Stages of hallux valgus

The second most common cause of hallux valgus is osteoporosis, which primarily affects older people, especially women, but also pregnant and breastfeeding women.

Treatment of hallux valgus

The deformity of the big toe ('lump' at the base of the big toe, a curve) is known in medical circles as hallux valgus. Hallux valgus is a very common deformity. In addition to being a cosmetic problem, it is also an orthopedic problem, as it causes pain, prevents you from wearing shoes properly and can lead to joint inflammation.

'Beauty requires sacrifice' is something girls hear from an early age, and conforming to accepted notions of beauty, they dress in pretty but sometimes uncomfortable clothes and shoes.

Over time, children's shoes are replaced by fashionable high-heeled sandals, and no amount of medical advice, no matter how good, can knock a woman off the pedestal of heels. She goes through life stylish, successful and self-confident, despite the aches, pains and fatigue of her shapely feet. However, every coin has a flip side, and years later, fashion-forward women encounter a problem called hallux valgus.

Causes of Hallux Valgus

The connective tissue syndrome is expressed by hypermobility of the joints, ligament weakness, a tendency to transverse flat feet and varus. Hereditary factors are clearly involved in the development of connective tissue defects, so that your mothers and grandmothers may have complained of hallus valgus.

Basically, wearing the wrong footwear (size, tightness, fit) or high-heeled shoes is just a predisposing factor that, if there are other causes, contributes to the development of the disease.

Dysregulation of the nerves in the foot tissues, previous trauma, congenital defects, polio can also lead to foot deformities.

Uneven tension in the muscles responsible for alignment of the big toe leads to instability of the foot and the compensatory appearance of a bony prominence at the base of the toe. The load of walking is abnormally distributed, which only aggravates the situation. The shape of the foot changes and the disease progresses steadily.

In most cases of hallux valgus, the causes are related and are assessed in their entirety. This systematic approach makes it possible to find the best possible treatment for the patient.

Causes of hallux valgus

• Hereditary weakness (dysplasia) of the connective tissue;
• Consequences of trauma, certain diseases (e.g. rickets, polio);
• Wearing high-heeled shoes;
• lack of adequate exercise, obesity;
• Excessive physical stress;
• involutionary processes;
• Congenital malformations.

Symptoms of hallux valgus

In the early stages of the deformity, an excruciating pain is felt, which intensifies towards evening. At night, the pain subsides, and bandages for hallux valgus are especially effective during this period.

The foot deformity is not pronounced. The inner part of the foot, which rubs against the walls of the shoe, is noticeable through redness and small skin injuries.

Irritation of the periarticular tissue leads to frequent exacerbations of synovitis.

Further deviation of the toes and metatarsals results in persistent, severe pain after a short period of walking.

Nerves can be pinched, which manifests itself as a sharp, burning pain. A deformation of the foot is noticeable. The pressure of the footwear causes blisters, the skin thickens and the bunions become chronic.

A traumatic exostosis, a subluxation of the 1st metatarsophalangeal joint, can occur. Corns form on the soles of the feet, which indicate a redistribution of the load on the foot.

The pronounced deformity of the foot makes it difficult to wear shoes. The pain is constant and gait is impaired.

The skin in contact with the footwear is rough and exostosis is visible. The impression of the metatarsophalangeal joint shows reddening and swelling of the skin, sometimes ulceration or suppuration up to osteitis.

There is severe pain in the sole area due to compression of the plantar nerve by the 3rd metatarsal. The mobility of the metatarsophalangeal joint is impaired.

WHAT CAN YOU DO ABOUT IT?
To get rid of the bones in the feet, their owners should consider the following
There are at least three ways to do this:

Treatment is generally ineffective, particularly for grades 2-4 valgus deformities.

– (Physical therapy, massage, physiotherapy, special orthoses, administration of medication)

The treatment inhibits the development of the hallux valgus deformity.
Effective only in the initial stages of the disease

– (Physical therapy, massage, physiotherapy, special orthoses, administration of medication).

There are 4 types:
Soft tissue surgery - effective in stage 1 disease;
Bariatric surgery - treatment of valgus deviation of the first metatarsal at grade 2-3;
Combined Surgery - Soft Tissue and Bone;
Minimally invasive surgery – by puncturing the skin with a special instrument.

Surgery is a simple and effective way to treat
Hallux valgus without recurrence of the deformity

A lump at the base of the toe is not a lump as most people think when trying to cure it using folk methods. It is a bony deformation of the 1st metatarsophalangeal joint. Therefore, the ideal solution to get rid of the nodule is surgery.

In the National Medical and Surgical Center of the Federal State Budgetary Institution 'SPMC' of the Ministry of Health of Russia, this 'inconvenience' can be quickly and irrevocably removed.

You used to have to stay in the hospital for 5-7 days - now you can go home on the day of the operation.

No cast and no crutches - you can walk in a special orthopedic shoe for up to 1.5 hours after the operation.

In most cases, no bandages are required - you will be rid of your problem forever.

Surgery for valgus deformity

For most patients, especially those who have severely 'neglected' the problem, surgery is the only way to relieve the suffering and return to normal life and active movement. Above all, only surgical intervention can completely eliminate the visual defects associated with a valgus deformity, such as a knot in the joint, crooked toes, corns and calluses, and a flat arch of the foot.

When treating hallux valgus, the surgeon separates (osteotomy) the metatarsal bones and moves them into the correct position. In addition, the joint can be replaced with an implant during the procedure. The incisions are usually made along the inner and outer edges of the big toe (leaving a small, inconspicuous scar).

Of the various methods, the two distal osteotomies are the most commonly used and offer good and lasting treatment results.

Chevron osteotomy is an operation intended for small deformities of the big toe. It is used for small deformities of the big toe, as long as there are no significant changes in the joint, e.g. B. osteoarthritis, are present.

Scapular osteotomy is an operation for advanced stages of valgus deformity of the big toe. It is well suited for correcting moderate to severe valgus deformities.

Thanks to modern technology, the foot can be loaded immediately after the operation without crutches, but with special shoes. For the next three weeks, the foot is kept in a postoperative cast. This is very important as the bandage will keep the toe in the correct position. You can take a bath during this time so that the bandage does not get wet.

The foot may initially appear swollen. Elevate your foot and try not to put excessive strain on your foot to relieve symptoms.

prevention of the disease

The following measures can prevent the development or rapid progression of a valgus deformity:

Regular visits to the orthopedist to evaluate flat feet and other conditions that can lead to a deformity;

Wearing special corrective orthopedic insoles (preferably custom-made), splints, toe stiffeners in footwear

Choice of 'safe' footwear: no tight socks, stilettos, heel no higher than 7 cm, made of natural materials.

Degree of valgus foot deformity.

A distinction is made between the following four degrees of transverse forefoot deformity.

The first degree is characterized by a cosmetic deformity with an unfixed forefoot and deformity of the first toe without pain. The second degree is pain in the foot with moderate forefoot laxity. The third stage is characterized by forefoot stiffness. The fourth stage is characterized by severe deforming arthrosis of the first metatarsophalangeal joint or a deformity of the middle toes.

The developed classification makes it possible to choose the best method of treatment for each patient.

For an objective assessment of the patient's condition, a special automated complex is used, which includes a special flatbed scanner and software for processing the information and drawing up a diagnostic result. The software package uses a combination of several methods to determine the anatomical and functional condition of the forefoot, including the Streeter, Balakirev and Streeter-Godunov methods using the Chizhin and Weifsloh index.

Surgical correction of the big toe misalignment

The condition is treated surgically using the technique of tenomyoplasty.

Surgical correction is performed under intraoperative anesthesia or anesthesia. A 4 cm longitudinal incision is made on the dorsum of the foot, muscles and tendons are transplanted and the bony hypertrophy is removed, but the bone itself is not severed. The wounds are sutured in layers and an aseptic dressing is applied with moderate compression. Immobilization with a plaster cast is not necessary.

The day after the operation, the foot is bandaged by inserting an individually adapted round gel pad in the first toe space and applying a modeling elastic foot orthosis over the aseptic bandage, which allows dosed loading of the operated extremity.

On the 5th postoperative day, UHF and magnetic therapy on the forefoot, massage of the lower leg and the operated limb, and hyperbaric oxygenation are performed. These measures are aimed at reducing edema in the tissues. The sutures are removed on day 12-13. The average hospital stay is 14 days, after which the patient is discharged on an outpatient basis. Walking unaided is acceptable.

The operation can also be performed on two limbs at the same time. In this case, the stay in the clinic is 19-20 days from admission to discharge.

In the six weeks after discharge, the legs must be protected from all sports such as running, jumping, step aerobics, etc.

Causes of valgus deformity of the big toe

'Lameness' or in medical jargon 'Hallux Valgus' is often associated with a general, systemic connective tissue disorder. Its manifestations may include varus, excessive joint mobility, abnormal stretching of the skin, fascia, and ligaments, and other external and occult organ and tissue changes; flat feet are also usually associated with this more genetically determined 'connective tissue deficiency syndrome'. An important aspect of the etiology of hallux valgus is considered to be a hereditary factor, a genetic mechanism of bony hypertrophy of the head of the first metatarsal (especially in the medial direction). In the pathogenesis of hallux valgus, in addition to the bony mechanism of the deformity, dysfunction of the antagonistic muscles, the adductors and adductors of the phalanx of the first metatarsal, is considered important. Traction (tension) of the adductors (tendon of the adductor muscle) against a background of genetically determined exostosis of the head of the first metatarsal increases the abduction effect of the toe.

Everything else - tight shoes, walking in heels, etc. - All other factors, like tight shoes and high heels, only add to the deformity of the forefoot.

Other causes of valgus can include trauma to the foot and shinbone, congenital foot deformities, arch deformities – flat feet, and neuromuscular disorders, e.g. B. polio, which can lead to paralysis.

When a valgus deformity of the big toe develops, there is an imbalance in the tension of the muscles of the foot that attach to the big toe—the flexor, extensor, and adductor muscles. This leads to what is known as instability of the metatarsophalangeal joint, which ultimately leads to deformation of the big toe.

The formation of a valgus deformity of the big toe is accompanied by the formation of a 'knot' in the metatarsophalangeal joint. The cause of this nodule is constant irritation of the bone in this area and swelling of the soft tissues. In addition, the lump is caused not only by the formation of a bony outgrowth, but also by an inward displacement of the head of the first metatarsal.

RISK FACTORS FOR HALLUX VALGUS

In addition to the direct causes of hallux valgus, there are also factors that play a role in the development of this pathology.

1. Wearing tight shoes. Tight, narrow shoes cause the thumb to shift toward the head of the first metatarsal. Continued shifting in this direction leads to pathology.

2. High-heeled footwear. High-heeled shoes cause displacement of the big toe. Also, high heels contribute to the development of flat feet, which in turn is a contributing factor to this deformity.

3. arthritis and osteoarthritis. Arthritis is the inflammation of the synovial membrane. Osteoarthritis is a degenerative disease of the articular cartilage. In older age, these joint diseases become more common due to age-related changes, which contributes to the development of valgus deformity of the big toe.

4. A 'hereditary' predisposition. In some cases, foot deformities are hereditary (congenital). This also contributes to the development of a valgus deformity of the big toe.

5. flat feet. Flat feet and other arch deformities are also considered risk factors for developing a valgus deformity of the big toe. Indeed, in this pathology of the arch of the foot, there is a loosening of the structures that support the arch of the foot, accompanied by an imbalance in the muscles that keep the big toe and the first metatarsal in their correct position.

Hallux valgus is a condition that mostly affects women, and with good reason. The reasons for this are the structure of women's feetThe musculo-articular system of women's feet is weaker. Men's feet have tighter ligaments that make the foot more compact and more resistant to deformities. Men also have a stiffer, less mobile joint system, making them less prone to thumb deformities. The more delicate muscle and joint structure of women's feet means they are more likely to develop hallux valgus than men.

Deformations of the big toe and the resulting deformations of the foot bones are also caused by other causes, among others. ... ill-fitting footwear .... Shoes that are too narrow or too tight with high heels overload the forefoot, which leads to a widening of the forefoot and a stretching of the transverse arch of the foot. Conversely, shoes with a narrow toe box misalign the toes, especially the big toe, by increasing pressure on the big toe, which can lead to chronic inflammation. It's important to remember that it's not just the shoes you wear that affect the appearance of a valgus deformity. There are other important factors such as age, type of work and other medical conditions.

A valgus deformity is also significantly influenced by genetic predisposition. The best proof of this is the fact that hallux valgus also occurs in young women who have hardly ever walked in heels. About 75 percent of hallux valgus cases are hereditary and are usually inherited from the mother. Therefore, if hallux valgus runs in the family, women should carefully choose their shoes so as not to increase the risk of the deformity. It is also important to prevent flat feet, especially at a young age.

Complications associated with hallux valgus deformity of the big toe

Local inflammation is one of the most common reasons why hallux valgus is painful. The inflammation can be accompanied by redness, burning, swelling and pain in the area of the first metatarsophalangeal joint.

The progressive course of the disease can lead to further changes in the feet, such as: B. Claw and hammer toe deformities and metatarsalgia (pain in the metatarsal bones).

The deformity can also lead to changes in gait, pain in the knee joints and even in the sacral spine.

In addition, progressive deformity of the foot, manifesting as a valgus deformity, can lead to transverse flatfoot. Flat feet can occur because the body weight on the deformed foot is unevenly distributed - the front part of the foot is loaded. In addition, the second toe rises and encloses the thumb, which is curved towards it. The foot loses its normal structure - the result is a reduction in the transverse arch of the foot and eventually its complete disappearance.

A progressive valgus deformity can also lead to painful calluses on the soles of the feet, which are caused by overloading and compression of the deformed bones.

Hallux valgus, in combination with other accompanying foot deformities, changes in normal function and symptoms of other toes, is not a single defect but a whole 'bouquet' of forefoot deformities. Today there are a number of treatments that can relieve the pain and restore the foot to its normal structure and function.

treatment methods

The treatment method depends on the severity of the problem. In medicine, three degrees of hallux valgus are distinguished:

• I: slight deformity, the displacement angle is between 16-25°.
• II: moderate deviation, from 25° to 35°.
• III: severe pathology, with an angle greater than 35°.

In the early stages of the disease, conservative measures are often effective. The traumatologist may recommend the following

• Constant wearing of special shoes or orthoses;
• spacers between the toes;
• therapeutic massage;
• Physical therapy;
• Physiotherapy: ultrasound, laser therapy, shock wave therapy (SWT).

The aim of these therapeutic measures is to stop the progression of the disease, make it easier to walk and wear shoes, reduce pain and prevent possible complications. However, if there are no results or the pathology continues to progress, doctors usually suggest surgical treatment.

Removal of tumors on feet at 'SOVA' clinic in Saratov

Surgical intervention is indicated when the problem causes serious discomfort to the patient - both physiological and psychological. Pain in the big toe, limited mobility, unaesthetic appearance of the feet - it is impossible to wear nice open shoes - are causes for concern.

Before correction, an initial consultation with a traumatologist is required. The specialist will take a medical history, conduct an examination, and diagnose the problem. Radiographs of the foot must be taken in two projections to determine the extent of the deformity.

The doctor will then recommend the usual comprehensive preoperative examinations, including:

• blood tests (general, biochemical, infections, Rhesus factor, blood group);
• electrocardiogram (ECG);
• fluorography;
• X-ray of the foot;
• urine test;
• Report of an internist on the absence of contraindications.

In our clinic in Saratov, the valgus foot deformity is operated by means of a corrective osteotomy (the price can be checked on the website or by phone). After the procedure, the patient is back in the anatomically correct position of the foot bones, mobility is restored and pain is eliminated.

surgical treatment

During surgery, the doctor makes an incision over the bony structure of the foot, files, and removes the head of the first metatarsal. He then brings the fragments back into their anatomically correct position and corrects the misalignment. The cartilaginous and bony elements are fixed with a special structure: screws, spokes or a plate. The surgical procedure is performed under general anesthesia.

rehabilitation

The rehabilitation period is 2 months. During this period, the following medical recommendations should be observed:

• Always wear special postoperative shoes - Baruca shoes - for the first 6 weeks;
• use of orthopedic insoles;
• limit physical activity and exercise;
• Limiting physical activity and movement and wearing compression garments (stockings, tights) to prevent swelling, varicose veins and blood clots.

surgical treatment

In advanced stages of hallux valgus, an effective restoration of the function and aesthetic appearance of the foot is only possible through surgery. Modern operations in Israel are complex interventions with corrections to bones, cartilage of the articular surfaces, joint capsule and ligaments of the foot. In foreign specialized clinics, they are performed using minimally invasive techniques that allow for a short rehabilitation period and long-lasting results. A number of surgical techniques have been developed and are widely used. The extent of surgical intervention depends on the degree of deformity:

• In patients with grade one, correction of the ligaments of the foot and the joint capsule of the metatarsophalangeal joint is often limited. Sometimes a resection of the bony prominence is performed;
• In patients with a second degree deformity, the position of the first metatarsal is corrected in addition to the soft tissue. A common operation at this stage of the disease is osteotomy followed by bone correction and fixation.

Several osteotomy options have been developed, each appropriate for the degree of deformity.

For example, a wedge osteotomy is performed at the first degree of angular deformity. The division of the wedge-shaped fragment of the first metatarsal allows the bone to be properly shaped and guided by fixing it with titanium abutments. In more advanced stages, chevron and scarf osteotomies are used to correct more complex deformities and to correct pathological first toe axial rotation;

• In the third phase, after the anatomically normal conditions in the foot have been restored, an arthrodesis (elimination of mobility of the first metatarsophalangeal joint) is often necessary. Titanium fixators are used, which no longer have to be removed and therefore do not require a second operation.

In Israel, the operation to correct the valgus deformity is performed minimally invasively through 3-5mm long incisions using an arthroscope. After the physiological position of the bone has been restored, the capsule of the metatarsophalangeal joint has been repaired and the ligament tension corrected, the correctness of all components of the foot is checked intraoperatively.

rehabilitation

After 1 to 3 days, the patients can already walk in special shoes that prevent the forefoot from being stressed. Through active rehabilitation with anti-inflammatory drugs, sleeping bandages, and physical therapy, patients can drive and walk freely in orthopedic shoes again within two weeks. If necessary, the other foot can also be corrected after three months.

The foot has a complex anatomy with many bones and joints connected in a harmonious arrangement by numerous tendons, ligaments and muscles. Therefore, the corrective operation requires brilliant mastery of several surgical techniques, experience and modern equipment, including endoscopic devices and microsurgical instruments.

Overseas there are specialized centers or departments of large orthopedic clinics, whose doctors work daily with patients suffering from valgus deformities. Therefore, they show low complication rates and excellent functional and cosmetic results.

• chalgus valgus.
• Shoes for hallux valgus.
• ICD 10 chalgus valgus.
• flatfoot μb.
• First metatarsophalangeal joint of the foot (metatarsophalangeal joint).
• metatarsophalangeal joint.
• Deflection of the first toe.
• Metatarsophalangeal joint of toe 1.