hallux valgus deformity of the first toe (hallux valgus) – orthopedic pathology, in which there is a deformity of the great toe at the level of the medical plyusnefalangovogo in common with the deviation of the metatarsal head bone on the inner side, and the thumb on the external side.
The problem is not just aesthetic - when hallux valgus is twisted the first (large) finger on the progression of the pathology starts to shift the other fingers of the foot, which led to the development of their ductili deformation.
The disease eventually causes pathological changes in all structures of the foot (tendons, ligaments, bones and joints), which leads to the development of:
- deformavit osteoarthritis of the metatarsophalangeal joints;
- chronic bursitis (inflammation of the lining of the joint bursas);
- exostosises (benign osseous and cartilaginous fetus) the heads of the metatarsal bones;
- in combination or the transverse platypodia;
- varusnogo (indented inward) deviation of the I metatarsal bone.
Normal metatarsal bones are arranged strictly parallel to each other. Under the influence of negative factors, the first plyusnevaya bone is deformed and to the side (laterally), so that the foot formed the lump is small, there is disruption of the ligaments and tendons lose their elasticity.
Depending on the severity of the pathology secrete:
- In the early stage of the disease, where the deviation of the big toe to the side, which does not exceed 15 degrees.
- Middle phase, in which the deviation of the first toe does not exceed 20 degrees. There is a deformity of the second finger is shaped to remind of the hammer and the raised above the thumb.
- A serious stage in which the deviation of the thumb is 30 degrees. All fingers in this strain is on the basis of the first phalanx observed the lump is large in size and in areas of the foot, where is the maximum voltage that produces the rough calluses.
The reasons for the development of
The main factor that causes the development of hallux valgus, in mismatched shoes (close foot close formation, tight shoes with narrow toe or high heel shoes).
In addition, the development of the disease affect genetic factors and associated diseases.
The development of hallux valgus may be due to:
- injuries of the foot and lower leg;
- the congenital weaknesses of the muscular-ligamentous apparatus (in the observed connective tissue dysplasia, which is a systemic disease);
- polyneuropathy, rickets, cerebral palsy (is a secondary manifestation of underlying disease);
- platypodia or low the arch of the foot;
- arthritis (this is different joint damage, which are combined in a single group), which most often occurs in the elderly;
- psoriaticheskoj artropatii is a chronic inflammatory disease of the joints that is associated with psoriasis;
- gout is a metabolic disease, which is accompanied by the deposition of urate crystals in different tissues of the body;
- diabetes mellitus (endocrinarum is a disease in which the hallux valgus deformity develops due to the increased load on the foot and poor circulation in the extremities);
- the increased mobility of the joints that occurs when down syndrome and Marfan syndrome;
- multiple sclerosis (chronic autoimmune disease, which is accompanied by damage to myelin sheath of nerve fibres);
- disease Charcot-Marie-tooth - hereditary motor sensory neuropathy that results in muscle weakness and atrophy of muscles of distal extremities;
- professional excessive strain of the feet (observed in dancers, athletes, waiters, etc);
- osteoporosis is a chronic systemic disease of the skeleton, which was accompanied by a significant loss of bone mass;
- the rapid growth of the foot in the period pubertata (juvenile hallux valgus deformity of the fingers).
When valgus deformity of the first toe angle between the first and second metatarsal bones increases, there is a shift of the I-th metatarsal bone. While the big toe, that is the adductor muscle, begins to move outwards, and the head of the bone in the form of bone (blow blow).
Bump does not allow the thumb to be or the norm (look inside), and the finger is gradually deflected to the outside.
Punch is constantly under friction and pressure when wearing the shoes, which leads to inflammation of the lining of the bag of the first metatarsophalangeal joint (bursitis).
Constant pressure causes a change in the bone tissue in the head of the I-th metatarsal bones, swelling, sensitivity, and hypersensitivity "bones" and the tissue around it.
Improper angle and change the location of the thumb cause premature wear of the main joint, loss of cartilage and a significant increase in bone increase in size. Increasing the "bones" leads to more trauma and further development of the pathology.
Symptoms depend on the stage of the disease.
In the initial phase, observed:
- the increase in "bones" in the region of the metatarsophalangeal joints;
- pain in the proximal (second from the nail end) of the divisions of the phalanges of the fingers, which intensifies when walking;
- redness and swelling of the skin in the area of "bones".
The average rate is accompanied by:
- the development of inflammation of the joints;
- the pain and swelling;
- formation of growths in the head of the metatarsal bone;
- education dry calluses under the middle finger phalangem.
In advanced, severe stage observed:
- sharp, debilitating pain in the big toe and sole of the foot;
- a well visible increased "bones" (ship-growth);
- cornification of the skin and formation of calluses under the second and third falangami fingers.
The diagnosis of hallux valgus include:
- The study of the history of the disease. During the conversation, the doctor explains what the symptoms bothering the patient. Also the doctor asked, what the factors that trigger the pain (physical activity, wearing shoes, walking), and if the history of injury, some systemic, metabolic and hereditary diseases, arthritis.
- External review, in which the doctor monitors gait of the patient (as is determined by the degree of pain and associated with an abnormal gait, visual disturbances), who studied the position of the first toe of the foot in relation to the other fingers (you can experience a variety of projections, that extends from the joint ligaments), examines the other toes of the foot and the affected area (swelling and redness, which are indicative of the pressure of the shoes). The doctor also checks the range of motion of the thumb in the metatarsal joint, presence of pain, and crepitations (normal dorsiflexion is between 65-75 degrees and plantar flexion less than 15 degrees). The presence of pain and the absence of crepitations is a symptom of synovitis (synovial inflammation of the membrane of the joint), and thickening of the Horny layer (keratosis) evidence of abnormal pressure due to inappropriate behaviour. He studied and changes in the movement of the thumb (when it is bent back, as you move away from the chest in the transversal and frontal plane), and the condition of the skin and peripheral pulse.
- X-rays, which allows to determine the degree of deformation and to identify subluxation and comorbidities. X-ray of the foot done in 3 projections.
If you want to exclude poor circulation, which is prescribed vascular ultrasound to exclude associated diseases and in the preparation for surgical treatment can prescribe laboratory tests and CT.
Treatment of valgus deformation of the thumb is to be conservative and surgical.
Conservative treatment is only effective in the early stages of the disease. It starts with the selection of the appropriate model of Shoe which will not cause the load and the friction (the initial stage of the disease the wearing of the samples with a wide toe stop further development of disease).
Your doctor may recommend the use of:
- special ring for the Bursa (joint capsule) of the thumb, which reduce the pressure of the shoes;
- spacer orthopedic products, locking finger, and changing the load distribution on the foot;
- arch support, proofreaders toes, interdigital folds, prevents further deformation.
When severe deformation of the orthopedic products are you can reduce the pain, but for relief of pain use of those products not.
Treatment with the inflammatory process include:
- the use of nonsteroidal anti-inflammatory medications;
- corticosteroid injections;
- physiotherapy (electrophoresis with calcium, ozokerito-paraffin baths, phonophoresis of hydrocortisone);
- shock-wave treatment.
It is also recommended that:
- massage, eliminates spasms and restore mobility of the joint;
- specific exercises;
- walking and running barefoot.
Surgical treatment is used for moderate to severe disease and failure of conservative treatment (as the disease is a chronic, slowly progressive nature, surgical methods are also recommended in mild hallux valgus).
The elimination of pathology uses a set of operational methods, which are aimed at:
- elimination of bursitis of the first toe;
- engineering bones that make up the big toe;
- the trim is located around the joint muscles to prevent a recurrence.
With moderately severe deformation during the surgical intervention can remove only the outgrowth in the articular capsule. During the operation the growth is removed through a small incision in the area of bursitis by using a special surgical drill, after which the bone is aligned and the incision is closed with stitching.
It is also possible the reconstruction of the big toe and metatarsal bone.
The need after the renewal of the metatarsal bone is dependent on the angle between the first metatarsal and the second bone (if this exceeds 13 degrees, to rebuild needed).
Rehabilitation takes about 8 weeks. In this period it is advisable to place the affected leg in a special brace or Shoe with a wooden sole (this will remove the likelihood of injury to the operated area and will allow normal tissue to regenerate). Directly after the surgery the patient may need crutches.
In severe bursitis perhaps the appointment physiotherapy, some time after the surgery (about 6 treatments). The use of proofreaders and wearing shoes with an extended front part allows to quickly restore normal walking.
Prevention of hallux valgus include:
- Improve the blood flow in the foot bath with the addition of herbal decoctions or sea salt.
- The wearing of comfortable footwear (for the correct position of the joints during walking deformity is rare), or the use of orthotic insoles.
- Proper nutrition (total damage, which may be due to excess weight or eat a certain food for gout).
- Physical exercise helps to keep the tone of the legs.