Hallux valgus symptoms and treatment

Hallux valgus complex disease, which manifests itself transverse and longitudinal platypodia, a curvature of the first toe, the formation of bone lump and the violation of their own musculo-ligamentous balance.

 valgus deformity of the big toe

The disease is accompanied by flattening of the feet and their inclination to the inner side.

According to statistics, among the many orthopedic diseases of the feet ranks cross-spread deformation of its front end division, accompanied by hallux valgus (outward) deviation of the first finger. For the first time pathology was described over 200 years ago and to this day is about 80% of all foot deformities. To a greater extent the condition relates to women about 98%.

In everyday life people call it a disease at 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 deformation occurs in the metatarsophalangeal joint (the same lump). In addition to the aesthetic component, the disease causes the person discomfort and discomfort when walking.

Produce a lot of reasons leading to the curvature of the foot, but they are rarely found in isolation:

  • flat feet: transverse, longitudinal, combined; congenital and acquired;
  • osteoporosis: low calcium in the bones, leading to loss of stiffness and change in shape. The reason may be hormonal disruptions, and genetic predisposition;
  • weight: at foot is the ultimate potential of the pressure which it can withstand without deformation. By reducing the resistance or weight gain ligaments and muscles do not stand up and strongly stretched;
  • genetic predisposition: hyperelasticity of the foot can 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 wear narrow shoes and high heels, as the load on the foot is distributed incorrectly - almost all the weight is on the front section, namely at the metatarsophalangeal joint of the first finger;
  • endocrine disruption: the sudden hormonal changes during pregnancy, at menopause and even monthly fluctuations due to menstrual cycle, can cause weakening of ligaments;
  • foot injury: a blow or drop a heavy object on the foot may cause fracture or injury, which provoke the beginning of deformation.

The symptoms of hallux valgus

the symptoms of hallux valgus

In the initial stages appears fatigued during the walk, corns on the foot and the presence of callosities on the inner side of the first metatarsophalangeal joint. There is pain in the joints, the big toe moves sideways, is a lump on the inner side. Together 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 thickened soft tissue becomes painful and inflamed. 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 overloaded the knees, hip joints and spine. Sometimes the ingrown nail of the first toe, which creates discomfort when walking.

Initially, patients are usually concerned only cosmetic defect is the deviation of the first toe and the bone growth on the inner side of the joint. This is particularly noticeable when wearing open shoes, visiting the beach or pool. This is what leads many women to come to a specialist podiatrist.

The pathogenesis of hallux valgus

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

Load and support goes to all 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 straight, as a result, he is rejected, and the curvature progresses.

Significant displacement of the bones of the first toe outwards is considered to be offset by more than 10 degrees. Parallel changes occur in the capsular ligaments sprain 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 excess load as normal in the anterior main support falls on the head I and V.

the pathogenesis of hallux valgus

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

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

The back office is also subject to change: it is curved in the heel bone it is pronation (internal rotation), with increasing 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 radiographs in two projections and survey of the traumatologist-orthopedist.

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

I degree, II degree and III degree;

Interstitial angle 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 accurate and used for primary diagnosis:

I article 15 degrees;

II. 20 degrees;

III. 30 degrees;

Article IV over 30 degrees.

To characterize the deformation in the rear Department with AD stop has its own classification, and one of the indicators is taken into account the installation of the heel to the axis of the tibia:

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

Stage II the corner of 15-20°;

Stage III the bending of 20-30°, and it can still be addressed;

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

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

In the process of flattening of the longitudinal arch of the foot contact with the floor the entire surface of the sole. Slightly increased the length of the foot, as the arch disappears. In this process there are three stages:

  1. At the first degree of the person usually feels no discomfort or pain. But the legs get tired quicker, 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 increasing angle until 141-155 degrees and the omission of REDD from 17 to 25 mm. pain, worse under load. Old shoes is getting tight.
  3. Third degree stop completely flattened, its roof angle increases more than 155 degrees, and the height falls below 17 mm. Constant pain in the leg muscles, joints, back. Develop various complications, the usual shoes impossible to wear, and to travel long distances impossible.

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

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

Complications of hallux valgus

complications of hallux valgus

The most frequent complication is inflammation of the synovial bags (Bursa).Manifested by redness, swelling, pain, which are amplified by mechanical action.

Another common complication is the formation of osteoarthritis of the first metatarsophalangeal joint destruction of the cartilage, the appearance of bone exostoses (growths), reducing the mobility and the beginning of pain.

Osteoarthritis of the first metatarsophalangeal joint

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

Common complication is a heel spur, which occurs due to distension of the plantar fascia. Patients suffering with this severe pain when walking in the heel area. Sometimes Achilles bursitis - inflammation of the Achilles tendon. So, delayed treatment causes a set of complications that require additional treatment.

Diagnosis of hallux valgus

To assign adequate treatment and to prevent progression of the disease is necessary to conduct a full 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;
  • x-rays stop in 3 projections in order to determine the stage of disease, and identify comorbidities, which include osteoarthritis, subluxation and dislocation of the joints. The study must be done under load, as a result of the curvature of the corners may differ by 20%. According to x-rays carried out all the calculations necessary to determine the tactics of treatment.

Radiography 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 necessary, exclusion of other diseases can be assigned to CT or MRI;
  • Ultrasound is necessary for research vessels if you suspect poor circulation.

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

Treatment of hallux valgus

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

When the initial changes you can do surgery McBride, silver method, the method of R. R. Vreden. The bone is sawn, and changing the place of attachment of the tendon of the adductor muscles of the thumb. The recovery period is 2-3 weeks.

The scheme of the operation McBride

If diagnosed II and III degree, it is more traumatic surgery osteotomy (cutting the bone) with setting 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 by 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° to 22° Z-shaped osteotomy M. Meyer (scarf), 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, wedge-shaped osteotomy M. Loison, E. Juvara, osteotomy at the G. W. Patton and E. J. Zelichowski;

the scheme of the operation McBride

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

The choice of making the traumatologist-orthopedist, given the localization of the main changes, congruency of the first metatarsophalangeal joint (the preservation of the articular surfaces) and the severity of the pathology.