Hallux valgus

Description:

Hallux valgus – valgus deformation of the first finger of foot in a metatarsophalangeal 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 the relaxation of ligaments at women, and also wearing inconvenient tight footwear high-heeled is the reason of such difference. Pathology is eurysynusic and comes to light at persons of all age.

Hallux valgus reasons:

Usually insufficiency of connecting fabric which can be shown by a metatarsus latus, excessive mobility of joints, the varicosis raised by distensibility of sheaves, fastion and skin is the main reason for development of deformation. Genetic 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 Hallux valgus – inborn deformations, injuries of foot and a number of diseases at which disturbance of nervous control of muscles of a shin and foot is observed (for example, poliomyelitis).
Along with weakness of sheaves a part in a course 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 exostosis 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 metatarsophalangeal 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 metatarsophalangeal joints.

Hallux valgus symptoms:

Patients show complaints to pain in the area I of a metatarsophalangeal 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 a sensation of discomfort (usually at early stages) to the sharp burning or constant aching pain. Expressiveness of a pain syndrome not always accurately correlates with deformation size 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 metatarsophalangeal joint significantly influences outward of foot. Therefore, along with pain, the reason of the address of patients to traumatologists and 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 an insignificant or moderate hyperemia in a projection of the I metatarsophalangeal joint comes to light. The first finger is rejected knaruzh at an angle to the others. The palpation is painless or unsharply painful, the bone exostosis and consolidation of skin is determined by an internal surface of foot in the area I of a metatarsophalangeal joint. Small local hypostasis is possible. The movements in the I metatarsophalangeal 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.

Diagnosis:

The diagnosis of Hallux valgus is exposed on the basis of symptoms and data of X-ray inspection. Carry out a X-ray analysis of the I metatarsophalangeal joint. For more exact assessment of pathology from the next anatomical structures if necessary in addition appoint a X-ray analysis II and III metatarsophalangeal joints. Degree of manifestation 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, an angle of deviation of the I finger less than 25 degrees.
2 degree – a corner between plusnevy bones less than 18 degrees, an angle of deviation of the I finger more than 25 degrees.
3 degree – a corner between plusnevy bones more than 18 degrees, an angle of deviation of the I finger more than 35 degrees.
Along with extent of deformation when studying x-ray films estimate expressiveness of artrozny changes. Existence of arthrosis is demonstrated by narrowing of a joint crack, deformation of the joint platform, regional growths and an osteosclerosis of a subchondral 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 a condition of soft tissues, foot KT – for studying of a condition of bone structures. At the diseases which are followed by disturbance of nervous control of muscles consultation of the neurologist is necessary.

Hallux valgus treatment:

Hallux valgus 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 is elimination of a pain syndrome and prevention of progressing of a disease. Treatment is performed in emergency station. Recommend to 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 metatarsophalangeal joint.
To use inserts between I and II fingers to prevent a further valgus deviation of the I finger.
At pains recommend the protivospalitelny and warming ointments. During remission at arthrosis of the I metatarsophalangeal joint appoint ozokerite or a paraffin therapy, an inductothermy, фонофорез with a hydrocortisone, an electrophoresis with novocaine or Trimecainum. In the presence of signs of an inflammation of the patient direct to UVCh or magnetotherapy.

Operational treatment of Hallux valgus.
There are about 300 options of operations at Hallux valgus. All surgical techniques can be divided into 3 groups:
Operative measures on soft tissues.
Operative measures on bones.
The combined bone operations and soft tissues.
Operations on soft tissues are effective only at the I extent of deformation. Carrying out operation of Silver at which the sinew of an adductor of the I finger, or operations of Mac-Brayda at which this sinew moves is cut is possible. The purpose of such interventions – to recover 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 metatarsophalangeal joint (Shede's operation).
At II and III degrees of Hallux valgus choice operations are the shevronny osteotomy and Scarf an osteotomy now. At a shevronny osteotomy delete a small V-shaped fragment in distal part I of a plusnevy bone. At Scarf of an osteotomy 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. Fragments fix screws.
All surgical interventions are carried out in the conditions of traumatologic or orthopedic department. In the postoperative period to the patient allow to load a leg in the special orthosis at once. Seams are removed in 10 days. Carrying the orthosis is obligatory within 6 weeks. During this period recommend to a thicket to keep a leg in sublime situation and to avoid 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.