Big toe deformity: treatment

Static leg deformity is a degenerative disease of the skeleton that seriously affects its support function.Usually, the load is not distributed evenly over the entire area of the foot, but is located along the main point and axis - from the heel tubercle along the outer edge to the toes.This structure ensures the formation of the arch of the foot - a set of bone formations and soft tissues that have shock-absorbing properties.

Therefore, damage to this formation leads to the development of a fairly common disease - flat feet.When mentioned, people usually imagine the longitudinal variant of the pathology, which causes the arch of the foot to fall along the inner edge.But the transverse form of this disease, which is accompanied by the characteristic curvature of the big toe, also refers to flat feet.

This type of pathology occurs mainly in mature and elderly women, it is often an acquired condition.It is associated with wearing shoes that are uncomfortable or ill-fitting, which over time contribute to the displacement of the bones of the forefoot.The result of hallux valgus is an unpleasant symptom that accompanies a person when wearing normal shoes and when walking normally.

Concept

In orthopedics, a valgus deformity is a deviation of any segment of the musculoskeletal system outward from the median axis.In this case, curvature can also occur at the joint - then the direction of the angle between the bones is assessed.The development of transverse flat feet corresponds precisely to this mechanism, eventually leading to irreversible damage to the metatarsophalangeal joint of the first toe.

Although this condition often develops over decades, patients seek help at a later stage.Therefore, it is necessary to indicate the characteristic features inherent in hallux valgus:

1. The first and main symptom is the curvature of the first metatarsophalangeal joint with the formation of an open angle to the outside.The formation of pathology occurs gradually, but it develops irreversibly.In the final stages of the disease, the deformity of the big toe reaches such severity that the angle at the joint becomes almost 90 degrees.
2. The next important sign is the formation of a characteristic "bone" located on the inner edge of the foot, where usually the heads of the metatarsal bones protrude slightly.Its appearance is associated with the compensatory deviation of this bone inward under the force of gravity.
3. The latest manifestation is the hammer-shaped curvature of the second finger, also caused by pathological pressure from the adjacent joint and surrounding soft tissue.

Hallux valgus is characterized by the appearance of additional (non-permanent) signs - pain in the forefoot, impaired walking, the appearance of dense corns on the soles of the feet under the middle toe.

Mechanism of formation

Like other degenerative skeletal diseases, transverse flatfoot goes through two stages in its development.In the first stage, only functional changes occur in the soft tissue, which leads to a decrease in its support and elastic properties.And in the second stage, the deformation of the joint or bone itself is already formed:

• The trigger factor is always improper loading of the forefoot due to wearing ill-fitting shoes - especially those with narrow toes and heels.
• This leads to chronic damage to the soft tissue - the ligaments and muscles that hold the base of the toes and metatarsals in an elevated position.
• Repeated trauma causes the forefoot to drop gradually, after which the maximum load begins to fall on the midfoot.
• In this case, there is a deviation of the peripheral metatarsal bones in the opposite direction.
• The first metatarsophalangeal joint usually experiences the maximum load, and therefore the pathological pressure force on it is maximum.The capsule gradually stretches, causing displacement further into the metatarsal bones.
• Joint stability decreases, which leads to the formation of subluxation of the first phalanx of the finger.The development of hallux valgus is associated with a continuous and slow process.
• Deformed soft tissues - ligaments and muscles - are fixed in this position over time, which explains the irreversibility of curvature.
• Chronic injury leads to the development of deforming arthrosis of the first metatarsophalangeal joint, which leads to the loss of the joint's functional ability.

The tactics of further assistance depend on the severity of the changes - at the initial stage, conservative measures are sufficient, and already in advanced cases, only surgery will remove the persistent deformity.

Conservative treatment

Valgus deformity of the big toe can be eliminated using traditional methods only if the functionality of the joint is fully preserved.This is explained by the condition of the ligaments and muscles, the damage of which in the early stages can be reversed.In this case, assistance is provided in three successive stages:

1. First, the patient is prescribed a passive treatment method, which involves fixing the fingers in the correct position.The joint is artificially returned to its normal configuration, which is carried out using various orthopedic means.Usually this period takes at least 6 months, necessary for soft tissue adaptation.
2. In the second stage, the active phase begins, which involves special training techniques to strengthen the leg muscles.To achieve this goal, physical therapy classes, massage sessions, and physiotherapy procedures are combined simultaneously.
3. The final period is uncertain, because hallux valgus is an incurable disease.Therefore, the patient consolidates the results of treatment throughout his life and is involved in preventing the development of the disease.

The choice of methods and methods for therapy is completely individual - the patient's age, concomitant diseases, as well as the characteristics of the curvature itself are taken into account.

Passive procedure

The first stage of treatment is the most difficult for the patient, because foot fixation rarely happens without the patient realizing it.The return of the normal anatomical structure of the arch of the foot is much more difficult and noticeable than the development of pathology.For this purpose, the following methods are used in orthopedics:

• The standard to start helping is to completely remove shoes or boots that have a narrow toe box.Now the patient should use only loose shoes, wide or open in the front.Individual stitching of orthopedic boots is considered ideal, but very rarely patients can afford such a luxury.
• For small defects, a special bandage made of adhesive plaster is used, which is applied to the back of the leg.It is set in such a way that when walking, the external and internal deviation of the metatarsal bones is excluded.
• A simpler and more reliable option is orthopedic fixation of the foot - treatment in this case is much more effective.For this purpose, various types of orthoses or bandages are used, the rigidity of which is chosen depending on the degree of deformation.

Wearing the support device should be almost continuous - in the first month it is recommended to remove it no more than 2 hours during the day.

Active procedure

The transition to the second stage is determined individually - after the doctor evaluates the symptoms, as well as an X-ray examination.The absence of disease progression, as well as at least some positive dynamics, allows us to start an active fight against disability.The following methods are used for this:

• First, physical therapy procedures are gradually introduced to prepare the joint and surrounding soft tissues for the upcoming loads.A warming and disturbing procedure is carried out, which can be applied to the legs.It includes laser, magnet, application with paraffin or ozokerite, ultrasound therapy.
• After a few days, a massage session is added, which begins with superficial heating of the tissue.Gradually, the specialist should proceed to warm up the actual muscles of the foot, which play an important role in eliminating curvature.
• When the unpleasant symptoms disappear completely, the patient continues independent physical exercise.It is not recommended to include many exercises in the program at once, so as not to cause muscle fatigue.It is better to increase the load gradually, allowing the soft tissues to adapt to the work being done.

To achieve the full effect, the activities listed must be carried out every day to prevent the pathological process from returning.

Surgical treatment

Indications for surgery should always be justified, as long-term recovery is required after it is performed.Therefore, they are not performed on patients in the early stages of hallux valgus, where the curvature of the fingers can be corrected naturally.Surgical intervention is required only in case of irreversible changes in the joints or surrounding tissues:

1. When there are signs of fixed transverse flatfoot - that is, the front arch of the foot is deformed during the load test and in the resting position.This conclusion appeared after an X-ray examination assessed the location of the head of the metatarsal bone.
2. With significant curvature of the first metatarsophalangeal joint, accompanied by constant dislocation between the bones that make it up.The absolute indicator in this case is the additional curvature of the adjacent joint, which leads to a change in the position of the second finger.
3. Even with early signs of arthrosis in the first metatarsophalangeal joint, which indicates irreversible damage to the surrounding soft tissue.Muscles and ligaments are securely fixed in a violent position, so it is not possible to carry out corrections in a conservative way.

The choice of the intervention method depends entirely on the individual characteristics of the course of the disease - it is usually performed on the most affected component of the arch of the foot.

Ligament surgery

This surgical treatment option is more suitable for patients who do not yet have signs of direct damage to the joint tissue.Therefore, the main mechanism of deformation in it becomes pathological muscle traction associated with changes in the position of the arch of the foot.To correct this, the following intervention options are used:

• The first type of operation includes all forms of transposition (movement) of the tendon attached to the first metatarsal bone.It is a pathological contraction of the muscle that leads to a gradual increase in the deviation between it and the phalanx of the finger.Therefore, the ligament is removed or partially split and attached to a new place - in the area of the outer edge of the metatarsal bone.Changing the point of application of muscle force allows you to gradually return it to its original place.
• The second type of operation involves the creation of various types of bonds - the creation of an artificial transverse arch of the foot.All metatarsal bones are fixed in the correct position, after which another part of the ligament, or a synthetic prosthesis, is sewn to them.But this option is only possible with "mild" deformation, when the displaced bone can be easily returned to its original place.

According to the results of observations, all operations on ligaments are still temporary - without correction of pathological factors, the transplanted tendons quickly stretch again.

Joint operation

If there is a significant curvature of the joint, orthopedic intervention is required to eliminate the deformity of the bone tissue.To do this, a resection is performed - the removal of a certain area of the affected bone.This method makes it possible to artificially return the joint to its normal position.The following options for such operations are in use:

• The main method to eliminate the deformity is Schede-Brandes osteotomy.This intervention includes two manipulations - the removal of pathological growths on the first metatarsal bones (ossicles), and the resection of the triangular fragment at its base.After the fusion of bone tissue, the deformed finger returns to its normal position.
• Less commonly used is an operation where resection of both areas is carried out in the area of the metatarsal head.Due to the massive damage, the risk of developing complications that will not allow the fragments to heal properly is too high.
• In advanced cases of the disease, a form of palliative intervention is performed - not restoring mobility, but eliminating pathological displacement.For this purpose, arthrodesis is performed - cutting and closing the joint cavity between the metatarsal bones and the phalanx.

Nowadays, these interventions are rarely performed separately - they are usually combined with simultaneous tendon plastic surgery, which eliminates improper muscle tension.

Combined operation

Performing complex manipulations is a priority in modern orthopedics, which leads to an increase in the frequency of combined interventions.Usually, a combination of soft bone resection and repositioning of one of the ligaments that move the thumb is done:

• The modified Schede-Brandes operation involves the removal of the standard part of the metatarsal bone - resection in the area of the head and base.In addition, the abductor pollicis muscle is transferred to its outer surface, a pressure that leads to subluxation in the joint.
• It is also possible to perform an osteotomy in combination with the formation of an artificial arch.Moreover, in one operation it is possible not only to return the metatarsal bone to its original place, but to give the remaining structure the correct position.
• In severe cases, interventions are combined to eliminate the deformity of the first and second metatarsophalangeal joints simultaneously.

This type of operation is characterized by the greatest severity - a large amount of destruction requires long healing and increases the recovery period.

Restoration

The completion of conservative treatment and surgery is the beginning of the recovery period, which continues in such patients throughout their lives.Without following special recommendations, the disease may return, reminding itself again with unpleasant symptoms:

1. First of all, all patients are required to wear a special orthopedic insole with the addition of a Seitz bolster.They will not only ensure the correct position of the foot while walking, but will create additional support for the arch.
2. You also need to pay attention to your shoes - completely exclude from your wardrobe any boots or shoes with a narrow front.
3. You need to take care of your own body weight - maintaining a normal body weight significantly reduces the load on the arches of your feet.
4. Doing preventive daily exercises regularly keeps the muscles in normal tone, which prevents displacement of the metatarsal bones.

The main difficulty for patients arises with physical therapy programs, because most patients recently do not know exercise techniques.Therefore, in order to perform it correctly, you need to study first with an instructor in the form of an individual or a group.