Foot deformity with displacement of the big toe and protruding bone is one of the most common orthopedic pathologies.At the beginning the disease manifests itself as a cosmetic defect and does not cause particular 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 (valgus foot)necessary as soon as the first signs of the disease appear.
Causes of hallux valgus
It 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
- transversal and longitudinal flat foot
- inflammatory processes (mainly arthritis: psoriatic arthropathy, gout, rheumatoid arthritis)
- congenital biomechanical instability of the feet
- hyperelasticity syndrome, connective tissue dysplasia
- neuropathies of various origins
- deformation of the knee and hip joints
External provoking factors:
- injuries with sprain of the ligaments of the foot and ankle, damage to the joints and fractures of the bones of the foot
- wearing anatomically incorrect shoes with high heels and narrow toes
- occupational risks: prolonged transport of heavy objects, prolonged standing
The hereditary predisposition to hallux valgus in itself is not considered the cause of the development of the disease, but it is an increased risk factor that is almost always triggered in the presence of negative external factors.
What happens with hallux valgus
Valgus deformity- not just a cosmetic defect, which causes many inconveniences to women 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 progresses and after some time enters an irreversible phase.What happens to the foot?
- Widening of the foot, modification of the anatomical shape, reduction of the curvature.
- Displacement of the first metatarsal bone and increase in the angle between it and the second metatarsal bone.
- Deviation of the big toe at an angle to the first metatarsal, the head of which takes the form of a protruding bump (therefore, hallux valgus is often called a bump or bunion).
- Subluxation of the metatarsophalangeal joint, leading to rotation of the sesamoid bones.
- Violation of biomechanical indicators: decrease in indicators of motor and support functions.
- Changes in the bones, cartilage tissue and the entire joint.First of all, the area of the head of the first metatarsal suffers: the tissues become more sensitive, the bones become inflamed and hurt, bursitis can 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 onset of a clearly visible pathology (in stage I the big toe deviates by 20-30° from the normal position) to the third degree of hallux valgus (the big toe deviates by more than 40° and is usually superimposed on the second) more than a decade can pass.
External manifestations of the disease:
- Lateral deviation of the big toe (outward from the inner surface of the foot) and protrusion of the bone.
- Hammertoe (the 2nd and 3rd toes deform and become hammertoe, i.e. they bend at the joints).
- Leg fatigue, pain, which often intensifies in the evening and at night.
Diagnostics
The diagnosis is made based on the data obtained during an external examination and an 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
In the initial stage of the disease (hallux valgus grade 1), conservative treatment is prescribed: gymnastics, use of 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), called valgus splints.For inflammation, physiotherapeutic treatment is prescribed: magnetotherapy, electrophoresis, paraffin therapy, etc., painkillers.
The orthopedist, if necessary, will provide recommendations on changes in lifestyle and nutrition.For example, many patients have to switch to diet food in order to lose excess weight and not cause disease.It is also advisable to limit excessive physical activity, often walk barefoot on the ground and on small stones, use orthopedic mats, buy safe shoes that do not pinch the toe, thanks 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 eliminate it forever.Therefore, in difficult cases, surgical treatment is prescribed.More than 100 different patented methods have been developed for treating bunions.All rely on distal angular and proximal osteotomies with foot reconstruction 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, it is not only possible to correct the deformity due to deviation of the finger, but also to lengthen or shorten the bone in the presence of concomitant pathologies.As a result, it is possible to achieve a long compensation phase 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 (chevron, cuneiform, SCARF+Akin (with resection and rotation), Lapidus arthrodesis.
- Osteotomy with bioabsorbable implants.
The final choice of treatment method can be made only after examination and determination of the degree of deformation and the individual clinical and radiological picture.
After the corrective osteotomy, the support function is restored, the pain disappears, corns and calluses are not formed, the soft tissues do not swell, all components of the deformation are eliminated: the finger returns to its anatomically correct position, 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.