Hallux Valgus. Valgus deformation of the first toe

The lesions of the feet begin to occur more and more often. One of the most common types of pathology of the foot joints is valgus deformity or Hallux Valgus.

What is valgus deformation?

Under valgus deformity, the most likely violation of the normal structure of the first metatarsophalangeal joint is due to the displacement of the first metatarsal head laterally (outside the foot) and the tilt of the proximal phalange of the first finger to the inside.

This disease of feet stops develops more often as a result of wearing tight, narrow shoes. As a result, under the effect of compression there is a "violent" displacement of the proximal phalanx of the finger. In parallel with this, stretching of ligaments and tendons of the finger develops, which aggravates the situation even more. Another cause of deformity development is an innate predisposition to the development of this pathology.

As a result of external factors, flattening of the arches of the foot occurs, after which a transverse-longitudinal flat foot develops , which leads to a curvature of the big toe.

Women most often suffer, regardless of age (usually the disease manifests itself in the middle and late age).

Degrees of gravity

Progressing, the curvature can be aggravated, which leads to even greater deformation of the finger. The degree of severity is determined by changing the two main values - metatarsal-phalangeal and interplusum (between 1 and 2 bones of the metatarsus) angles.

When the bones deviate by 12 and 25 degrees, respectively, the first degree of severity of valgus deformity develops.

If the process progresses, and the discrepancy is 18 degrees (metatarsal-phalanx node) and more than 25 degrees between the bones of the metatarsal, the second degree of development of the disease is indicated in the diagnosis.

If angles increase more than 18 and 35 degrees, respectively, you can expose the third degree of severity of the disease.

Sometimes the question arises - what degree of severity should be set, if a change in one angle is typical for, for example, the first degree, and the other angle is increased more than necessary. In this situation, one should be guided by changes in the metatarsal-phalanx joint, so the change in it is the dominant one in the pathogenesis of the disease.

Clinic

At the initial stage of the disease, the main manifestation of the disease will be stiffness when walking, a feeling of discomfort. With the progression of the process, the development of the inflammatory process in the joint bag (bursitis) is observed, which worsens the course of the disease. Pain in the joint is added, which increases with walking, the inability to perform the function of depreciation. With progression, the disease can be complicated by the development of osteochondrosis, osteoarthritis (due to flattening intervertebral discs). There are non-intensive, aching pains in the spine, a feeling of heaviness and leakage after a period of rest, as well as intense soreness after exercise.

In passing, the joint develops edema: it increases in size, the joints are flattened. When the articular cartilage is exhausted, the surface of the bones begin to rub against each other, which leads to the erosion of the joint surfaces and the subsequent development of osteophytes.

Diagnostics

Usually, for diagnosing valgus curvature of the thumb, patient complaints, a history and visual examination are sufficient. Flat-valgus deformation of the feet is diagnosed by radiography of the affected joint in order to determine the angles of deviation between the bones and the severity. Sometimes magnetic resonance imaging and scintigraphy are used.

As additional methods used for differential diagnosis, a general blood test, a biochemical blood test, Diagnostic puncture of the joint, investigation of the synovial fluid followed by its sowing on the nutrient medium (for the determination of microorganisms). The primary indicators, which are the main diagnostic criteria, are the determination of rheumatoid (diagnosis of rheumatoid arthritis), uric acid (gout), and also certain specific pathogens of arthritis.

Treatment of valgus deformity

Treatment of Hallux Valgus should begin with the normalization of lifestyle. In the presence of excess weight it is recommended to get rid of it (flat feet and osteochondrosis worsen the course of the disease and contribute to its progression). In this case, if there is still Hallux Valgus, treatment without surgery can have a significant effect.

Shoes, presumably leading to deformation, should be stopped as far as possible.

Important is the rejection of bad habits.

As a prophylaxis for the development of valgus curvature, comfortable shoes with a soft sole without heels should be used. It will also be useless to hold the foot baths, as well as foot massage after a strong static load on the legs. Between the fingers can be placed special orthopedic pads, preventing the shift of the phalanx of the thumb.

If such conservative methods do not help, resort to the additional use of symptomatic drug therapy aimed at improving the condition by posindrome exposure.

Medication Therapy

To improve the condition for the treatment of Hallux Valgus often take various medications.

The main groups of drugs are non-steroidal anti-inflammatory drugs (NSAIDs) - preparations "Nimesulide", "Meloxicam". These drugs help to stop the inflammatory process by blocking cyclooxygenase-2, the main pro-inflammatory mediator. The drugs can remove inflammation, reduce local swelling, reduce pain. Can be used both for oral use, and through applications (lubrication) of the affected area.

In addition to NSAIDs, solutions of electrolytes and anti-inflammatory drugs used by electrophoresis were widely used. This method allows you to bring the medicine directly into the area of inflammation, bypassing the gastrointestinal tract. Thus, the negative effect of NSAIDs on the gastric mucosa is eliminated when ingested.

Surgery

With ineffectiveness of conservative treatment resort to surgical intervention. It is carried out most often with the advanced course of the disease in its late stages, as well as with severe deformation of the fingers.

The earlier the operation is performed, the more favorable the forecast.

At the initial stages, a rather difficult operation was used to treat this pathology. Hallux Valgus was eliminated with the help of massive excision of the joint heads. Due to this, he was significantly injured, which led to distant violations of the function. Currently, priority is given to joint-preserving surgeries, the goal of which is minimal interference on the bones with maximum impact on the tendons and ligaments. Chevron, Scarf (corrective osteotomy) operations are widely used. With their ineffectiveness resorted to the creation of arthrodesis. Flat-valgus deformation of the feet in severe cases may require prosthetics of the affected joint.

The operations are conducted in six variations (although at present there are more than 130 of them, but they have not confirmed their effectiveness).

In addition to excision of the heads of bones, a correction of the flattened arches of the feet is also carried out.

Postoperative prognosis

In the postoperative period, it is recommended to avoid significant physical exertion (they can contribute to improper restoration of the joint). Do not load your feet for one and a half to two months (the minimum period of joint fusion after the surgery). For all this time should be a special orthopedic boot. If these conditions are met, the forecast is most favorable.

If the condition was diagnosed untimely and the process progressed and led to irreversible changes, then the prognosis smoothly passes into a group of conditionally unfavorable ones. This disease of the feet stops the growth of disability, disruption of walking. In this case, even the intervention of surgeons becomes inefficient, since it only slows the progression of the process, but does not eliminate its cause.

Is it worth treating this condition?

This question is often asked by many people. For some, the development of such a deformation is a catastrophe, since this group of people sacredly protects their appearance and can not allow an unpleasant defect to spoil their appearance. Others are calm about changing bones and are not rushing to see a doctor. How to be - to treat or not to treat? Should I contact the surgeons for help with the development of Hallux Valgus? Reviews about this disease are diverse and specific.

On the one hand, it is best to contact the orthopedist or traumatologist at the slightest change from the joint. Timely diagnosis of this disease can get rid of it without any undesirable consequences. The later this condition is revealed, the more severe consequences for the musculoskeletal system it can turn out. That is why the question of treating valgus deformity of the thumb is purely individual. Everyone decides whether to "lie down under the knife", or better leave it as it is.