hallux valgus deformity of the first toe (hallux valgus) – orthopedic pathology, in which there is deformity of the great toe at the level of the medial plyusnefalangovogo joint with deviation of the metatarsal head bone on the inside, and thumb to exterior side.
The problem is not just aesthetic - when hallux valgus is twisted first (large) finger on the progression of the pathology begins to shift the other fingers of the foot, provoking the development of their ductili deformation.
The disease eventually causes pathological changes in all structures of the foot (tendons, ligaments, bones and joints) that leads to the development of:
- deformavit of osteoarthritis of the metatarsophalangeal joints;
- chronic bursitis (inflammation of the mucous joint bursas);
- exostosises (benign osseous and cartilaginous fetus) of the heads of the metatarsal bones;
- combined or transverse platypodia;
- varusnogo (shifted inward) deviation of the I metatarsal bone.
Normal metatarsal bones are arranged strictly parallel to each other. Under the influence of negative factors first plyusnevaya bone is deformed and deflected to the side (laterally), so that the foot formed the lump is small, there is dysfunction of the ligaments and tendons lose their elasticity.
Depending on the severity of the pathology secrete:
- The early stage of the disease, where the deviation of the big toe to the side 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 — it's shaped to remind a hammer and elevated above the thumb.
- Serious stage in which the deviation of the thumb is 30 degrees. All the toes in this strain at the base of the first phalanx observed the lump is large in size and in areas of the foot where there is the greatest tension produced rough calluses.
The reasons for the development
The main factor that causes the development of hallux valgus, is the mismatched shoes (tight foot tight formation, tight shoes with narrow toe or high-heel shoes).
In addition, the development of disease influenced by genetic factors and associated diseases.
The development of hallux valgus may be the result of:
- injuries of the foot and lower leg;
- congenital weakness of the muscular-ligamentous apparatus (observed in connective tissue dysplasia, which is a systemic disease);
- polyneuropathy, rickets, cerebral palsy (is a secondary manifestation of underlying disease);
- platypodia or low foot arch;
- arthritis (this is different joint damage, which are combined into one 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 that is accompanied by the deposition of urate crystals in various 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 fibers);
- disease Charcot-Marie-tooth - hereditary motor sensory neuropathy, which is manifested in muscular 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 during the period pubertata (juvenile hallux valgus deformity of the finger).
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, which is the adductor muscle, begins to move outward, and the head bone to form bone (bump bump).
Bump does not allow the thumb to be respectively the norm (to look inside), and the finger is gradually deflected to the outside.
Bump is constantly under friction and pressure when wearing shoes, leading to inflammation of the mucous bag of the first metatarsophalangeal joint (bursitis).
Constant pressure causes a change in bone tissue in the head of the I-th metatarsal bones, swelling, tenderness, and hypersensitivity "bones" and the tissue around it.
Improper angle and change the location of the thumb provoke premature wear of the main joint, loss of cartilage and a significant increase in bone increase in size. The increase in "bones" leads to increased trauma and further development of the pathology.
Symptoms depend on the stage of the disease.
At the initial stage observed:
- the increase in "bones" in the region of the metatarsophalangeal joints;
- pain in the proximal (second from the nail end) the divisions of the phalanges of the fingers, which intensifies when walking;
- redness and swelling of the skin in the area of "bone".
The average stage is accompanied by:
- the development of the joint inflammation;
- pain and swelling;
- formation of growths in the head metatarsal bone;
- education dry calluses under the middle finger phalangem.
In advanced, severe stage observed:
- sharp, debilitating pain in the big toe and the sole of the foot;
- well visible increased "bone" (ship-growth);
- cornification of the skin and formation of calluses under the second and third falangami fingers.
Diagnosis of hallux valgus include:
- The study of the history of the disease. During the conversation, the doctor clarifies which symptoms bother the patient. Also the doctor asked what factors trigger pain (physical activity, wearing shoes, walking) and whether history of injury, some systemic, metabolic and hereditary diseases, arthritis.
- External examination during which the doctor monitors gait of the patient (thus is determined by the degree of pain and associated with abnormal gait disturbance), studying the position of the first toe of the foot in relation to the other fingers (can experience different projection of the stretching of the joint ligaments), examines the other fingers of the foot and the affected area (swelling and redness are indicative of the pressure of shoes). The doctor also checks the range of motion of the big toe 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 (inflammation of synovial membrane of the joint), and thickening of the Horny layer (keratosis) evidence of abnormal pressure due to improper gait. Studied and changes in the movements of the thumb (when bent back, as you move away from midline in transverse 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 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 big toe can be conservative and surgical.
Conservative treatment is only effective in the early stages of the disease. It begins with selection of a suitable model of Shoe which will not cause the load and the friction (the initial stage of the disease the wearing patterns with wide toe stops further development of disease).
Your doctor may recommend the use of:
- special gaskets for Bursa (joint capsule) of the thumb, which reduce the pressure of 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 able to reduce the pain, but to relieve the pain of the application of these products not.
Treatment with the inflammatory process include:
- the use of nonsteroidal anti-inflammatory drugs;
- corticosteroid injections;
- physiotherapy (electrophoresis with calcium, ozokerito-paraffin baths, phonophoresis of hydrocortisone);
- shock-wave treatment.
It is also recommended that:
- massage, eliminates spasms and restoring mobility of the joint;
- special 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 recommended even in mild hallux valgus).
To eliminate pathology applied a set of operational methods, which are aimed at:
- elimination of bursitis of the first toe;
- the engineering of the bones that make up the big toe;
- the trim is located around the joint muscles to prevent relapse.
With moderately severe deformation during the surgical intervention can be removed only the outgrowth of 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 bits, after which the bone is aligned and the incision is closed with sutures.
It is also possible the reconstruction of the big toe and metatarsal bone.
The need for reconstruction of metatarsal bones depends on the angle between the first metatarsal and the second bone (if it exceeds 13 degrees, reconstruction necessary).
Rehabilitation takes about 8 weeks. During this period it is recommended to put the affected leg in a special brace or Shoe with a wooden sole (this will eliminate the likelihood of trauma to the operated area and will allow normal tissue to regenerate). Directly after surgery the patient may need crutches.
In severe bursitis perhaps the appointment physiotherapy, some time after the operation (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 a foot bath with the addition of herbal decoctions or sea salt.
- Wearing comfortable shoes (for the correct position of the joints during walking deformity is rare) or the use of orthotic insoles.
- Proper nutrition (joint damage can be due to overweight or eat certain foods for gout).
- Physical exercise helps to maintain tone legs.