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 it is not treated, it progresses with age.The legs quickly get tired when walking, pain begins, the problem of choosing shoes arises, and it becomes more and more difficult to correct the defect even with surgery.Therefore, start treatmenthallux valgus (foot valgus)necessary 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 flatfoot
- 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, damage to joints and fractures of the bones of the foot
- 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 almost always triggers 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 restrictions 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 enter an irreversible stage.What happens to the foot?
- Spreading of the foot, 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.
- 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 lumps or bunions).
- Subluxation of the metatarsophalangeal joint, which leads to rotation of the sesamoid bones.
- Violation of biomechanical indicators: decreased 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 hurt, bursitis can develop, and cartilage is destroyed.The lumen of the joint space narrows, focal cystosis develops with local osteoporosis.
Symptoms of Hallux valgus
The disease does not develop in a week or a month; from the onset of a clearly visible pathology (at 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 usually superimposed on the second) can take more than one decade.
External manifestations of the disease:
- Deviation of the big toe to the side (outward from the inner surface of the foot) and 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 of the legs, pain, which often intensifies in the evening and at night.
Diagnostics
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 collects 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 disorders, and neurological disorders.After an examination, during which concomitant diseases are often diagnosed, treatment is prescribed.
Treatment methods for hallux valgus
At the initial stage of the disease (grade 1 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), which are called valgus splints.For inflammation, physiotherapeutic treatment is prescribed: magnetotherapy, electrophoresis, paraffin therapy, etc., painkillers.
The orthopedist, if necessary, will give recommendations on changes in lifestyle and nutrition.For example, many patients need to switch to diet food in order to lose excess weight and not provoke illness.It is also advisable 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, 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 get rid of it forever.Therefore, in difficult cases, surgical treatment is prescribed.More than 100 different proprietary methods for the treatment of hallux valgus have been developed.All are based on distal angular and proximal osteotomies with reconstruction of the foot to correct the deformity.To perform surgery, the first metatarsophalangeal joint is exposed through an incision in the skin.Next, the surgeon cuts the bone and places it in the functionally correct position.With the help of osteotomy, you can not only correct deformity due to deviation of the finger, but also 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, 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 an 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.