Shallow valgus deformity in adolescents

Valgus deformity is a multifactorial condition that develops as a result of hereditary predisposition, other diseases of the musculoskeletal system, neurological pathologies, metabolic disorders and external factors.

What is a valgus deformity?

The deformity of the foot with displacement of the big toe and bony protrusion is one of the most common orthopedic pathologies. Initially it is a cosmetic defect and causes little discomfort, but if left untreated it progresses with age. The legs quickly get tired when walking, pain occurs, the choice of shoes becomes problematic, and correcting the defect, even through surgical intervention, becomes increasingly difficult. Therefore the treatment of the Valgus halgus necessary as soon as the first symptoms of the disease appear.

Causes of hallux valgus

It is a multifactorial disorder that develops as a result of hereditary predisposition, other musculoskeletal disorders, neurological and metabolic abnormalities, and external factors.

• Inherited predisposition to the formation of hallux valgus
• Transverse and longitudinal flat feet
• inflammatory processes (mainly arthritis: psoriatic arthropathy, gout, rheumatoid arthritis)
• Congenital biomechanical instability of the foot
• Hyperelasticity syndrome, connective tissue dysplasia
• Neuropathies of various origins
• Deformities of the knee and hip joints

1. Dislocations of the foot and ankle, joint injuries and fractures of the foot bones
2. Wearing anatomically incorrect shoes with high heels and narrow toes.
3. Occupational risks: constant heavy lifting, standing for long periods of time and standing on your feet.

General Symptoms

Flat feet are already present in newborns. The active formation of the arch of the foot occurs between the ages of 3 and 5 years. If the parents (or at least one of them) have already been diagnosed with flat feet, there is a high probability that the child will develop this disease again. The main signs of this condition are:

• Uneven wear on the soles of shoes. The heel is more worn on the inside;
• An awkward walk. This is especially true for children. If they have flat feet, they may stumble and fall frequently, even on flat surfaces;
• Difficulty walking on a flat surface because feet are in the wrong position;
• Posture problems. These may include excessive forward bending (lordosis) in the lumbar region and a 'rounded back' (compensatory kyphosis) in the thoracic region;
• rapid fatigue of the legs, even with little physical activity. Some children may complain of pain in their lower legs and feet. Pain in the back and hips is less common.

Methods for preventing flat feet

There are various methods for treating and preventing flat feet. Their effectiveness depends on the severity of the disease. To achieve positive dynamics, a number of measures should be used.

massage. They are useful and pleasant procedures, but to achieve results it is important to have them carried out by a professional. The regularity of the meetings is also important. This procedure involves massaging the entire lower extremity.

self massage. It is carried out using special equipment. They can be made yourself or purchased from a store. To prevent flat feet, preschool children are offered mats with divisions that differ in shape and texture. You can also use a massager made of wooden parts with small spikes. These are attached to a base and rotate around their axis.

To run barefoot. This is one way to prevent arch abnormalities. On warm days, the child should walk without shoes as often as possible. Walking on uneven surfaces such as dirt, pebbles or sand is particularly useful.

Physical activity. You should seek advice from a specialist about what type of exercise you should do. Exercise also improves local blood circulation and strengthens the foot and lower leg.

Symptoms of valgus deformity of the big toe

The pathology is accompanied by the following symptoms.

• The big toe begins to move toward the other four toes and the bunion begins to enlarge and protrude at the base of the big toe.
• The remaining toes are compressed and have a characteristic valgus position.
• Discomfort and pain in the ankle joints increases, and sometimes cramps occur.
• The legs become very tired after short periods of exercise.
• The changes in bone tissue lead to inflammatory processes.

Later, the following orthopedic pathologies may appear and worsen.

• Osteoarthritis of the toe joints.
• Chronic bursitis (arthritis).
• clubfoot.
• Claw deformation of the toes (downward curvature) and others.

Diagnosis of valgus deformity

Due to the obvious external signs of deformity, the initial diagnosis is not difficult, but requires evaluation to determine the degree of deformity, differentiate other orthopedic pathologies and identify associated pathological processes.

It is carried out in two projections and provides a picture of the changes in the structure of the foot and the condition of the bone and cartilage tissue.

Multi-slice computed tomography (MSCT)

Highly informative and technologically advanced measurement method, the gold standard in modern diagnostics. It provides a visual picture of the smallest changes in the composition and structure of the tissues of the human body.

Ultrasound examination of the bone, cartilage and soft tissues of the foot to detect pathological changes in these tissues and make an accurate diagnosis.

The hardware examinations are ordered by the podiatrist selectively or in combination, depending on the individual characteristics and the overall clinical picture of the disease.

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Prevention of foot deformities should begin at a young age:

• Walking barefoot on uneven surfaces (pebbles, grass, sand). Alternatively, you can also use special massage mats;
• Playing and exercising with massage balls;
• Anatomical shoes with a rigid back and a closed, wide forefoot with a small heel (up to 0.5 cm);
• Prophylactic insoles from the age of 5-7 years.

However, there are anomalies. The most common problem is flat feet. The child rests on the inside edge of the foot and the heel 'goes out'. Over time, an X-shaped curvature of the foot develops.

Causes of valgus feet in children:

• overweight, obesity;
• prematurity;
• Early arch (up to 10 months);
• genetic predisposition;
• Diseases (rickets, cerebral palsy, polio, frequent acute respiratory infections, etc.).
• sedentary lifestyle;
• Walking only on flat surfaces (tiles, parquet, laminate, linoleum, etc.);
• unsuitable footwear.

At the initial stage of the disease, the child may not feel any discomfort. In the advanced stage of the disease, the child only feels discomfort when walking and talks about foot pain. The foot deformity can be easily recognized by the change in the shape of the shoes the child is wearing, and then only visually.

The disease is difficult to recognize: at first it is not noticeable at all. However, if left untreated, a deformity develops that has serious consequences: poor posture, pain in the knee and hip joints, and increasing fatigue. It will be difficult for the child to lead a healthy lifestyle and play and play sports with peers.

The first signs of an anomaly can be seen in the shape of children's shoes - wear is greater on the inside of the shoe.

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Ozone therapy

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This treatment is not suitable for everyone. It should not be performed during the menstrual cycle and in patients with blood clotting disorders.

Mesotherapy

Also an injectable treatment, but in this case a complex of active ingredients is introduced into the skin, which contains all the necessary vitamins, minerals, nutrients, useful amino acids, etc. Hyaluronic acid supplies the roots with oxygen and accelerates hair growth, copper and zinc improve the hair structure, coenzymes accelerate cell regeneration. All drugs used in scalp mesotherapy are selected individually for each patient, depending on the existing problem, hair type and desired result. Mesotherapy treats scalp baldness and improves hair structure by working at the cellular level. The treatment cocktails regenerate, nourish, hydrate, strengthen the roots and detoxify.

Treatment is not carried out during pregnancy and breastfeeding, with exacerbation of chronic diseases and with the development of skin inflammation. In addition to those mentioned above, there are a number of contraindications to mesotherapy, which your doctor will inform you about.

Plasma lifting

The procedure essentially consists of injecting the patient's own plasma, obtained from the blood, into the skin. The blood is taken from a vein and, after processing in a special centrifuge, the doctor obtains the platelet-rich plasma. This is injected into the scalp using a very fine needle, making the Plasmolift procedure virtually painless. This awakens the body's own stem cells and renews the skin from the inside out.

causes

Valgus deformity of the first toe is a multifactorial, polyetiological disease. The influence of a single cause is very rare.

Pathogenesis of valgus

There are several mechanisms for the development of the pathological condition. The most common causes and causes of the orthopedic problem include:

• Osteoporosis: It is accompanied by a reduction in bone strength, which makes the bones more brittle and deformed more easily, which is the cause of the disease;
• Flat feet: both congenital and acquired forms, regardless of type;
• Injuries, including bruises (any injury can be the start of a valgus deformity that worsens over time);
• Hormonal imbalances (including natural hormonal imbalances: pregnancy, menopause, etc.).
• Gout or gouty arthritis – acute, recurrent inflammation that primarily affects the big toes and leads to permanent deformity over time;
• other forms of arthritis and the degenerative-dystrophic pathology of osteoarthritis.

The cause may be a genetic abnormality, but hereditary diseases are rare as causes of the disorder.

The causes of valgus are almost never isolated. In 90 % cases, the etiology of the disorder is mixed. It is caused by two or more causes, resulting in difficult treatment and complete correction.

High risk factors

In addition to the direct causes, there are risk factors that further increase the likelihood of a valgus deformity. The risk factors for hallux valgus include:

• Female gender: for physiological and subjective reasons;
• Overweight: Overweight people are more susceptible to the disease because the initial load on the foot is greater;
• History of diabetes (especially in advanced forms, when neuropathy develops), as tissue sensitivity is impaired and orthopedic and podiatric problems are added;
• Wearing uncomfortable footwear: Women are more often affected; it is no coincidence that wearing high heels leads to an abnormal distribution of the load on the foot;
• Genetic predisposition: Hereditary factors play an important role; an increased likelihood of developing the disease in the future is passed on;
• excessive physical activity: as a result of occupational factors (standing in one place, long walks, lifting weights, etc.) or as part of lifestyle;
• traumatic work due to the risk of leg and foot injuries;
• susceptibility to hormonal imbalance;
• Age 50+ as most patients belong to this age group; Valgus deformity takes time, it is not an instant process.

Classification and types of pathological process

The diseases can be classified according to their severity. To accurately determine the type and severity of the disease, two criteria are used:

• Intertarsal angle, defined as the angle between the first two metatarsals;
• Degree of valgus deformity: the angle between the thumb and the first metatarsal bone.

Depending on the combination of these indices, 3 degrees of valgus deformity are distinguished:

• Grade I: The typical valgus angle is less than 25 degrees and the interdigital angle is less than 12 degrees;
• Grade II: The valgus angle is between 25 and 35 degrees, with the interdigital angle being less than 18 degrees;
• Grade III: with a valgus angle of more than 35 degrees and an interdigital angle of less than 18 degrees.

The exact stage and severity of the disorder can only be determined through special diagnostics. During the initial examination, the doctor makes a rough assessment. He only uses the interdigital angle. This is not as precise, but gives a rough clinical indication. More precise data will be determined in further investigations.

It is not possible to self-assess the severity of the valgus deformity. Self-diagnosis is not possible.

Conservative treatment methods

Conservative treatment of valgus deformity abroad includes the following approaches:

• wearing custom-made orthopedic shoes, using orthoses and special valgus splints;
• comprehensive use of physiotherapeutic manipulation, foot massage;
• Selection of a complex of therapeutic exercises;
• Use of local and systemic anti-inflammatory drugs to eliminate pain, redness and swelling.

Patients should be aware that the valgus deformity cannot be corrected conservatively, but all of the above measures will slow its progression. After discharge from the hospital, patients need to perform therapeutic exercises, control the quality of footwear and use special orthopedic devices. This is the only way to stop the disease. Of course, this does not mean that conservative treatment of hallux valgus is ineffective and everyone should undergo surgery, but there are also a number of recommendations for adjusting lifestyle after surgery so that the pathological process does not recur.

surgical intervention

If the pathology is of significant severity - defined by prominent bony prominences and significant outward deviation of the toe - treatment of valgus without surgery is ineffective. In such cases, foreign specialists prescribe an operation. European doctors have numerous surgical options at their disposal so that the most appropriate treatment is selected for each patient.

The most commonly used therapies are the following:

It should be noted that the treatment of valgus deformity of the big toe also depends on whether or not degenerative-dystrophic changes (arthrosis) are present in the background of the pathology.

Chevron osteotomy

Chevron osteotomy involves restoring the anatomically correct position of the bones in the foot using fixation devices. During the operation, the soft tissues and the joint capsule are severed and small bone outgrowths are removed. The bones are then fixed with screws or wires made of materials that are completely biocompatible with the structures of the foot. After a few months, all fixed parts can be removed again.

Arthrodesis of the big toe

After accessing the structures, the surgeon disassembles the articular surfaces, aligns the bones and fixes them with high-quality, body-compatible screws. Once the structures have fused together, the screws must be removed in a second operation.

Arthrodesis is an operation to immobilize the joint. If there are severe arthritic changes in the affected joint and a surgical intervention such as chevron osteotomy cannot be performed, foreign specialists use arthrodesis. Immobilizing the first toe does not affect the patient's mobility.

• flatfoot μb.
• Flat valgus deformity.
• Shallow valgus deformity in children.
• Stages of hallux valgus.
• Deflection of the first toe.
• ICD 10 chalgus valgus.
• chalgus valgus.
• First metatarsophalangeal joint of the foot (metatarsophalangeal joint).