Static foot deformities are degenerative diseases of the skeleton that seriously compromise its support functions.Normally, 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 tubercle along the outer edge to the toes.This structure ensures the formation of the arch of the foot, a set of bone formations and soft tissues that have shock-absorbing properties.
As a result, damage to this formation leads to the development of a fairly common disease - flat feet.When we talk about it, we usually imagine a longitudinal variant of the pathology, which causes the arch of the foot to lower along the internal 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, being often an acquired condition.It is associated with the use of uncomfortable or ill-fitting shoes, which over time contribute to the displacement of the bones of the forefoot.The result of hallux valgus is constant unpleasant symptoms that accompany a person both when wearing familiar shoes and when walking normally.
Concept
In orthopedics, valgus deformity is the deviation of any segment of the musculoskeletal system outward from the median axis.In this case, a curvature in the joints may also occur, so the direction of the angle between the bones is evaluated.The development of transverse flatfoot corresponds precisely 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 later stages.Therefore, it is necessary to indicate the characteristic features inherent in hallux valgus:
- The first and main symptom is the curvature of the first metatarsophalangeal joint with the formation of an open angle towards the outside.The formation of the pathology occurs gradually, but progresses irreversibly.In the later stages of the disease, the deformity of the big toe reaches such severity that the angle of the joint reaches almost 90 degrees.
- The next important sign is the formation of a characteristic “bone” located on the inside edge of the foot, where the head of the metatarsal bone normally protrudes slightly.Its appearance is associated with a compensatory deviation of this bone inward under the force of gravity.
- The last manifestation is a hammer-like curvature of the second toe, also caused by the pathological pressure of 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 sole under the middle toes.
Training mechanism
Like other degenerative diseases of the skeleton, transverse flatfoot passes through two phases in its development.In the first phase, only functional changes occur in the soft tissues, leading to a decrease in their support and elastic properties.And in the second stage, deformations of the joints or bones themselves are already formed:
- The trigger is always an improper load on the forefoot due to the use of inappropriate shoes, especially those with narrow toes and heels.
- This leads to chronic damage to the soft tissues: the ligaments and muscles that keep the base of the toes and metatarsals in an elevated position.
- Repeated trauma causes the front arch to gradually lower, after which the maximum load begins to fall on the midfoot.
- In this case, a deviation of the peripheral metatarsal bones in opposite directions occurs.
- 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 inward.
- The stability of the joint decreases, which leads to the formation of subluxation of the phalanx of the first finger.The progression of hallux valgus is precisely associated with the continuous and slow course of this process.
- The deformed soft tissues - ligaments and muscles - are fixed in this position over time, which explains the irreversibility of the curvature.
- The chronic injury leads to the development of deforming arthrosis of the first metatarsophalangeal joint, which causes the loss of the functional capabilities of the joint.
Further assistance tactics depend on the severity of the changes: in the initial stages, conservative measures are sufficient, and already in advanced cases only surgery will eliminate the persistent deformity.
Conservative treatment
Valgus deformity of the big toes can be eliminated with traditional methods only if the functionality of the joint is completely preserved.This is explained by the condition of the ligaments and muscles, damage to which at an early stage is reversible.In this case the assistance is provided in three subsequent phases:
- First, the patient is prescribed passive treatment methods, which involve fixing the finger in the correct position.The joint is artificially brought back to its normal configuration, which is performed using various orthopedic means.Usually this period lasts at least 6 months, necessary for the adaptation of the soft tissues.
- In the second phase, the active phase begins, which involves special training techniques to strengthen the foot muscles.To achieve this, physiotherapy classes, massage sessions and physiotherapy procedures are combined simultaneously.
- The final period is indefinite, since hallux valgus is an incurable disease.Thus, the patient consolidates the results of the treatment for the rest of his life and is committed to preventing the progression of the disease.
The choice of therapeutic means and methods is completely individual: the age of the patient, concomitant diseases and the characteristics of the curvature itself are taken into account.
Passive procedures
The first phase of treatment is the most difficult for the patient, since fixation of the foot rarely occurs without the patient realizing it.The return to the normal anatomical structure of the arch of the foot is much more difficult and evident than the development of the pathology.For these purposes, the following means are used in orthopedics:
- The standard to start helping is to completely eliminate shoes or boots that have a narrow toe box.Now the patient will have to use only loose, wide or open-front shoes.Individual making of orthopedic boots is considered ideal, but it is extremely rare for patients to be able to afford such a luxury.
- For minor deformities, a special adhesive plaster bandage is used, which is applied to the back of the foot.It is fixed in such a way that when walking the external and internal deviation of the metatarsal bones is excluded.
- A more comfortable and reliable option is orthopedic fixation of the foot - the treatment in this case is much more effective.For this purpose, various types of orthoses or bandages are used, the rigidity of which is selected depending on the degree of deformation.
The use of support devices should be almost constant: during the first month it is recommended to remove them for no more than 2 hours during the day.
Active procedures
The transition to the second phase is determined individually, after a doctor evaluates the symptoms and an x-ray examination.The absence of progression of the disease, as well as at least a slight positive dynamics, allows us to start an active fight against the deformity.For this purpose, the following methods are used:
- First, physical therapy procedures are gradually introduced to prepare the joint and surrounding soft tissues for the upcoming load.Warming and distraction procedures are performed that can be used on the foot.They include laser, magnet, paraffin or ozokerite applications, ultrasound therapy.
- After a few days, massage sessions are added which begin with the superficial heating of the tissues.Gradually, the specialist should proceed to warming up the actual muscles of the foot, which play an important role in eliminating the curvature.
- When the unpleasant symptoms completely disappear, the patient proceeds to independent physical exercise.It is not recommended to include many exercises in the program at the same time, so as not to cause muscle fatigue.It is best to gradually increase the load, allowing the soft tissues to adapt to the work being done.
To achieve the full effect, the listed activities must be carried out daily to avoid the return of pathological processes.
Surgical treatment
Indications for surgery should always be justified, since 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.Surgery is necessary only in case of irreversible changes in the joint or surrounding tissues:
- When there are signs of fixed transverse flatfoot, i.e. the front arch of the foot deforms both during load tests and in the rest position.This conclusion is obtained after a radiographic examination that evaluates the position of the heads of the metatarsal bones.
- With pronounced curvature in the first metatarsophalangeal joint, accompanied by a persistent dislocation between the bones that form it.The absolute indication in this case is a further curvature of the adjacent joint, which leads to a change in the position of the second finger.
- Even with the first signs of arthrosis in the first metatarsophalangeal joint, which indicates irreversible damage to the surrounding soft tissues.The muscles and ligaments are firmly fixed in a vicious position, so it will not be possible to carry out the correction conservatively.
The choice of method of intervention 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 surgeries
This surgical treatment option is best suited to those patients who do not yet have signs of direct damage to the joint tissues.Therefore, the main mechanism of deformation in them becomes pathological muscle traction associated with a change in the position of the arch of the foot.To correct it, the following intervention options are used:
- The first type of operations includes all forms of transposition (movement) of the tendons attached to the first metatarsal.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 removed or partially divided and fixed in a new place - in the area of \u200b\u200bthe outer edge of the metatarsal bone.Changing the point of application of muscle force allows it to gradually return to its original position.
- The second type of operation involves the creation of various types of laces - the creation of an artificial transverse arch of the foot.All metatarsal bones are fixed in the correct position, after which a section of another ligament or a synthetic prosthesis is sewn to them.But this option is possible only with “light” deformation, when the displaced bones can be easily returned to their original position.
According to the results of observations, all operations on the ligaments are still temporary in nature: without correction of pathological factors, the displaced tendons quickly stretch again.
Joint operations
If there is a significant curvature in the joint, orthopedic interventions are required to eliminate bone tissue defects.To do this, resections are performed: removal of certain areas of the affected bone.This method allows you to artificially return the joint to its normal position.The following options are currently used for such operations:
- The main method to eliminate the deformity is the Schede-Brandes osteotomy.This operation includes two manipulations: the removal of the pathological growth on the first metatarsal bone (ossicles) and the resection of a triangular fragment at its base.After fusion of the bone tissue, the deformed finger returns to its normal position.
- Less commonly used are operations in which the resection of both areas is performed in the area of the metatarsal head.Due to the massive damage, the risk of developing complications that will not allow the fragments to heal properly is too high.
- In advanced cases of the disease, palliative forms of intervention are performed, not restoring mobility, but eliminating the pathological displacement.For this purpose, arthrodesis is performed: excision and closure of the joint cavity between the metatarsal bone and the phalanx.
Nowadays, these interventions are rarely performed in isolation: they are usually combined with simultaneous tendon plastic 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.Typically, a combination of gentle bone resection and repositioning of one of the ligaments that move the thumb is performed:
- The modified Schede-Brandes operation involves the removal of standard sections of the metatarsal bone - resection in the area of the head and base.In addition, the abductor inch muscle is transposed onto its outer surface, the pressure of which leads to subluxation of the joint.
- It is also possible to perform an osteotomy in combination with the formation of an artificial arch.Moreover, in a single operation it is possible not only to return the metatarsal bone to its original position, but also to give the remaining structures the correct position.
- In more severe cases, operations are combined to simultaneously eliminate the deformities of the first and second metatarsophalangeal joints.
This type of operation is characterized by the greatest severity: a large volume of destruction requires a long recovery and increases the rehabilitation period.
Recovery
The completion of conservative and surgical treatment is the beginning of the recovery period, which continues in these patients for the rest of their lives.Without following special recommendations, the disease can recur, reminding itself again with unpleasant symptoms:
- First, all patients must wear special orthopedic insoles with additional Seitz reinforcements.Not only will they ensure the correct position of the foot while walking, but they will create additional support for his arches.
- You also need to pay attention to your shoes: completely exclude boots or shoes with a narrow front from your wardrobe.
- You need to take care of your weight: maintaining a normal body weight significantly reduces the load on the arches of the feet.
- Regular performance of preventive daily exercises keeps the muscles in a normal tone, preventing displacement of the metatarsal bones.
The main difficulties for patients arise with the physical therapy program, since most recent patients do not even know the exercise technique.Therefore, to perform them correctly, you must first study with an instructor individually or in a group.