Hallux valgus symptoms and treatment

Hallux valgus complex disease, which is manifested cross-sectional and longitudinal platypodia, a curvature of the first finger of the foot, the formation of bone tumor and the violation of their own musculo-ligamentous balance.

 valgus deformity of the big toe

The disease is accompanied by the flattening of the feet and their attachment to the inner face.

According to statistics, among the many orthopedic diseases of the feet rows cross-the propagation of the deformation of the first end of the division, accompanied by hallux valgus (outside) deflection of the first finger. For the first time pathology was described more than 200 years and today is approximately 80% of all foot deformities. To a large extent, the condition refers to women about 98%.

In the everyday life of the people call it a disease in different gallux, hallux, bunions, curvature of the first finger etc Like any name, but the essence does not change: the first finger is deflected in the direction of the second, and the deformation occurs in the metatarsophalangeal joint (the same package). In addition to the aesthetic component, the disease causes the person discomfort and discomfort when walking.

They produce a large amount of reasons that lead to the curvature of the foot, but which are rarely found in isolation:

  • foot plane: transverse, longitudinal, combined; congenital and acquired;
  • osteoporosis: low calcium in the bones, which leads to loss of stiffness and change in shape. The reason may be hormonal changes, and genetic predisposition;
  • weight: on foot is the ultimate potential of the pressure it can withstand without deformation. To reduce the resistance or weight gain ligaments and muscles do not stand up and the strength extended;
  • genetic predisposition: hyperelasticity of the foot may be congenital. In this case, the musculo-ligamentous apparatus is weak, and the likelihood of developing flat feet is increased;
  • walking in the wrong shoes. It is undesirable to carry shoes in narrow and high heels, as the load on the foot is distributed incorrectly -almost all the weight is in the first section, that is to say, in the metatarsophalangeal joint of the first finger;
  • endocrine disruption: the sudden hormonal changes during pregnancy, menopause and even monthly fluctuations due to menstrual cycle, can cause the weakening of the ligaments;
  • foot injury: a blow or fall of a heavy object on the foot may cause fracture or wound, which lead to the beginning of the deformation.

The symptoms of hallux valgus

the symptoms of hallux valgus

In the initial stages appears tired during the walk, corns in the foot and the presence of callosities on the inner face of the first metatarsophalangeal joint. There is pain in the joints, the big toe moves sideways, it is a knot on the inner face. Along with the first finger is deformed and the rest, are like hammers.

The pain intensifies, old shoes become narrow, and to pick up comfortable shoes is almost impossible. Corn and the healing of the soft tissues becomes pain and inflammation. Bursitis is formed, which can become chronic.

The rear part of the foot is also curved, which looks like an unusual clubfoot. The pain increases and starts to appear in quassae and ankle joint. In the absence of treatment of overload in the knee, hip joints and spine. Sometimes the ingrown nail of the first finger of the foot, which creates discomfort when walking.

Initially, the patients tend to worry about only cosmetic defect is the deviation of the first toe and the bone growth on the inner face of the union. This is particularly noticeable when wearing open shoes, a visit to the beach or the pool. This is what leads many women to get to a specialist podiatrist.

The pathogenesis of hallux valgus

As a result of the weakening of the muscular-ligamentous apparatus of feet and damage the load change occurs of the points of support and flattening of the transverse and longitudinal arches.

Loading and support goes to all the metatarsophalangeal joints, which leads to a fanlike divergence of the bones of the forefoot. There is an imbalance of muscle strength that holds the first finger of the front, as a consequence, is rejected, and the curvature progresses.

Significant displacement of the bones of the first toe towards the outside is considered to be offset by more than 10 degrees. Parallel changes occur in the capsular sprain of ligaments lateral divisions, the displacement of the sesamoid of the hammock.

Another transverse divergence contributes to the development of metatarsalgias pain in the region of II-IV metatarsal bones due to the excess load as normal in the previous main support lies with the head I and V.

the pathogenesis of hallux valgus

In addition to the metatarsalgias are formed in the shape of hammers of the second, third and fourth fingers due to the increase of the tension of the flexor tendons and extender tendons. This leads to sprains and contractures in the respective joints.

Deformation (collapse) of the middle division of the foot occurs with the weakening of the ligamentous apparatus of the joint Shaparova. This pathology is rare and is usually caused by an injury.

The back office is also subject to change: it is the curve in the heel bone is pronation (rotation inner), with the increase which diagnosed subluxation in quassae joint.

Classification and stages of development of hallux valgus

Depending on the division of foot deformities front or rear, there are different stages of the disease. To determine the stage necessary x-rays in two projections, and a survey of the traumatologist-orthopedist.

In the deformation of the first finger that there are three stages on the basis of deflection angles:

And degree II degree III degree;

Interstitial angle of 12°, 18° and 18° respectively;

The angle of the valgus deviation of the first toe: 25°, 25° and 35°, respectively.

There is another classification of the degree of deformation of the hallux, which assesses only the interstitial angle. It is less precise and is used for the primary diagnosis:

I article 15 degrees;

II. 20 degrees;

III. 30 degrees;

Article IV over 30 degrees.

To characterize the deformation in the posterior part of the Department with the ANNOUNCEMENT of the stop has its own classification, and one of the indicators is to take into account the installation of the heel to the axis of the tibia:

Phase I, the foot is flat, but the deviation is small: 10-15°;

Phase II of the corner of 15-20°;

Phase III is the bending of 20-30°, and it can still be directed;

Stage IV is a serious, stop completely divorced, and the deviation from the norm is 30° or more.

Of course, it is necessary to distinguish the current degree of flatfoot (longitudinal and transversal) due to all the deformities, as they are directly connected to him.

In the process of flattening of the arch lengthwise of the foot in contact with the floor the whole surface of the sole. Slight increase in the length of the foot, as the arch disappears. In this process there are three stages:

  1. In the first degree of the person usually feels no discomfort or pain. But the legs get tired faster, long-term stress transferred is not so easy. Rentgenograficheski roof angle of 130-140 degrees, and a height of 25 mm.
  2. Second degree is diagnosed with increase the angle until 141-155 degrees and the omission of REDD from 17 to 25 mm. pain, worse under load. Old shoes are reduced.
  3. Third grade stop completely flattened, its roof angle increases more than 155 degrees, and the height falls below 17 mm. Constant pain in the muscles of the legs, joints, again. Develop complications, the usual shoes impossible to wear, and traveling long distances impossible.

When the transverse arch becomes flatter, the process of making a plan foot is characterized by the divergence of the fingers and the increase of the width of the foot. Therefore, the definition of the severity of the flat feet is to measure the angle between the 1st and 2nd metatarsal bones

  • first stage: difference of not more than 10-12 degrees;
  • the second degree of this angle greater than 15 degrees;
  • the third degree is characterized by a deviation of up to 19 degrees.

Complications of hallux valgus

complications of hallux valgus

The most common complication is swelling of the synovial bags (Bursa).It is manifested by redness, swelling, pain, which is amplified by mechanical action.

Another common complication is the formation of osteoarthritis of the first metatarsophalangeal joint of the destruction of the cartilage, the appearance of the bone exostoses (growth), the reduction of the mobility and the onset of pain.

Osteoarthritis of the first metatarsophalangeal joint

In sum, the rest of the violations of the defeat of the joints of the foot, and the whole gait disturbance. In advanced cases suffer from knee, hip joints and the spine, which is manifested by arthritis and deformity.

Common complication is a heel spur, which occurs due to the distention of the fascia plantar. Patients suffering from this severe pain on walking in the area of the heel. Sometimes Achilles bursitis - inflammation of the Achilles tendon. Thus, delay in the treatment caused a series of complications that require additional treatment.

Diagnosis of hallux valgus

To assign an adequate treatment and avoid the progression of the disease is necessary to conduct a thorough examination of the patient to identify the causes of deformation and to determine the stage of the process.

The main methods of diagnosis:

  • full-time consulting orthopedist-traumatologist;
  • the x-rays stop in 3 projections in order to determine the stage of the disease, and identify comorbidities, including osteoarthritis, subluxation and dislocation of the joints. The study must be done under the load, as a result of the curvature of the corners may differ by 20%. According to the x-rays to perform all the calculations necessary to determine the tactics of treatment.

The x-ray of the foot (video projection)

rentgenografija foot
  • plantography to determine flat feet (footprints);
  • podoscopy examination of the plantar part of the foot in the standing position;
  • if it is necessary, to the exclusion of other diseases can be assigned to CT or MRI;
  • The ultrasound is needed for the research vessels if you suspect that poor circulation.

After the exam, the required differential diagnosis to rule out diseases with similar symptoms (arthritis, gout, osteoarthritis deformans). For this assigned lab tests: factors inflammatory, markers specific and General clinical research.

Treatment of hallux valgus

Over the last hundred years the surgery of the foot not only has not lost its relevance, but also makes the constant steps forward, with the arrival of better tools and clamps. Currently developed more than 400 types of transactions and their modifications for the correction of deformations of the different parts of the foot.

When the initial changes that can make surgery McBride, silver method, the method of R. R. Vreden. The bone is sawn, and the change of the place of union of the tendon of the adductor muscles of the thumb. The recovery period is 2-3 weeks.

The outline of the operation McBride

If diagnosed II and III level, it is more traumatic the surgery, the osteotomy (cutting the bone) with the creation of the proper angle and fixing by screws or spokes. There are many techniques of correction of the first finger:

The distal (used if the angle between the 1st and 2nd metatarsal bones not more than 14°): operation qui Effusus est eliminating exostosis (cones), caput continentiam wedge osteotomy of J. Reverdin, operation T. R. Allen, D. W. Austin surgery (Chevron osteotomy);

Diaphyseal (applies if the angle between the 1st and 2nd metatarsals from 15° 22° Z-shaped osteotomy M. Meyer (scarf), the operation K. Ludloff, osteotomy of C. L. Mitchell;

Proximal (the angle between I And II metatarsal bones of more than 22°): a double osteotomy for Logroscino, in the form of a wedge osteotomy M. Loison, E. Juvara, osteotomy in the G. W. Patton and E. J. Zelichowski;

the outline of the operation McBride

Sometimes when there is a deformation of the main phalanx of the first finger of the foot requires additional O. F. Akin osteotomy (Moberg).

The choice of the realization of the traumatologist-orthopedist, given the location of the main changes, congruency of the first metatarsophalangeal joint (the preservation of the articulating surfaces) and the severity of the disease.

12.08.2018