Valgus deformity of the big toe is the most common acquired foot deformity characterised by deviation of the big toe towards the outside.
The pathology is bilateral nature that affects mainly women over the age of 35 years. In the majority of cases the deformity is accompanied by chronic inflammation of the joint capsule and deforming arthrosis of the metatarsophalangeal joints, pronational deviation of the first metatarsal bone.
Causes of the disease. Why is it dangerous?
Etiological causes of valgus deviation of the big toe, is still not fully understood. There are several theories:
- Vestigial theory. In the mid 19th century, it was believed that this strain only affects the model through the use of shoes with high heels, but in the study of this pathology was found and the men who wore flat shoes.
- The theory of the main weakness of the muscles – has been disproved in a detailed study of the problem.
- The theory of the weakness of the ligaments and of the insufficiency of the fascia of the sole – of the majority of scientists adhere to this theory.
There are a number of factors that lead to the onset of this disease:
- Excess weight increases the load on the legs.
- Age-related degenerative changes in joint ligamentous apparatus.
- The use of shoes with heels more than 5 cm, conical at the tip.
- Existing deformities in the skeletal (scoliosis, deformity, congenital hip and knee joints, flat feet).
The risk of disease is that over time, this stress leads to the deformation of the posture may develop dystrophic-degenerative diseases of the spine, hip and knee joints because of the bad distribution of the load when walking, and muscle injuries of the foot accompanied by constant pain, which significantly impairs the health of the person.
At the beginning of the disease valgus deformity clinically does not manifest itself. The majority of women are more concerned about the appearance of the foot — becoming a noticeable increase in the metacarpophalangeal joint, and the outwards deviation of the first toe.
Over time, pain occurs first when wearing shoes narrow and the long walk, and later the pain turns into a constant, aching in nature.
Because of the irregular distribution of the weight of the limb, between the first and the second finger on the sole are formed corns, second finger high, difficult to extend, they formed the "malleus" fingers that make it much more difficult to walk. Because of the worsening of blood circulation and innervation in the anterior margin of the foot, can develop into arthritis and bursitis chronic.
- An objective examination of the visible classical deformity with valgus deviation of the big toe, enlargement of the part distal of the foot. In the projection head of the first metatarsal bone, there are signs of bursitis – redness and swelling of the skin, sensitivity to palpation.
- The x-ray of the foot in two projections. In front projection is determined by the degree of coercion of the general, as the metacarpophalangeal joint, the degree of displacement of the sesamoid bone and the lateral projection to be visualized and calculated the degree of flat feet, which often occurs when a valgus deviation of the first toe.
- Plantography. The foot print is made on paper, draw a line through the center of the heel and between the fourth and third fingers, figuratively, formed in the outside arch of the foot, which shows the presence of flattening of the foot and its degree. In these patients more often revealed a flattened foot or flat feet And degree.
Treatment and prevention
Depending on the severity of the process is conservative or surgical treatment.
Conservative treatment is carried out at mild stage of the disease, there are different types of templates for orthopedic which can be selected individually and the deformed lead finger in a normal position, where stabiliziruemost and distribute the load on the limb above.
In childhood and old age used cross bandaging of the distal extremity with the separation between the first and the second finger. In order to reduce the pain apply warm baths with sea salt and sodium, give a good result radon baths.
To combat bursitis are used as topical anti-inflammatory gels, compresses with Dimexidum and Lidocaine, and in severe pain used novocaine blockade and intra-joint injections of glucocorticoids.
Surgical treatment is possible at any stage of the disease, which is done under local anesthesia, which reduces the list of contraindications for surgery.
On the stage, I remove the bone and growth plate on the inner edge of the bone, therefore, it is possible to decrease the pain of the process, but not prevent the occurrence of warping in the future.
In marked deviation of the finger with the presence of flat feet is osteotomy at the base of the metatarsal bone of the first finger with the bone of the blade to deflect the finger to its normal position, with a ribbon of Mylar to form the transverse ligament of the sole. After the surgery, the foot is fixed with a bandage to tight for 4 weeks, during the year, it is recommended to use individual orthotics.
Prevention of the disease is the use of comfortable shoes without heels of the shoes should sit at the foot of a loose, tapered feet, should not bring discomfort in the thumb area. If there is any deformation of the skeleton, it is recommended to undergo preventive examination by a podiatrist to identify and decrease the progression of hallux valgus of the big toe.
Consequences and complications
Complication of this process is the development of the disease Deichländer or "motion" of the foot, which is characterized by acute pain due to micro-cracking in the metacarpophalangeal joints of the foot and tenosynovitis.
Due to the constant inflammation and mechanical damage, there is a risk of development of malignant neoplasms of the bone.