Foot deformity with displacement of the big toe and protruding bones is one of the most common orthopedic pathologies.At first, the disease appears as a cosmetic defect and does not cause any particular problems, but if left untreated it progresses with age.The legs quickly get tired when walking, begin to ache, problems arise when choosing shoes, and correcting the defect even with surgery becomes more and more difficult.So let's start the treatmenthallux valgus (valgus foot)necessary as soon as the first signs of the disease appear.
Causes of hallux valgus
This is a multifactorial disease that develops due to genetic predisposition, other diseases of the musculoskeletal system, neurological and metabolic disorders and external factors.
Internal causes:
- Genetic predisposition to hallux valgus
- Horizontal and vertical flat feet
- Inflammatory processes (mainly arthritis: psoriatic arthritis, gout, rheumatoid arthritis)
- Congenital biomechanical instability of the foot
- hyperelasticity syndrome, connective tissue dysplasia
- Neurological diseases of various origins
- knee and hip deformities
External stimulating factors:
- injuries with sprained ligaments in the foot and ankle, joint damage and metatarsal fractures
- wearing anatomically incorrect high heels with narrow toes
- Occupational risks: carrying heavy objects for long periods of time, standing for long periods of time
Genetic predisposition to Hallux valgus itself is not considered a cause of the development of the disease, but is an increased risk factor that is almost always caused under negative external factors.
What happens with hallux valgus
Valgus deformity- is not only an aesthetic defect, but also causes many inconveniences for women due to limitations in shoe choice (the disease is more common in women than men).Changes occur throughout the musculoskeletal system of the foot, they progress gradually and after a while enter the irreversible stage.What happens to the feet?
- Spreads the feet, changes anatomical shape, reduces curvature.
- Displacement of the first metatarsal and increase in the angle between it and the second metatarsal.
- The big toe is at an angle relative to the first metatarsal bone, the tip of the big toe has the form of a protruding lump (therefore, Hallux valgus is often called a lump or bunion).
- Subluxation of the ankle joint, leading to rotation of the sesamoid bone.
- Violation of biomechanical indicators: decrease in indicators of movement and support functions.
- Changes in bones, cartilage tissue and entire joints.First of all, the area of the first metatarsal head is affected: tissues become more sensitive, bones become inflamed and painful, bursitis may develop and cartilage is destroyed.The lumen of the joint space narrows, a localized cyst develops with local osteoporosis.
Symptoms of Hallux valgus
The disease does not develop in a week or a month;From the onset of obvious pathology (in stage I, the toe is deviated from its normal position by 20-30°) to the third degree of hallux valgus (the big toe is deviated more than 40° and often overlaps the second toe) can take more than a decade.
External manifestations of the disease:
- The big toe is deviated laterally (outwards from the inner surface of the foot) and the bones protrude.
- Hammertoes (the 2nd and 3rd toes are deformed and become hammer-shaped, i.e. the joints are bent).
- Leg fatigue and pain often increase in the evening and at night.
Diagnose
Diagnosis is made based on data obtained during external examination and X-rays of the foot.To find out the cause of the development of the disease, the orthopedist collects a history (during a conversation, asks the patient about occupation, hereditary diseases, previous injuries, lifestyle, habits), recommends laboratory tests and consults with other specialists.In fact, hallux valgus can be caused by autoimmune and systemic diseases (e.g., rheumatoid arthritis), metabolic disorders, and neurological disorders.After an examination, during which accompanying diseases are usually diagnosed, treatment will be prescribed.
Treatment methods for hallux valgus
In the early stages of the disease (hallux valgus grade 1), conservative treatment is prescribed: exercise, wearing separate orthopedic insoles to prevent flat feet, massage, foot baths and medication.One should also wear an elastic fixator (first metatarsal head protector), called a valgus splint.For inflammation, physiotherapeutic treatment is prescribed: magnetic therapy, electrophoresis, paraffin therapy, etc., analgesics.
The orthopedist, if necessary, will give recommendations on changes in lifestyle and nutrition.For example, many patients need to switch to a diet to lose weight and not get sick.You should also limit excessive physical activity, regularly walk barefoot on the ground and kick small stones, use orthopedic mats, buy safe shoes that do not squeeze the toes, causing the legs to not bend, and the whole body's center of gravity does not move.
However, all conservative methods can only slow down the progression of the disease but cannot cure it forever.Therefore, in difficult cases, surgical treatment is indicated.More than 100 different proprietary methods for treating hallux valgus have been developed.All rely on distal and proximal osteotomies along with foot reconstruction to correct the deformity.To perform the surgery, the first metatarsophalangeal joint is exposed through an incision in the skin.Next, the surgeon cuts the bone and places it in the correct functional position.With the help of osteotomy, you can not only correct the deformity caused by finger misalignment, but also lengthen or shorten the bone if there is an accompanying pathology.As a result, it is possible to achieve a period of long-term compensation or complete elimination of the pathology, maintaining or restoring joint functions.
Basic methods of hallux valgus correction surgery:
- Corrective osteotomy of the first metatarsal (V-shaped, wedge-shaped, SCARF+Akin (with resection and rotation), Lapidus joint.
- Osteotomy using biological implants.
The final choice of treatment method can be made only after examination and determination of the degree of deformity as well as 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 position, cartilage is not destroyed, and the joint is not deformed.Patients can live a full life, play sports, walk, run and wear comfortable shoes.