Big toe deformity: treatment

Static foot deformity is a degenerative disease of the skeleton that seriously impairs its support functions.Usually, the load is not evenly distributed over the entire area of the sole, but is located along the main points and axes - from the heel tube along the outer edge to the toes.This structure ensures the formation of the arch of the foot - a set of bone and soft tissue structures that have shock-absorbing properties.

Accordingly, damage to this formation will lead to the development of a fairly common disease - flat feet.When mentioned, people often imagine a longitudinal pathological variation that causes the arch of the foot to drop along the inner edge.But the transverse form, accompanied by a characteristic curvature of the big toe, also implies flat feet.

This type of pathology occurs mainly in adult and elderly women, and is often acquired.It involves wearing uncomfortable or ill-fitting shoes, which over time contributes to displacement of the forefoot bones.The result of valgus hallux is constant unpleasant symptoms that occur to a person both when wearing familiar shoes and when walking normally.

Concept

In orthopedics, a valgus deformity is the deviation of any segment of the musculoskeletal system beyond the midline axis.In this case, curvature can also occur at the joints - then evaluate the direction of the angle between the bones.The development of transverse flatfoot corresponds exactly to this mechanism, eventually leading to irreversible damage to the metatarsal joint of the first toe.

Although the condition often develops over decades, patients still seek help at a later stage.Therefore, it is necessary to point out the inherent characteristics of hallux valgus:

1. The first and main symptom is curvature of the first metatarsal joint forming an outward opening angle.Pathological formation occurs gradually but progresses irreversibly.In the later stages of the disease, the deformity of the big toe reaches such a severe level that the angle of the joint becomes close to 90 degrees.
2. The next important sign is the formation of a characteristic “bone” located on the inside edge of the foot, where the metatarsal head normally protrudes slightly.Its appearance is associated with the compensatory displacement of this bone inward under the influence of gravity.
3. The latest manifestation is a hammer-curved second finger, also caused by pathological pressure from the adjacent joint and surrounding soft tissues.

Hallux valgus is characterized by the appearance of additional (non-permanent) signs - pain in the forefoot, gait disturbances, the appearance of dense calluses on the soles of the feet under the middle toes.

Formation mechanism

Like other degenerative bone diseases, flat feet go through two stages of development.At the first stage, only functional changes occur in soft tissues, leading to a decrease in their support and elastic properties.And at the second stage, deformations of joints or bones are already formed:

• The trigger is always improper forefoot loading due to wearing inappropriate shoes - especially shoes with narrow toes and heels.
• This leads to chronic damage to the soft tissues - the ligaments and muscles that hold the base of the toes and metatarsal bones in an elevated position.
• Repeated trauma causes the anterior arch to gradually lower, after which the maximum load begins to fall on the midfoot.
• In this case, there is a deviation of the peripheral metatarsal bones in the opposite direction.
• The first ankle joint usually bears the maximum load and therefore the pathological pressure on it is maximum.Its capsule gradually stretches, causing deeper medial displacement of the metatarsal.
• Joint stability decreases, leading to the formation of subluxation of the phalanx of the first finger.The progression of hallux valgus is precisely related to the slow and continuous progression of this process.
• Deformed soft tissues - ligaments and muscles - are fixed in this position over time, which explains the irreversibility of the curvature.
• Chronic injury leads to the development of deforming osteoarthritis of the first metatarsal joint, causing loss of joint function.

Further supportive tactics depend on the severity of the changes - in the early stages, conservative measures are sufficient, and in severe cases, only surgery can eliminate persistent deformity.

Conservative treatment

Valgus deformity of the big toe can only be eliminated by traditional methods if the function of the joint is completely preserved.This is explained by the condition of the ligaments and muscles, damage in the early stages is reversible.In this case, support is provided in three consecutive stages:

1. First, the patient is prescribed passive treatments, which include fixing the finger in the correct position.The joint is artificially returned to its normal shape, which is done using various orthopedic means.Usually this phase takes at least 6 months, necessary for the adaptation of soft tissues.
2. In the second phase, the active phase begins, which includes special training techniques to strengthen the calf muscles.To achieve this, physiotherapy classes, massage sessions and physiotherapy treatments are combined simultaneously.
3. The final period is indefinite, because hallux valgus is an incurable disease.Thus, the patient consolidates the results of treatment for the rest of his life and participates in preventing the progression of the disease.

The choice of means and method of therapy is purely individual - the patient's age, comorbidities as well as the characteristics of the curvature are taken into account.

Passive procedure

The first stage of treatment is the most difficult for the patient, since immobilization of the foot rarely occurs without the patient's attention.The return to the normal anatomical structure of the foot arch is much more difficult and noticeable than the development of pathology.For these purposes, the following means are used in orthopedics:

• The standard way to start helping is to completely eliminate shoes or boots with a narrow toe box.At this time, patients should only wear shoes that are loose, wide or open in the front.Tailoring orthopedic shoes is considered ideal, but patients can rarely afford such a luxury.
• For minor deformities, a special bandage made of adhesive plaster is applied to the back of the foot.It is fixed in such a way that when walking, external and internal misalignment of the bones of the foot is excluded.
• A more convenient and reliable option is orthopedic fixation of the foot - treatment in this case is much more effective.For this purpose, various types of orthotics or bandages are used, their stiffness is selected depending on the degree of deformation.

Wearing assistive devices is almost constant - during the first month, they should be removed for no more than 2 hours a day.

Aggressive procedure

The transition to the second stage is determined individually - after the doctor evaluates the symptoms, as well as X-ray examination. The lack of progression of the disease, as well as at least a little positive momentum, allows 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 surrounding soft tissues for the upcoming load.Warming and distraction procedures are performed, which can be used on the feet.These include laser, magnet, application with paraffin or ozokerite, ultrasound therapy.
• After a few days, massage sessions are added, starting with heating the superficial tissues.Gradually, the specialist should move on to warming up the actual muscles of the foot, which play an important role in eliminating the curvature.
• When unpleasant symptoms disappear completely, the patient proceeds to independent exercise.Do not include many exercises in the program at the same time to avoid causing muscle fatigue.It is better to increase the load gradually so that the soft tissues adapt to the work being performed.

To achieve full effect, the listed activities must be performed daily to prevent the return of pathological processes.

Surgical treatment

Indications for surgery must always be reasonable because long-term rehabilitation is required after the procedure.Therefore, they are not performed on patients in the early stages of hallux valgus, when the curvature of the finger can be corrected naturally.Surgical intervention is required only in cases where there are irreversible changes in the joint or surrounding tissues:

1. When there is a sign of fixed transverse flatfoot - that is, the anterior arch of the foot is deformed both during load testing and at rest.This conclusion appeared after X-rays evaluated the position of the metatarsal heads.
2. With pronounced curvature at the first metatarsophalangeal joint, accompanied by persistent dislocations between the bones that form it.The absolute sign 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 early signs of osteoarthritis in the first ankle joint, this indicates irreversible damage to the surrounding soft tissues.The muscles and ligaments are firmly fixed in a bad position, so it will not be possible to make conservative corrections.

The choice of intervention method depends entirely on the individual characteristics of the disease process - it is usually performed on the most affected part of the arch of the foot.

Ligament surgery

This surgical treatment option is more suitable for patients who have not shown signs of direct damage to joint tissue.Therefore, the leading mechanism of deformation in them becomes pathological muscle traction associated with changes in the position of the arch of the foot.To correct it, the following intervention options are used:

• The first type of surgery includes all forms of transposition (movement) of the tendons attached to the first metatarsal bone.It is the pathological contraction of the muscles that leads to a gradual increase in the deviation between it and the phalanx of the finger.Therefore, the ligament is excised or partially separated and attached to a new location - 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 position.
• The second type of operation involves the creation of various laces - creating an artificial transverse arch of the foot.All the bones of the foot are fixed in place, then part of another ligament or a synthetic prosthesis is sewn to them.But this option is only possible when the deformation is "slight", when the displaced bone can easily return to its original position.

According to the results of observations, all operations on the ligaments remain temporary in nature - if pathological factors are not corrected, the displaced tendons will quickly stretch again.

General activities

If the joint is significantly curved, orthopedic intervention is required to eliminate bone tissue defects.To do this, excision is performed - removal of some affected bone areas.This method makes it possible to artificially return the joint to its normal position.The following options for such operations are currently in use:

• The main method of eliminating deformity is Schede-Brandes osteotomy.This intervention includes two operations - removal of pathological growth on the first metatarsal (small bone) and removal of a triangular piece at its base.After fusion of bone tissue, the deformed finger will return to its normal position.
• Less commonly used are surgeries in which the excision of both areas is performed in the area of the metatarsal head.Because of the extensive damage, the risk of developing complications that prevent the fragments from healing is too high.
• In cases of progressive disease, palliative forms of intervention are performed - not restoring mobility, but eliminating pathological displacement.For this purpose, arthroplasty is performed - excision and closure of the joint cavity between the bones of the foot and the phalanges of the fingers.

Today, these interventions are rarely performed alone - they are often combined with concurrent tendonoplasty, which helps eliminate inappropriate muscle pulls.

Combined activities

Performing complex operations is a priority in modern orthopedics, leading to an increased frequency of combined interventions.Typically, a combination of gentle bone excision and relocation of one of the ligaments that move the thumb is performed:

• The modified Schede-Brandes surgery involves removing standard portions of the metatarsal bones - excision in the head and base areas.In addition, the abductor muscle is transferred to its outer surface, the pressure of which leads to subluxation.
• An osteotomy can also be performed in conjunction with the formation of an artificial arch.Furthermore, during an operation, it is possible not only to return the ankle bone to its original position, but also to return the remaining structures to their correct position.
• In severe cases, interventions are combined to simultaneously eliminate deformities in the first and second metatarsal joints.

This type of operation is characterized by the greatest severity - large volumes of destruction require long healing and increased recovery time.

Recover

Completion of conservative and surgical treatment is the beginning of the recovery phase, which will continue in these patients for the rest of their lives.If special recommendations are not followed, the disease may return, reminding yourself again with unpleasant symptoms:

1. First of all, all patients must wear special orthopedic insoles with additional Seitz pads.They not only ensure the correct position of the foot when walking, but also create additional support for the arch of the foot.
2. You also need to pay attention to your shoes - completely exclude from your wardrobe boots or shoes with a narrow front.
3. You need to pay attention to your weight - maintaining a normal body weight will significantly reduce the load on the arch of the foot.
4. Regularly perform daily preventive exercises to help the muscles stay in a normal state, preventing displacement of the bones of the feet.

The main difficulties for patients arise with the physiotherapy program, since most recent patients do not even know the exercise technique.Therefore, to perform them correctly, you first need to study with an instructor either individually or in a group.