diseases, previous injuries, lifestyle, habits), makes referrals for laboratory tests, consults 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 examination, often accompanying diseases are diagnosed and treatment is prescribed.
Treatment methods for hallux valgus
In the initial stage of the disease (1st degree hallux valgus), conservative treatment is prescribed: gymnastics, wearing individual orthopedic insoles to prevent flat feet, massage, foot baths and medications.Wearing elastic fixators (protectors of the head of the first metatarsal bone) called valgus splints is also recommended.Physiotherapy treatment is prescribed for inflammation: magnetotherapy, electrophoresis, paraffin therapy, etc., painkillers.
If necessary, the orthopedist will give recommendations on changes in lifestyle and nutrition.For example, many patients have to switch to diet food in order to lose excess weight and not cause diseases.It is advisable to limit excessive physical activity, often walk barefoot on the ground and on small stones, use orthopedic mattresses, buy safe shoes that do not squeeze the toe due to the fact that the foot does not bend and the center of gravity of the whole body does not move.
However, all conservative methods can only slow down the progression of the disease, but cannot get rid of it forever.Therefore, surgical treatment is prescribed in difficult cases.More than 100 different proprietary methods have been developed for the treatment of hallux valgus.All rely on distal angle and proximal osteotomies with foot reconstruction to correct the deformity.To perform the operation, the first metatarsophalangeal joint is exposed through an incision in the skin.The surgeon then cuts the bone and places it in the functionally correct position.With the help of osteotomy, it is not only possible to correct the deformation due to deviation of the finger, but also, if there is an accompanying pathology, the bone can be lengthened or shortened.As a result, it is possible to achieve a long compensation phase or completely eliminate the pathology, maintain or restore joint functions.
The main 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 treatment method can be made only after examination and determination of the degree of deformation and 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 components of the deformity are eliminated: the finger returns to its anatomically correct place, the cartilage is not destroyed, the joint is not deformed.The patient can live a full life, do sports, walk, run, wear comfortable shoes.