flatfoot

On the side of the flat tire it looks like this

hallux valgus

A valgus deformity of the big toe is a deformation of the metatarsophalangeal joint of the big toe and its subsequent deviation to the side. It has a gradual progression and is often referred to as 'valgus' or 'lump'. The cosmetic defect manifests itself through symptoms that lead to complications, reduce the quality of life and require treatment.

A Valgus 1 (bone valgus) – is a valgus deformity of the joint of the first toe. Due to the weakening of the ligaments and wearing tight high-heeled shoes, women are affected more often than men. The pathology is hereditary.

Symptoms of hallux valgus deviation of the 1st toe

The disease manifests itself as a cosmetic defect in the form of a protruding bone, popularly known as a 'hump'. Over time, symptoms develop that characterize the stage of the disease:

In stage 1, pain initially occurs in the foot, which increases after walking for a long time. The sensation is of different nature. There may be mild discomfort followed by a nagging, burning pain.

Grade 2 hallux valgus is associated with a loss of the natural shape of the foot. It is widened and flattened. Along with the repositioning of the toe, there are accompanying deformities in other areas of the foot.

In grade 3 hallux valgus, a permanent pathological forefoot deformity develops. Pain, swelling, blisters and osteoarthritis noticeably reduce the quality of life.

Symptoms of flat feet

The main symptom of a developing flat foot is pain in the feet, ankles and lower legs, especially after prolonged exercise. The gait becomes heavy and 'unnatural'. Flat foot also causes unevenness in the feet (valgus deformity of the first toe), which leads to foot deformities. Since the natural distribution of loads is disrupted in flat feet, pain can also occur in the knee and hip joints and often in the lower back.

grade 1 Slight deformation of the foot, fatigue and pain usually occur after standing for a long time.

grade 2 The deformation (flattening) may be visible on normal examination. The foot begins to flatten and the foot is slightly lowered inward. The pain in the foot is no longer limited to the foot, but extends to the lower leg and knee.

grade 3 Marked deformity. Abnormalities of the musculoskeletal system occur, and the pain appears after even a short walk. Valgus deformity of the first toe is often present, leading to severe deformity of the foot, the appearance of corns and 'hammertoes'.

Diagnosis of flat feet

The orthopedist will perform a visual inspection of the foot and order x-rays. Based on the x-rays, a final diagnosis is made by determining the extent of the disease and the type of flat foot. Depending on the diagnosis, the specialist selects a treatment method (conservative or surgical) and draws up a treatment program.

Eliminating flat feet using conservative treatment methods is rather difficult. It is only possible at a very early stage of development, when flat feet are discovered at a very young age (3-5 years). If at this time it is possible to teach the child certain exercises that need to be performed over a long period of time, the likelihood of flat feet appearing in the future will be lower. In addition to exercises, flat feet in children can also be corrected with orthoses, orthopedic devices and special footwear. Unfortunately, in most cases this does not happen and the flat feet remain.

Basically, there are no conservative therapies that can cure flat feet in adults. We can use custom-made orthoses, various physiotherapy treatments, massages, physical therapy and acupuncture, but all of this only serves to stop an already existing deformity and thus slow down its development. However, if we already have flat feet, and especially if they have reached an advanced stage, it can only be cured through surgery.

Of course, the term 'surgery for flat feet' raises fears, but there are now surgical procedures that can eliminate flat feet quickly and with little trauma through small incisions. The essence of these operations is to bring the bony structures into an anatomically correct position with the help of a special implant. The patient walks for several years, during which the ligaments and muscles get used to this condition, and then the implant is removed.

Causes of valgus deformities

• wearing high-heeled shoes;
• wearing shoes with a flat sole;
• Hereditary predisposition (weakening of the ankle ligaments);
• Overloading of the forefoot (sports, dancing).

As the valgus deformity increases, the first metatarsal bone tilts inward, causing the inner foot to rub against shoes, often tight shoes, leading to chronic inflammation. The inner edge of the joint capsule becomes inflamed and the tissue thickens due to the inflammation. The body attempts to strengthen this area by forming a bone structure in the thickness of the inflamed capsule. This is called calcification.

Many problems that occur in the feet are the result of abnormal pressure or friction.

Hallgus valgus symptoms

• Pain, swelling, redness in the area of the big toe
• Deformation of the forefoot
• Abduction of the big toe outwards (towards the second toe).
• Sometimes this is accompanied by a deformation of the hammer toe of the second toe. As the first toe curls outward, it begins to push the second toe up, causing blisters that rub against the shoe.

Clubfoot (club foot bone)

One of the most common foot diseases is transverse flatfoot, which is caused by a congenital weakness of the ligaments of the forefoot and special features of the footwear (narrow toes, high heels). Valgus deformity of the big toe (Hallux valgus), also known colloquially as lump, valgus, gout, clinically looks like an inward deviation of the big toe and is most common in women over 40 years old. It causes pain in the area of the first toe due to the pressure of the shoe on the head of the metatarsal bone and pain in the area of the heads of the 2 - 3 metatarsal bones on the sole side due to the load transferred to them from the first metatarsal bone, making it difficult to wear normal shoes , because a 'bone' has formed at the base of the big toe, corns and calluses appear on the surface of the sole, which make walking difficult because they are very painful. This pathology is not only a cosmetic problem (visually ugly foot), but also an orthopedic problem. In addition to the deviation of the big toe, this disease is associated with a number of pathological changes in all structures of the foot (tendons, ligaments, bones and joints), which lead to this deformity:

• Osteoarthritis of the deforming metatarsophalangeal joint of the big toe,
• chronic synovitis,
• Exostoses on the heads of the metatarsal bones,
• combined or transverse flat feet,
• Internal deviation (varus) 1. Metatarsal bone.
• Hallux valgus deviation of the metatarsals 2-5

Hallux valgus is a multifactorial condition. Flat feet, genetic predisposition, obesity, endocrine disorders and osteoporosis play an important role in the development of the deformity.

Correction of the foot

In our clinic we use low-injury corrective surgery in which the metatarsal bones are fixed with special screws. After the operation, it is necessary to relieve the forefoot with special shoes (Baruca shoes) or a cast. In complicated cases, operations on the remaining metatarsal bones are also necessary to restore the anatomically correct shape of the foot. The most common operations are the calcaneal or chevron osteotomy of the first metatarsal, the Akin osteotomy of the proximal phalanx of the first toe, and the Weil osteotomy of the lesser radius.

In case of doubts or complaints, each operated patient has the opportunity to contact the surgeon the surgeon who operated on her free of charge The treatment of valgus deformities is free of charge - by telephone arrangement or by making an appointment in the clinic.

Cost of treating a valgus deformity of the big toe

Consultation fee: RUB 4,130.00.
Preoperative examination: RUB 15,000.00.
Cost of surgical treatment: 250 000.00 RUB.

Additional testing may be required during the consultation (e.g. vitamin D3 testing, antibodies to citrulline-containing peptides, densitometry, etc.), for which a fee will be charged in accordance with the current OPP price list.

The final cost of the operation will be determined at the consultation and will depend on the following factors:

• Preoperative examination by doctors: orthopedist and anesthetist
• Surgery in the clinic with a surgeon, an anesthesiologist and a nurse
• Anesthesia and any medications used
• Post-operative ward

• Tests and examinations before the operation
• Post-operative shoe
• first aid kit
• Postoperative supervision by an orthopedic surgeon
• Complete foot hygiene (medical pedicure) – recommended before surgery and after bandage removal

Indications and contraindications for surgery

Bunion surgery is indicated for the following symptoms:

The operation is not performed for rheumatoid arthritis, diabetic foot, obliterating atherosclerosis, purulent infections and hematopoietic disorders.

Types of surgery for valgus deformities

Two types of surgery are used to correct valgus deformities: minimally invasive and reconstructive procedures. The former are effective in the early stages and in exostoses. During minimally invasive procedures, 2-3 punctures with a diameter of 3-4 mm are made around the joint.

More traumatic and invasive reconstructive surgeries result in changes in the position of the foot bones and are performed for severe valgus deformities. The procedures are carried out through a 2-4 cm long incision on the inside of the foot. The doctor restores the first metatarsophalangeal joint to the anatomically correct position and brings the metatarsal bones into the correct position.

Depending on the area of intervention, a distinction is made between soft tissue manipulation, bone manipulation and combined manipulation. The former is indicated for hallux valgus grade I when the head of the metatarsal bone has not yet formed. The doctor works on the tendons, muscles and the joint capsule. Grade II-III anomalies require an osteotomy or undercutting of the bone. Combined procedures, in which the removal of the bony outgrowths is combined with ligamentoplasty, are indicated for severe hallux valgus with impairment of normal foot function.

The osteotomy of the foot is performed under general anesthesia.

The operation can be performed using different methods:

• In the Akin osteotomy, a wedge-shaped incision is made near the metatarsal phalanx of the big toe and the metatarsal bone;
• The Scarfe osteotomy is performed with a Z-shaped incision on the bone;
• V-shaped chevron osteotomy: artificial fracture with excision of additional fragments, followed by fusion and fixation of the bone fragments;
• Evans extension osteotomy of the calcaneus with implantation to correct flat feet;
• During the Weil operation, the head of the first metatarsal bone is shortened and raised.

The appropriate surgical technique is determined after a comprehensive examination based on the medical history, the degree of valgus and individual contraindications.

There are many causes for this deformity. The main causes include:

• inheritance
• Excessive pressure on the forefoot in athletes, dancers, figure skaters, etc.
• Prolonged wearing of tight shoes and high-heeled boots.
• Genetically determined pathology of the skeletal system
• Metabolic disorders (excess weight, which increases the load on the joints, urate accumulation, disorders of carbohydrate metabolism)
• Deformities caused by trauma

The diagnosis is made on the basis of a clinical examination of the patient by a doctor, an orthopedist, and X-ray data.

The condition cannot be corrected without surgery. However, in the early stages of the disease, conservative treatment is recommended in young patients and also in older people. The main goals are to eliminate pain and prevent disease progression. The most important components of conservative treatment are anti-inflammatory measures, physiotherapy, physical therapy and individual care with orthoses.

If conservative treatment is ineffective, there is significant forefoot deformity and surgical treatment is performed for aesthetic reasons. Currently, there are a number of different methods of surgical treatment of hallux valgus, the most common of which involve osteotomy of the metatarsal bones and the main phalanx of the first toe (Scarf, Shevron, Austin, Akin), that is, correction of their axis.

At the International Health Center, surgical treatment of valgus deformities of the foot is carried out using modern and effective methods. The clinic offers diagnosis, surgical treatment and rehabilitation.

Diagnosis of valgus deformity

Due to the obvious external signs of pathology, the initial diagnosis is not difficult, but it needs to be refined to determine the degree of deformity:

• The x-ray of the foot, which is carried out in two projections, provides information about the changes in the structure of the foot and the condition of the bone and cartilage tissue.

• Ultrasound – an ultrasound examination of the bone, cartilage and soft tissues of the foot reveals pathological changes in these tissues and allows an accurate diagnosis.

X-rays are often sufficient, but are ordered selectively or in combination by the orthopedist depending on the individual characteristics and the overall clinical picture of the disease.

Surgery for Foot Injuries: Treating Flat Feet

Transverse longitudinal flatfoot, which occurs to varying degrees in most people, progresses with age and is a complex deformity associated with valgus positioning of the foot.

The figure shows that the foot is biomechanically composed of two springs: the longitudinal arch and the transverse arch.

The vaults can be flattened individually or together. The illustration shows a flattened longitudinal vault

When the transverse arch is flattened (most often in women due to overloading of the transverse arch in heels), there is a load in the anterior region not only on the heads of metatarsals I and V, but also on the heads of metatarsals II and III. A painful callus forms there, which can be removed indefinitely with a stable relapse effect until the patient feels comfortable with custom-made insoles and changing shoes.

In most cases it is a combined deformity: there is a flattening of the longitudinal and transverse arch and a simultaneous formation of valgus in the foot. The direction of deformation is indicated by the arrows.

It is obviously a redistribution of loads at all levels, including the spine with the progression of scoliosis and the formation of herniations.

The alignment of the valgus foot can be shown schematically as follows. To illustrate the effect, the patient is asked to support himself on one foot in isolation on the side of the deformity.

Valgus type deformity

Lower limb deformities represent a large group of diseases in which a distinction is made between congenital and acquired forms. Some of the most common pathologies in this series are valgus deformities. The use of the name in the plural is not accidental: by 'valgus deformity' you can basically mean a different disease. Therefore, first of all, it is necessary to clarify the difference between valgus deformity in children and hallux valgus, as well as the peculiarities of their treatment.

Hallux valgus is characterized by an X-shaped shape of the foot. If the child's knees touch each other when the legs are straightened, and the distance between the feet is more than 5 cm, this is a reason to consult a doctor.

Causes of X-shaped feet

One of the most important congenital risk factors is heredity, which leads to connective tissue dysplasia: something goes wrong during fetal development and the connective tissue does not form. Acquired factors include excessive strain on the child's legs when standing upright and early start of walking when the muscles and ligaments are not yet developed. In this case, the child lacks coordination and spreads their legs wide apart to gain stability. In this position, the knees move closer together and the legs form an X shape.

Treatment of X-shaped legs

• Plantar arthrodesis, in which an implant is inserted between the hip and heel bones to correct the misalignment of the leg axis;
• Surgery to strengthen the tibialis posterior tendon and lengthen the Achilles tendon.

Untreated valgus deformity of the lower limbs can lead to flat feet and spinal curvature.

Square deformation of the big toe

It is important to differentiate between valgus in the lower leg ('X-foot') and hallux valgus in the big toe. These are different diseases. Hallux valgus more often affects adults, especially older people. In hallux valgus, the metatarsophalangeal joint of the first toe protrudes laterally and a hard nodule forms.

In the initial stage, the nodule is small, the defect is cosmetic and there is no pain. In stage 3, the nodule enlarges and twists not just the first toe, but all the toes, causing them to twist.

Causes of hallux valgus formation

One of the main causes of hallux valgus is an unbalanced load distribution in the foot. This can be caused by uncomfortable shoes that deform the forefoot, causing the big toe to stiffen and the foot to stick out to the side.

Other risk factors include heredity, obesity and transverse flat feet.

Treatment of hallux valgus

Conservative treatment of the big toe deformity is unlikely to be successful. What can be done is to slow down the deformation process to prevent progression. Conservative treatment is selected by your orthopedic surgeon taking into account your individual characteristics (age, gender, degree of deformity, etc.). The main conservative treatment methods are the selection of orthopedic shoes, physiotherapy and massage.

With surgical treatment, the problem of a tumor on the leg can be solved at any stage. The orthopedic surgeon selects the appropriate surgical method depending on the degree of deviation of the metatarsal bone. A plaster cast is not required; instead, a special orthopedic shoe - the Baruca shoe - is worn. The duration of rehabilitation is individual and is determined by the doctor.

You can contact the GUTA CLINIC with any type of limb misalignment, where specialists will make a comprehensive diagnosis and select the appropriate treatment method.

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• Valgus flatfoot (valgus flatfoot).
• Stages of hallux valgus.
• chalgus valgus.
• Flatfoot Deformity.
• ICD 10 chalgus valgus.
• Deflection of the first toe.
• First metatarsophalangeal joint of the foot (metatarsophalangeal joint).