Hallux valgus is a disease at which the first finger of foot is deformed at the level of a plusnefalangovy joint and deviates knaruzh. Pathology is followed progressing artrozoartrity the first plusnefalangovy joint. The disease develops gradually and is usually aggravated with age. It is shown by pains when walking, night pains are possible. At the expressed deformation there is a restriction of movements in the I plusnefalangovy joint. The diagnosis is exposed on the basis of clinical signs and data of a X-ray analysis. Treatment at early stages conservative, symptomatic. At considerable deformation surgical correction is carried out.
Hallux valgus – valgusny deformation of the first finger of foot in a plusnefalangovy joint. Owing to deformation the finger deviates knaruzh at an angle to the others. The disease comes to light at women by 10 times more often than at men. It is supposed that weakness of the copular device at women, and also wearing inconvenient tight footwear high-heeled is the reason of such difference. Pathology is widespread and comes to light at persons of all age.
Usually insufficiency of connecting fabric which can be shown by cross flat-footedness, excessive mobility of joints, the varicose veins raised by tensile properties of sheaves, fastion and skin is the main reason for development of deformation. Hereditary predisposition comes to light – as a rule, the immediate family of patients (mothers or grandmothers) also has this deformation. Other factors: high heels, circulation in inconvenient tight, close or short footwear – are secondary and only promote Hallux valgus formation. The second group of the reasons of development of pathology – congenital deformations, injuries of foot and a number of diseases at which violation of nervous regulation of muscles of a shin and foot is observed (for example, poliomyelitis).
Along with weakness of sheaves a part in development of a disease is played by an uneven tension of the muscles which are bringing and taking away the I finger, and also genetic tendency to formation of an ekzostoz on an internal surface of a head of the I plusnevy bone. When forming deformation the disbalance in a tension of muscles is even more aggravated, the plusnefalangovy joint becomes unstable. The internal surface of a joint is constantly irritated at contact with footwear therefore the shift of a head of the I plusnevy bone is supplemented with formation of a bone outgrowth that aggravates deformation even more. Because of change of a form of foot there is a redistribution of loading – the area of heads III and II plusnevy bones perenagruzhatsya constantly during walking. It leads to developing of pains and formation of arthrosis not only in the area I, but also in the area II and III of plusnefalangovy joints.
Hallux valgus symptoms
Patients show complaints to pain in the area I of a plusnefalangovy joint. Pain amplifies after long walking or long stay standing and decreases at rest. Night pains, especially after considerable load of foot are possible. The pain syndrome can differ considerably both on character, and on force – from feeling of discomfort (usually at early stages) to the sharp burning or constant aching pain. Expressiveness of pains not always accurately correlates with weight of arthrosis and size of deformation though at the considerable shift of a head of the I plusnevy bone symptomatology usually brighter.
In process of development of deformation of stop gets out of a normal form more and more, it extends and flattened, the I finger "lays down" on II, quite often there are accompanying deformations of the II finger. All this in combination with "cone" in a projection of the I plusnefalangovy joint significantly influences appearance of foot. Therefore, along with pain, the reason of the address of patients to orthopedists often there is a cosmetic defect and problems at selection of footwear. Especially often similar complaints are shown by young women.
At visual survey of stop it is spread. Visible deformation and insignificant or moderate hyperaemia in a projection of the I plusnefalangovy joint comes to light. The first finger is rejected knaruzh at an angle to the others. The palpation is painless or unsharply painful, also consolidation of skin is determined by an internal surface of foot in the area I of a plusnefalangovy joint bone . Small local hypostasis is possible. The movements in the I plusnefalangovy joint are, as a rule, limited (extent of restriction of movements can vary considerably), at the maximum extension of the I finger there can be pain.
The diagnosis of Hallux valgus is exposed on the basis of symptoms and data of a radiological research. Carry out a foot X-ray analysis. Degree of expressiveness of Hallux valgus is defined with two sizes: a corner between II and I plusnevy bones (Intermetatarsal angle) and a corner under which the I finger is rejected in relation to the I plusnevy bone (Hallux valgus angle). Hallux valgus degrees:
- 1 degree – a corner between plusnevy bones less than 12 degrees, a corner of a deviation of the I finger less than 25 degrees.
- 2 degree – a corner between plusnevy bones less than 18 degrees, a corner of a deviation of the I finger more than 25 degrees.
- 3 degree – a corner between plusnevy bones more than 18 degrees, a corner of a deviation of the I finger more than 35 degrees.
Along with extent of deformation when studying x-ray pictures estimate expressiveness of artrozny changes. Existence of arthrosis is demonstrated by narrowing of an articulate crack, deformation of the articulate platform, regional growths and an osteosclerosis of a subkhondralny zone. In some cases for more exact assessment of pathological changes of foot of the patient direct to MPT or KT. MRT of foot is appointed for a research of soft fabrics, foot KT – for studying of a condition of bone structures. At the diseases which are followed by violation of nervous regulation of muscles consultation of the neurologist is necessary.
Hallux valgus treatment
The disease cannot be eliminated without operation. Nevertheless, at early stages of a disease at young patients, and also at any extents of deformation at senile or advanced age conservative therapy is recommended. Main objectives of such therapy are elimination of a pain syndrome and prevention of progressing of a disease. Treatment is performed by the orthopedic surgeon in the conditions of outpatient appointment. At pains use the protivospalitelny and warming ointments. During remission at arthrosis of the I plusnefalangovy joint apply ozokerite, an induktotermiya, with a hydrocortisone, appoint an electrophoresis with novocaine or trimekainy. In the presence of signs of an inflammation of the patient direct to UVCh or magnetotherapy. Besides, advise patients:
- To lose weight (at excessive body weight) to reduce load of foot.
- To optimize loading: to carry out a special set of exercises for strengthening of sheaves and muscles of foot, whenever possible to exclude long standing and walking.
- To use special orthopedic footwear to eliminate the excessive pressure upon area I of a plusnefalangovy joint.
- To use inserts between I and II fingers to prevent a further valgusny deviation of the I finger.
At inefficiency of conservative therapy surgical intervention is shown. There are about 300 options of operations at Hallux valgus. All techniques can be divided into 3 groups: on soft fabrics, on bone structures, at the same time on bones and soft fabrics.
Operations on soft fabrics are effective only at the I extent of deformation. Carrying out operation of Silver at which the sinew of the bringing muscle of the I finger, or operations of Mac-Brayda at which this sinew moves is cut is possible. The purpose of such interventions – to restore uniformity of draft of the bringing and taking away muscles. Quite often listed surgeries are carried out in combination with excision of a bone outgrowth and hypodermic mucous bag in the area I of a plusnefalangovy joint (Shede's operation).
Now at treatment of II and III degrees of Hallux valgus the choice is made between two methods: shevronny and Scarf osteotomiy. At a shevronny osteotomiya delete a small V-shaped fragment in disteel part I of a plusnevy bone. At Scarf of an osteotomiya carry out a Z-shaped section (cut) practically throughout the I plusnevy bone, and then "shift" fragments to eliminate a corner between I and other plusnevy bones. Otlomki is fixed screws.
All surgical interventions are carried out in the conditions of office of traumatology and orthopedics. In the postoperative period allow the patient at once is dosed to load a leg in the special orthosis which is obligatory for carrying within 6 weeks. During this period recommend to a thicket to keep a leg in sublime situation and avoiding overloads. In the subsequent it is necessary to wear wide shoes, to carry out the LFK special complex and to carry out self-massage of the arch of foot with use of a tennis ball.
1. Foot surgery / Cherkes-Zade D. I., Kamenev Yu. F.
2. Hallux valgus/of Golev A. V.//the Territorial doctor - 2010 - No. 2
3. Operational orthopedics and Traumatology / Boychev B., Konforti B., Chokanov To.