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 a cosmetic defect and does not cause any special problems, but if left untreated, it progresses with age.Legs get tired quickly when walking, pain begins, problems arise when choosing footwear and it becomes increasingly difficult to correct the defect even with surgery.Therefore, start treatmenthallux valgus (valgus foot)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 and 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 transport of heavy objects, prolonged stay
Hereditary predisposition to hallux valgus alone 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 choosing footwear (the disease is much more common in women than in men).Changes occur throughout the musculoskeletal system of the foot, which progress gradually and after some time enter an irreversible stage.What happens to the foot?
- Removal of the foot, changing the anatomical shape, reducing 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 to the first metatarsal bone, the head of which takes the form of a protruding lump (therefore, hallux valgus is often called a lump or bunion).
- Subluxation of the metatarsophalangeal joint, which leads to rotation of the sesamoid bones.
- Violation of biomechanical indicators: decrease in indicators of motor and support functions.
- Changes in the bones, cartilaginous tissue and the entire joint.First of all, the area of the head 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 in a week or a month;from the onset 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 by more than 40° and is often superimposed on the second) can take more than a decade.
External manifestations of the disease:
- Deviation of the big toe to the side (outside the inner surface of the foot) and protrusion of the bone.
- Hammer-shaped foot (the 2nd and 3rd toes are deformed and become hammer-shaped, that is, they bend at the joints).
- Fatigue in the legs, pain that often intensifies in the evening and at night.
Diagnosis
The diagnosis is made based on data obtained during an external examination and x-ray of the foot.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 occupation, hereditary diseases, previous injuries, lifestyle, habits), gives a referral for laboratory tests and consultations with other specialists.The fact is that hallux valgus can be caused by autoimmune and systemic diseases (for example, rheumatoid arthritis), metabolic and neurological disorders.After an examination, during which concomitant diseases are often diagnosed, treatment is prescribed.
Hallux valgus treatment methods
At the initial stage of the disease (grade 1 hallux valgus), conservative treatment is prescribed: gymnastics, the use of individual orthopedic insoles to prevent flat feet, massages, foot baths and medications.It is also recommended to use elastic fixators (protectors of the head of the first metatarsal bone), called valgus splints.For inflammation, physiotherapeutic treatment is prescribed: magnetotherapy, electrophoresis, paraffin, etc., analgesics.
The orthopedist, if necessary, will give recommendations on changes in lifestyle and diet.For example, many patients need to switch to diet foods to lose weight and not provoke illness.It is also advisable to limit excessive physical activity, often walk barefoot on the ground and on small stones, use orthopedic mats, buy safe shoes that do not pinch the toe, due 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 eliminate it forever.Therefore, in difficult cases, surgical treatment is prescribed.More than 100 different proprietary methods for treating hallux valgus have been developed.All are based on distal and proximal angular osteotomies with reconstruction of the foot to correct the deformity.To perform the surgery, the first metatarsophalangeal joint is exposed through a skin incision.Then, the surgeon cuts the bone and places it in the functionally correct position.With the help of osteotomy, it is possible not only to correct the deformity due to deviation of the finger, but also to lengthen or shorten the bone if there is concomitant pathology.As a result, it is possible to achieve 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 bone (chevron, cuneiform, 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 and the 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 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 a full life, play sports, walk, run and wear comfortable shoes.