Valgus deformity of the big toe

Hallus valgus (valgus deformity of the big toe) is a situation in which it is shame that the knuckle of the thumb. This disease is often called bunion big toe. Bursitis is the big toe is associated with the formation of bone growth in response to injury. In fact, Hallus valgus is not only a response to trauma. It is interesting that this disease almost never occurs in cultures that do not wear shoes. Narrow shoes such as high heels and cowboy boots, can contribute to the development of valgus deformity of the big toe. Wide shoes, with space for the toes, lessen the opportunities for developing the deformity and help reduce the irritation on the bunion big toe, if present.

Hallux valgus

The term Hallus valgus actually describes what happens to the big toe. Hallus - the medical term for big toe, and valgus anatomic term that means the deformity is a deviation away from the midline of the body. So in hallux valgus the big toe to the outer side of the foot. The progression of this process there are also other changes. One of these changes is that the bones, which is over a thumb, the first bone begins to deviate more in the other direction. This bone is called primus varus. Primus means the first bone, and varus is the medical term which means that the deformation is manifested by a deviation from the midline of the body.This creates a situation where the first bone and the big toe now form an angle against the line on the inner edge of the foot. Bursitis is the big toe which develops first, it is actually a response to pressure from the shoes. The first response to trauma is an area of irritated, swollen tissue that is constantly rubbing between the shoes and the bones under the skin. Over time, constant pressure can cause thickening of the bone tissue, which increases swelling and more friction about the footwear.

Reasons

A lot of the problems that occur in the legs, which are the result of abnormal pressure or friction. The easiest way to find out the presence of pathological consequences of stress is an overview of the forefoot. The leg is solid bone covered with skin. In most cases the symptoms develop gradually as the skin and soft tissues absorb excess impact on the foot. All of the bulging bone injury or aggravate existing injury. The skin responds to friction and pressure, forming blisters. The soft tissue under the skin response to excessive load. And corn and thickened soft tissue beneath the corn becomes painful and inflamed. Reduce pain promotes the reduction of pressure. The pressure may be reduced from the outside because of the more loose shoes or inside due to surgery and removal of excess tissue.

Risk factors

  • The shoes affect the frequency of occurrence of hallux valgus big toe (this is lower in adults who don't wear shoes). However, this does not mean that the footwear causes the condition. Constricting shoes can cause pain and nerve entrapment foot nerve along with the formation of hallux valgus. Fashionable shoes may be too short and too narrow, that "the foot look aesthetically pleasing". High heels increase the load on the foot, which further exacerbates the problem. And adhere to fashion trends not only young people, but also people in the older age groups. Risk factors can be divided into primary:
  • Shoes
  • A high probability of hallux valgus in women. The reason may be the shoes.
  • In the dancers, who spend a lot of time on the blocks, dancing on the toes, and so you can expect a higher likelihood of hallux valgus
  • Age. The frequency of the voltage, increases with age, with the rate of 3% of people aged 15-30 years, 9 % of people aged 31-60 years, and 16% of those over 60 years old 1
  • Genetic factors have a certain value
  • Related diseases

There are some of the reasons for biomechanical instability, including neuro-muscular diseases. This can be caused by arthritis of different types. These associated diseases include:

  • Gout.
  • Rheumatoid arthritis.
  • Psoriatic arthropathy.
  • Overall, the high mobility associated with diseases, such as Marfan syndrome.
  • Multiple sclerosis.
  • Cerebral palsy.

Symptoms

Symptoms of hallux valgus are mostly caused by bursitis big toe. Bursitis is the big toe is very painful. In severe valgus deformity of the big toe appears and a cosmetic problem. In addition, the selection of shoes is difficult, especially for women, who want to be fashionable and wearing fashionable shoes becomes a real challenge. Finally, the increase in strain begins to move, the second toe and can create the conditions for the friction of the other fingers on the shoes.

Diagnosis

History

  • The patient may experience pain in the big toe when walking or any movement. This may indicate a degeneration of articular cartilage.
  • The pain can be a pain in the area of shank due to the wearing of shoes. It is possible to increase the deformation.
  • You need to find out what exercise can increase pain and what relieves the pain ( maybe only the removal of shoes).
  • History of trauma or arthritis.
  • Very rarely severe pain, or a tingling sensation in the dorsal region of the Bursa of great toe, which may indicate a traumatic neuritis in the middle of the cutaneous nerve.
  • The patient may also describe symptoms caused by the deformity, such as a painful second toe, interdigital keratosis, or ulceration.
Symptoms of hallux valgus

External review

  • You need to take into account walking patient. This will help to determine the degree painful manifestations, and possible gait disturbances, associated with problems in the legs.
  • The position of the thumb to the other leg. The distortion of the joint may be in different projections.
  • The emphasis of the joint. Erythema or swelling indicates the pressure of the Shoe and the irritation.
  • Range of motion of the thumb in the joint. And it is necessary to pay attention are pain, crepitus. Pain without the crunchy sound suggests the presence of synovitis.
  • The possible presence of keratosis, which include pathological rubbing of inappropriate behaviour.
  • The associated deformations can also involve other toes of the foot and a flexible or rigid flat feet. This deformation can result in faster progression of the hallux valgus great toe, reducing lateral support of the foot.

Changes in motion in the big toe joint:

  • The increase of abduction in the thumb side of the foot in the transverse and frontal planes.
  • The increase in the average emphasis on the toes.
  • Changes in the bending of the back of the joint.

In addition, you must pay attention to the condition of the skin and peripheral pulse. Good circulation, especially in regard to this, if you plan for the surgical treatment, and you will have normal healing of the surgical wound.

Research

X-ray allows you to see the degree of deformation and may indicate subluxation of the joint. If necessary, exclusion of other diseases, which can be placed in the CT. Ultrasound is required for research vessels, if you suspect poor circulation. In laboratory tests, to define, to exclude associated diseases and in the preparation for surgical treatment.

Treatment

Conservative Treatment

Treatment of valgus deformation of the thumb, almost always, to start by picking a comfortable Shoe that does not cause friction or load. In the early stages of Hallus valgus wearing shoes with a wide front part can stop the progression of the deformity. As the pain is caused by bursitis big toe due to pressure from the Shoe, treatment focuses on removing the pressure that the shoes has to deformation. Wider shoes reduces pressure on bunions big toe. Strap for Bursa of big toe may reduce the pressure and friction from shoes. There are also numerous devices, such as a push-in orthopedic products that strengthen the finger and change the load distribution on the foot.

Drug treatment and physiotherapy

Nonsteroidal anti-inflammatory drugs and physiotherapy can be prescribed to reduce inflammation and relieve pain. In addition, it is possible injection of corticosteroids. Long-term treatment is not of proven therapeutic effectiveness.

Orthopedic products

Perhaps the use of different orthotic devices ( insoles, factors the toes, the interdigital rolls ).The use of orthoses helps in the early stages, to stop further deformation. When severe deformation of the use of orthotic devices can only reduce some pain. Individual insoles to help fix the broken arch of the foot.

If the deformation due to metabolic disturbances or systemic disease should be treatment is aimed at correction of the underlying disease with the involvement of a rheumatologist or endocrinologist.

Surgical treatment

If all conservative measures are not effective, the decision about surgical treatment. Currently, there are more than 100 operational methods for the treatment of Hallus valgus.The main objectives in the surgical treatment of the following:

  • if you want to remove a bunion the big toe
  • to rebuild the bones that make up the big toe
  • to balance the muscles around the joint, so that there was no recurrence of the deformity
Treatment

Remove "build-up"

In some mild cases the formation bunion big toe, the operation can only be removed with the construction of the bag of the joint. This operation is performed through a small incision on the side of the leg at the area of the bunion of great toe. When the skin is removed cut the knot with a special surgical drill. The bone is aligned and the skin incision sutured with small stitches.

It is more likely that the reconstruction of the big toe will also be required. The most important decisions that must be made is whether it is necessary for cutting the bone and also for reconstruction. To address this issue is the value of the angle between the first and second bones.The normal angle is about nine or ten degrees. If the angle is 13 degrees or more, is likely to be cut apart and rebuild the bones. When the surgeon cuts and the production of displacement of the bone, is a surgical procedure designed to eliminate deflection or to improve the function of the musculoskeletal system for the artificial fracture. There are two basic methods used to perform the osteotomy and reconstruction of the first bone.

Distal Osteotomy

In some cases, the distal end of the bone is cut and moved laterally. This allows you to effectively reduce the angle between the first and second bones. This type of operation usually requires one or two small incisions in the leg. When the surgeon achieves a satisfactory position of the bone, the osteotomy accompanied by a clip of the bones with metal pins. After surgery and treatment pins are removed( this is usually removed within 3-6 weeks after surgery).

The proximal osteotomy

In other situations, the first bone cut in the proximal end of the bone. This type of operation usually requires two or three small incisions in the leg. When the skin is cut, the surgeon performs the osteotomy. Bone undergoes reconstruction and is limited on time, the metal pins. This operation also decreases the angle between bones. Alternatively, release of the tendon of the muscle that causes the big toe. Therefore, after the operation a special bandage is worn.

Rehabilitation after surgery

You need an average of 8 weeks, for the treatment of soft tissue and bone. The foot on this period, it is better to put in the footwear with wooden soles or a special brace in order to remove the damage of the operated tissues and to allow the normal regeneration. Immediately after the surgery, you may need crutches.

In patients with severe bursitis, over time after surgery can be awarded to physical therapy (6-7 treatments). In addition, you need to wear shoes with an extended front. We also use proofreaders. All of this can enable a quicker return to normal walking.

12.08.2018