Hallux valgus is one of the most common diseases in orthopedics, which is a curvature of the first toes of the lower limbs with concomitant displacement of the heads of the metatarsal bones outward, and the joints inside the foot.
In a healthy state, the metatarsal bones are parallel. In the first stage of disease development, the position of the first bone changes from the outside, with the formation of a swollen bump of a small size. As a result, a person has problems not only in aesthetic terms: the curvature of the thumb with the progression of the disease will necessarily follow the displacement of the rest, with their subsequent deformation. In addition, the pathology, due to its natural violation of the distribution of the load, gradually begins to adversely affect all the constituent elements of the foot - bone structures, tendons, ligaments. This, in turn, can become the basis of the following complications:
- osteoarthritis of the metatarsophalangeal joints;
- chronic bursitis (inflammation of the mucous membranes of the articular sacs);
- exostosis (benign bone growth and cartilage) of the metatarsal head;
- combined or transverse flat feet;
- varus (displaced inward) deviation of the first metatarsal bone.
With a severe form of the pathological process flowing, the only effective way to deal with it is surgery. However, if the patient consults a specialist at an early stage of the disease, conservative treatment is also possible.
The disease is often observed in women who have reached the age group of 30 and above, moreover, in European and American women, it is more common than in Asian or African women, which is directly related to the shoe modeling traditions in theseregions. As a result of wearing mainly fashionable shoes (as a rule, narrow, narrow, high and unstable heels), the front parts of the lower limbs are exposed to excessive overloads, the imbalance in the distribution of which with the passageof time can cause hallux valgus (curvature as a result of instability of the metatarsophalangeal node and unfolding of the metatarsal bones).
The disease often develops in people who are overweight and with some foot pathology. The risk group also includes those citizens whose professional activities are accompanied by prolonged, monotonous physical exercises in the leg area. Also, the disease sometimes occurs due to mechanical damage received.
Forms of the disease and their manifestations
Depending on the size of the deviation of the thumb, there are 3 stages of pathology:
At an early stage, there are:
- insignificant inclination of the first finger to the rest (less than 20 °);
- the appearance of pain when wearing shoes, the area where the pain appears - the proximal parts (second in a row from the end of the nail) of the phalanges, intensified during walking;
- hyperemia and swelling in the area of the metatarsophalangeal joint due to synovitis;
- formation of a prominent "bone" of small size on the side of the affected area.
The average is characterized by:
- deformation of the second toe, shaped like a hammer and raised above the first.
- development of the inflammatory process in the joints;
- increased pain and swelling;
- formation of a lump in the area of the metatarsal head;
- formation of corns (dry calluses) below the middle phalanx.
Signs of a severe degree are:
- deviation of the thumb (more than 30 °), with the curvature of the rest;
- sharp, debilitating pain;
- a conspicuous prominent tubercle (growth-thorn);
- keratinized skin and the presence of corn under the second and third phalanges;
- severe foot deformity.
The causes of the disease can be as follows:
- improperly chosen shoes ("pressing", with a narrow toe and knitted heel, with a high, unstable heel, with an extremely rigid quality of the material from which the product is made);
- professionally conditioned excessive tension of the lower extremities;
In addition, mechanical trauma to the foot and leg, as well as hereditary factors or concomitant diseases, including genetic predisposition, may contribute to the onset of the disease.
Pathology can develop when:
- flat feet (transverse or combined type), as well as low arch of the foot;
- initially weak muscular apparatus (for example, with connective tissue dysplasia);
- polyneuropathy, rickets (as a complication of the primary disease);
- various forms of arthritis and osteoarthritis (characteristic mainly of the elderly);
- diabetes mellitus (due to increased stress on the legs or poor circulation);
- psoriatic arthropathy;
- Charcot-Marie-Tooth disease (inherited motor-sensory neuropathy, the manifestations of which are characterized by weakness or atrophy of the muscles of the distal extremities);
- Down and Marfan syndrome, associated with joint hypermobility;
- multiple sclerosis, accompanied by damage to the myelin sheath of nerve fibers;
- osteoporosis (which is characterized by a significant decrease in bone mass).
In addition, the appearance of juvenile hallux valgus may be associated with rapid limb growth at puberty.
With hallux valgus, patients have an increase in angle between the first and second metatarsal bones. As a result, the first toe shifts outward, and the head of the bone begins to form a tubercle on its side (in simple words, a "bone"). At the same time, constant pressure on the tubercle and friction while wearing the shoe causes inflammation of the mucosa of the first metatarsophalangeal joint (bursa), and also provokes changes in bone structure, swelling and pain of the "bone" and tissues located aroundhis. Deformation leads to premature wear of the main joint, cartilage damage, as well as significant increase in bone growth, and this, in turn, includes its trauma and further development of the pathological process.
Diagnosis is performed in stages:
- A specialist (traumatologist-orthopedist) reviews the medical history. When a patient is interviewed by a doctor, the symptoms are clarified, as well as the presence of factors that provoke the onset of pain (physical activity, improperly chosen shoes, frequent and intense walking), results if there has been mechanical damage, if there issystemic, metabolic, genetic or orthopedic diseases, etc. . .
- The general external examination, in which the doctor analyzes the characteristics of the patient's gait, determines the discomfort in it and the intensity of the pain syndrome while walking, looks at the location of the thumb in relation to the rest (by identifying articular ligament sprains), detects if there is swelling or redness (if any - means the shoes do not fit well and are squeezed). Further, the specialist checks the range of motor activity in the metatarsophalangeal joint (in normal condition, the angle of flexion of the spine is 65-75 °, and the flexion of the toe is less than 15 °), the presence of pain and crepitus. Pain in the absence of a crack indicates inflammation of the synovium (synovitis), and a thick layer of thickening (keratosis) is a sign of friction due to improper gait. In addition, the doctor examines violations of movement of the first finger, skin, peripheral pulse.
If necessary, an X-ray is prescribed, which makes it possible to judge the degree of deformation, as well as the presence or absence of subluxation of the joints and accompanying pathologies.
To rule out circulatory disorders, a vascular ultrasound is performed. Laboratory tests and MRI may be prescribed to identify comorbidities as well as in preparation for surgery.
Principles of healing
More than 85% of women and men suffer from deformities of the feet, in particular - flat transverse feet, the manifestation of which is the "flattening" of the front of the limbs, the curvature of the toes, the appearance and growth of "bones", as well as rapid leg fatigue when walking. The development of hallux valgus is negatively affected by chronic inflammation, leading to destruction of tendons and weakening of the capsule apparatus, as well as destruction of the articular surfaces of the joint, especially the head of the first metatarsal bone. As a result of the combined action of these factors, varying degrees of hallux valgus can occur.
Treatment of this pathology can be:
- conservative (with the use of corrective orthopedics, as well as medication, physiotherapy, kinesio taping, manual therapy, etc. );
The conservative technique mainly aims at fixing the correct position of the leg, uniform distribution of the load, normalization of blood circulation, stabilization of musculo-ligamentous tone.
Regular wearing of individual orthopedic shoes, insoles and correctors allows you to suspend the progression of the disease in the early stages, or slow it down, as the main purpose of these products is to prevent flat feet, "spread", foot extension. , preventing the appearance and growth of the "bones" of the thumb and hook-shaped deformities, as well as the elimination of added fatigue. The therapeutic effect is achieved in this case by neutralizing the pathological disorders of the lower extremity segments and improving their spring ability, by unloading the articular structures and supporting the arch of the foot - this is the main principle of basic therapeutic methods and prevention of "overload pain"", early wear of joints and their displacement.
Medication - involves the introduction of hormonal agents into the joint cavity in order to slow down the inflammatory process and relieve pain.
Physiotherapy - medication ultrasound, laser therapy and shock wave therapy. All of these methods aim to reduce inflammation, swelling, pain, and improve blood circulation.
Kinesio taping - to relieve stress on the legs, feet, thighs and normalize venous outflow.
Manual therapy - removes muscle blocks, tightening, spasms, tightening, relieves joints and restores the correct anatomical position of all parts of the limbs, improves lymph and blood circulation. It also restores muscle imbalance, however, it is necessary to consider the stage of the disease. the therapeutic effect is most pronounced in the initial stage.
If the deformation progresses, then the following factors should be considered:
- concomitant pathologies that may complicate surgery (varicose veins with lesions of the venous system of the legs, especially with signs of thrombophlebitis), steroid vascular in the area of the legs and feet;
- the presence of visible and hidden foci of infections in the limb area;
- pain in the affected parts of the foot coming from straining, as well as difficulty in selecting and wearing shoes;
- allergic history.
Surgical treatment restores normal limb configuration, relieves discomfort, and improves quality of life.
The main preventive measures are systematic examinations by an orthopedic traumatologist, especially if the patient has factors that contribute to the disease. In addition, women should avoid wearing high heels all the time. this leads to the appearance of flat feet, and then - to hallux valgus.
It is important that foot workers maintain certain rest periods and, if necessary, use orthopedic shoes or insoles.
In addition, regular barefoot walking is a good preventative measure, as it trains the muscles and tendons of the lower extremities.