Foot deformity with displacement of the big toe and protruding bone is one of the most common orthopedic pathologies.The disease initially manifests itself as a cosmetic defect and does not cause any particular problems, but if left untreated, it progresses with age.The legs get tired quickly when walking, the pain starts, there is a problem with the choice of shoes, and even with surgery, it is increasingly difficult to correct the defect.So start treatmenthallux valgusnecessary as soon as the first signs of the disease appear.
Causes of hallux valgus
This 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 foot
- hyperelasticity syndrome, connective tissue dysplasia
- neuropathies of different origins
- deformation of knee and hip joints
External provoking factors:
- injuries with sprained foot and ankle ligaments, joint damage and foot bone fractures
- 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 activated under negative external factors.
What happens with hallux valgus
Valgus deformity- not only an aesthetic defect, which causes women a lot of inconvenience due to limitations 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 some time pass into an irreversible phase.What happens to the foot?
- Expansion of the foot, change in anatomical shape, reduction of bending.
- Moving the first metatarsal bone and increasing the angle between it and the second metatarsal bone.
- Deviation of the big toe at an angle in relation to the first metatarsal bone, the head of which has the shape of a protruding bump (hence Hallux valgus is often called bumps or bunions).
- Subluxation of the metatarsophalangeal joint, which leads to rotation of the sesamoid bones.
- Violation of biomechanical indicators: reduced indicators of motor and support functions.
- Changes in bone, cartilage 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 appearance 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 usually rests on the other) more than a decade can pass.
External manifestations of the disease:
- Deviation of the big toe to the side (outwards from the inner surface of the foot) and bone protrusion.
- Hammer-shaped foot (the 2nd and 3rd toes are deformed and become hammer-like, that is, they bend at the joints).
- Tiredness in the legs, pain, which often increases in the evening and at night.
Diagnostics
The diagnosis is made on the basis of data obtained from an external examination and X-ray of the foot.In order to find out the reasons for the onset of the disease, the orthopedist collects an anamnesis (during the interview, 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 disorders and neurological disorders.After the examination, during which accompanying diseases are often diagnosed, treatment is prescribed.
Methods of treating 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.It is also recommended to wear elastic fixators (protectors of the head of the first metatarsal bone), called valgus splints.For inflammation, physiotherapeutic treatment is prescribed: magnetotherapy, electrophoresis, paraffin therapy, etc., painkillers.
The orthopedist will, if necessary, give recommendations on changes in lifestyle and diet.For example, many patients have to switch to diet food in order to lose excess weight and not cause illness.It is also recommended to limit excessive physical activity, often walk barefoot on the ground and small stones, use orthopedic mats, buy safe shoes that do not squeeze the toe, because of 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 severe cases, surgical treatment is prescribed.More than 100 different patented methods have been developed for the treatment of hallux valgus.All are based on distal angular and proximal osteotomies with foot reconstruction 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, you can not only correct the deformity due to deviation of the finger, but also lengthen or shorten the bone if there is an accompanying pathology.As a result, it is possible to achieve a long phase of compensation or completely eliminate the pathology, maintain or restore joint functions.
Basic methods of surgical correction of hallux valgus:
- Corrective osteotomy of the first metatarsal bone (chevron, wedge, 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, the pain disappears, corns and calluses do not form, soft tissues do not swell, all components of the deformation are removed: 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.