Toe deformity: treatment

Static foot deformities are degenerative diseases of the skeleton that seriously impair its supporting functions.Usually, the load is not distributed evenly over the entire area of the sole, but is located along the main points and axes - from the heel along the outer edge to the toes.This structure ensures the formation of the arch of the foot - a set of bony formations and soft tissues that have cushioning properties.

Consequently, damage to this formation leads to the development of a fairly common disease - flat feet.When this is mentioned, people usually imagine the longitudinal variant of the pathology, which causes the arch of the foot to drop along the inner edge.But the transverse form of the disease, which is accompanied by a characteristic curvature of the big toe, also refers to flat feet.

This type of pathology occurs mainly in mature and elderly women, it is often an acquired condition.It is associated with wearing uncomfortable or uncomfortable shoes, which over time contributes to the displacement of the bones of the forefoot.The result of hallux valgus is constant unpleasant symptoms that accompany a person both when he wears familiar shoes and when he walks normally.

The concept

In orthopedics, valgus deformity is the deviation of any segment of the musculoskeletal system outward from the central axis.In this case, there may also be curvature in the joints - then the direction of the angle between the bones is assessed.The development of transverse flat feet corresponds to this mechanism, which ultimately leads to irreversible damage to the metatarsophalangeal joint of the first toe.

Although this condition often develops over decades, patients seek help in the later stages.Therefore, it is necessary to indicate the characteristic features of hallux valgus:

1. The first and main symptom is the curvature of the first metatarsophalangeal joint with the formation of an outwardly open angle.Pathology formation occurs gradually, but progresses irreversibly.In the later stages of the disease, the deformity of the big toe reaches such severity that the angle in the joint becomes almost 90 degrees.
2. The next important sign is the formation of a characteristic "bone" located on the inner edge of the foot, where usually the head of the metatarsal bone protrudes slightly.Its appearance is associated with the compensatory deviation of this bone inwards under the action of the force of gravity.
3. The most recent manifestation is the curvature of the second finger in the form of a hammer, also 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) signs - pain in the front part of the foot, gait disturbance, the appearance of thick calluses on the sole of the foot under the middle toes.

Mechanism of formation

Like other degenerative diseases of the skeleton, transverse flatfoot goes through two stages in its development.In the first phase, there are only functional changes in soft tissues, which leads to a decrease in their load-bearing and elastic properties.And in the second phase, deformations of the joints or the bones themselves are already formed:

• The trigger factor is always improper loading of the forefoot due to wearing ill-fitting shoes - especially those with narrow toes and heels.
• This leads to chronic damage to the soft tissues - ligaments and muscles that hold the base of the toes and the metatarsal bone in an elevated position.
• Repeated trauma causes a gradual lowering of the forefoot, after which the maximum load begins to fall on the midfoot.
• In this case, the peripheral metatarsal bones deviate 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, causing the metatarsal bone to move further inwards.
• The stability of the joint decreases, which leads to subluxation of the phalanx of the first finger.The progression of hallux valgus is precisely related to the continuous and slow course of this process.
• Deformed soft tissues - ligaments and muscles - are fixed in this position over time, which explains the irreversibility of curvature.
• Chronic injury leads to the development of deforming arthrosis of the first metatarsophalangeal joint, which causes the loss of functional abilities of the joint.

Further tactics of help depend on the severity of the changes - in the early stages, conservative measures are sufficient, and in advanced cases, only surgery will remove persistent deformity.

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, the damage of which is reversible in the early stages.In this case, assistance is provided in three consecutive stages:

1. First, the patient is prescribed passive treatment methods, which include fixing the finger in the correct position.The joint is artificially returned to its normal configuration, which is performed by various orthopedic means.Usually this period lasts at least 6 months, which is necessary for the adaptation of soft tissues.
2. In the second phase, the active phase begins, which includes special training techniques to strengthen the foot muscles.To achieve this, physical therapy classes, massage sessions and physiotherapy procedures are combined at the same time.
3. The final period is unlimited, because hallux valgus is an incurable disease.Therefore, the patient consolidates the results of the treatment for the rest of his life and deals with preventing the progression of the disease.

The choice of means and methods for therapy is completely individual - taking into account the age of the patient, accompanying diseases, as well as the characteristics of the curvature itself.

Passive procedures

The first stage of treatment is the most difficult for the patient, because foot fixation rarely happens unnoticed by the patient.The return of 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 means are used in orthopedics:

• The standard to start helping is to completely get rid of shoes or boots that have a narrow toe.Now the patient should use only loose shoes, wide or open in the front.Individual tailoring of orthopedic boots is considered ideal, but it is extremely rare that patients can afford such a luxury.
• In the case of minor deformities, a special bandage made of adhesive plaster is used, which is placed on the back of the foot.It is fixed in such a way that the outer and inner deviation of the metatarsal bones is excluded when walking.
• A more convenient and reliable option is orthopedic fixation of the foot - treatment is much more effective in this case.For this purpose, different 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 that you take them off for no more than 2 hours during the day.

Active procedures

The transition to the second stage is determined individually - after the doctor evaluates the symptoms, as well as an X-ray examination.The absence of disease progression, as well as at least a slight positive dynamic, allow us to start an active fight against deformities.The following methods are used for this:

• First, physiotherapy procedures are gradually introduced to prepare the joint and the surrounding soft tissues for the upcoming load.Warm-up and distraction procedures are performed, which can be used on the foot.They include laser, magnet, applications with paraffin or ozokerite, ultrasound therapy.
• After a few days, massage sessions are added, which begin with superficial tissue heating.Gradually, the specialist should move on to warming up the actual muscles of the foot, which play an important role in removing curvature.
• When the unpleasant symptoms completely disappear, the patient moves on to independent physical exercise.It is not recommended to include several exercises in the program at once, in order not to fatigue the muscles.It is better to gradually increase the load, allowing the soft tissues to adapt to the work being done.

To achieve the full effect, the mentioned activities must be carried out daily in order to prevent the return of pathological processes.

Surgical treatment

Indications for surgery should always be justified, because long-term rehabilitation is required after their performance.Therefore, they are not performed on patients in the early stages of hallux valgus, in whom the curvature of the toe can be corrected naturally.Surgical intervention is required only in case of irreversible changes in the joint or surrounding tissues:

1. When there are signs of a fixed transverse flatfoot - that is, the anterior arch of the foot is deformed both during load tests and at rest.This conclusion appears after an X-ray examination that assesses the location of the metatarsal heads.
2. With pronounced curvature in the first metatarsophalangeal joint, accompanied by persistent dislocation between the bones that form it.The absolute indication in this case is the additional curvature of the adjacent joint, which leads to a change in the position of the second finger.
3. Even with the initial signs of arthrosis in the first metatarsophalangeal joint, which indicates irreversible damage to the surrounding soft tissues.The muscles and ligaments are securely fixed in the enchanted 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 option of surgical treatment is more suitable for those patients who do not yet have signs of direct damage to the joint tissue.Therefore, the leading mechanism of deformation in them becomes pathological muscle traction associated with a change in the position of the arch of the foot.To correct this, the following intervention options are used:

• The first type of surgery includes all forms of transposition (displacement) of the tendons attached to the first metatarsal bone.It is a pathological muscle contraction that leads to a gradual increase in the deviation between it and the phalanx of the finger.Therefore, the ligament is removed or partially split and attached to a new place - in the area of the outer edge of the metatarsal bone.Changing the point of application of muscle force allows you to gradually return it to its original place.
• Another type of surgery involves the creation of different types of connections - the creation of an artificial transverse arch of the foot.All metatarsal bones are fixed in the correct position, after which a part of the second ligament or a synthetic prosthesis is sewn to them.But this option is possible only in the case of "mild" deformation, when the displaced bones can easily return to their original place.

According to the results of observation, all operations on ligaments are still temporary in nature - without correction of pathological factors, displaced tendons are quickly stretched again.

Joint operations

If there is a significant curvature of the joint, orthopedic interventions are needed to eliminate bone tissue defects.To do this, resections are performed - removal of certain areas of the affected bone.This method allows artificially returning the joint to its normal position.The following options are currently used for such operations:

• The main method for removing deformities is the Schede-Brandes osteotomy.This intervention includes two manipulations - removal of the pathological growth on the first metatarsal bone (bone) and resection of the triangular fragment at its base.After joining the bone tissue, the deformed finger returns to its normal position.
• Operations in which resection of both areas is performed in the area of the head of the metatarsal bone are less commonly used.Because of the massive damage, the risk of developing complications that will not allow the fragments to heal properly is too great.
• In advanced cases of the disease, palliative forms of intervention are carried out - not restoring mobility, but removing the pathological shift.For this purpose, arthrodesis is performed - excision and closure of the joint cavity between the metatarsal bone and the phalanx.

Today, these interventions are rarely performed in isolation - they are most often combined with simultaneous plastic tendon surgery, which eliminates improper muscle traction.

Combined operations

Performing complex manipulations is a priority in modern orthopedics, which leads to an increase in the frequency of combined interventions.A combination of gentle bone resection and repositioning of one of the ligaments that move the thumb is usually performed:

• The modified Schede-Brandes operation involves the removal of standard parts of the metatarsal bone - resection in the area of the head and base.In addition, the abductor pollicis muscle is transposed on its outer surface, the pressure of which leads to subluxation in the joint.
• It is also possible to perform an osteotomy in combination with the formation of an artificial arch.Moreover, with one operation it is possible not only to return the metatarsal bone to its original place, but also to give the remaining structures the correct position.
• In more 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 - the large volume of destruction requires long healing and increases the rehabilitation period.

Recovery

The end of conservative and surgical treatment is the beginning of the recovery period, which in such patients continues for the rest of their lives.Without following special recommendations, the disease can return, reminding itself with unpleasant symptoms:

1. First of all, all patients must wear special orthopedic insoles with additional Seitz pads.They will not only ensure the correct position of the foot when walking, but will also create additional support for his arches.
2. You also need to pay attention to your shoes - completely exclude from your wardrobe any boots or shoes with a narrow front.
3. You must take care of your own weight - maintaining a normal body weight significantly reduces the load on the arches of your feet.
4. Regularly performing preventive daily exercises keeps the muscles in normal tone, which prevents the metatarsal bones from moving.

The greatest difficulties for patients arise with the physical therapy program, since most recent patients do not even know the exercise technique.Therefore, in order to perform them properly, you must first study with an instructor in an individual or group format.