One of the causes of hallux valgus was first described in 1852, Dr. Brock, who linked the occurrence of deformation, wearing of improper shoes.
Deformity of the big toe with deviation outward is predominantly found in women after the age of 30. From this disease often affects women of Russian, American and European countries than women in Asian and African region, which is associated with the specifics of the Shoe.
The frequency of the disease increases with age – at the age of 15-30 years valgus deformation detected 3% of the population, from 31 to 60 years of age – 9% of men and 16% in people over 60.
The problem is not just aesthetic — when hallux valgus is twisted first (large) finger on the progression of the pathology begins to shift the other fingers of the foot, provoking the development of their hammer shaped.
The disease eventually causes pathological changes in all structures of the foot (tendons, ligaments, bones and joints) that leads to the development of:
- deformity of osteoarthritis in metatarsal phalangeal joints;
- chronic bursitis (inflammation of the mucous joint bursas);
- de exostosis (benign bone and cartilage to grow) the heads of the metatarsal bones;
- combined or transverse platypodia;
- varus (shifted inward) deviation of the I metatarsal bone.
Normal metatarsal bones are arranged strictly parallel to each other. Under the influence of negative factors of the first metatarsal bone is deformed and deflected to the side (laterally), so that the foot forms a convex bump small size, there is dysfunction of the ligaments and tendons lose their elasticity.
Depending on the severity of the pathology secrete:
- The early stage of the disease, where the deviation of the big toe to the side does not exceed 15 degrees.
- Middle phase, in which the deviation of the first toe does not exceed 20 degrees. There is a deformity of the second finger — it's shaped to remind a hammer and elevated above the thumb.
- Serious stage in which the deviation of the thumb is 30 degrees. All the toes in this strain at the base of the first phalanx observed the lump is large in size and in areas of the foot where there is the greatest tension produced rough calluses.
The reasons for the development
The main factor provoking the development of hallux valgus, is the mismatched shoes (tight foot tight formation, tight shoes with narrow toe or high-heel shoes).
In addition, the development of disease influenced by genetic factors and associated diseases.
The development of hallux valgus may be the result of:
- injuries of the foot and lower leg;
- congenital weakness of the muscular-ligament apparatus (observed in connective tissue dysplasia, which is a systemic disease);
- polyneuropathy, rickets, cerebral palsy (is a secondary manifestation of underlying disease);
- flat feet or low foot arch;
- arthritis (this is different joint damage, which are combined into one group), which most often occurs in the elderly;
- psoriatic arthropathy is a chronic inflammatory disease of the joints that is associated with psoriasis;
- gout is a metabolic disease that is accompanied by the deposition of urate crystals in various tissues of the body;
- diabetes (an endocrine disease in which the Valgus deformity develops due to the increased load on the foot and poor circulation in the extremities);
- Hyper mobility of joints, which occurs when down syndrome and Marfan syndrome;
- multiple sclerosis (chronic autoimmune disease, which is accompanied by damage to the myelin sheath of nerve fibers);
- disease Charcot-Marie-tooth — hereditary motor sensory neuropathy, which is manifested in muscular weakness and atrophy of muscles of distal extremities;
- professional excessive strain of the feet (observed in dancers, athletes, waiters, etc.);
- osteoporosis is a chronic systemic disease of the skeleton, which was accompanied by a significant loss of bone mass;
- the rapid growth of the foot during the period pubertatem (youth Valgus deformity of the finger).
Symptoms depend on the stage of the disease.
At the initial stage observed:
- the protrusion of the underwire in the field in metatarsal phalangeal joints;
- pain in the proximal (second from the nail end) the divisions of the phalanges of the fingers, which intensifies when walking;
- redness and swelling of the skin in the area he "bones".
The average stage is accompanied by:
- the development of the joint inflammation;
- pain and swelling;
- formation of growths in the head metatarsal bone;
- education corns (dry corn) under the middle phalanx of a finger.
In advanced, severe stage observed:
- sharp, debilitating pain in the big toe and the sole of the foot;
- well visible rounded "bone" (ship-growth);
- cornification of the skin and formation of calluses under the second and third phalanx of the fingers.
Diagnosis of valgus deformity include:
- The study of the history of the disease. During the conversation, the doctor clarifies which symptoms bother the patient (sometimes a sharp pain in dorsal region near the joint capsule of the big toe can be caused by traumatic neuritis of the middle dorsal cutaneous nerve, etc.). Also the doctor asked what factors trigger pain (physical activity, wearing shoes, walking) and whether history of injury, some systemic, metabolic and hereditary diseases, arthritis.
- External examination during which the doctor monitors gait of the patient (thus is determined by the degree of pain and associated with abnormal gait disturbance), studying the position of the first toe of the foot in relation to the other fingers (can experience different projection of the stretching of the joint ligaments), examines the other fingers of the foot and the affected area (swelling and redness are indicative of the pressure of shoes).
- X-rays, which allows to determine the degree of deformation and to identify subluxation and comorbidities. X-ray of the foot done in 3 projections.
If you want to exclude poor circulation is prescribed vascular ultrasound to exclude associated diseases and in the preparation for surgical treatment can prescribe laboratory tests and CT.
Treatment of valgus deformation of the big toe can be conservative and surgical.
Conservative treatment is only effective in the early stages of the disease. It begins with selection of a suitable model of Shoe which will not cause the load and the friction (the initial stage of the disease the wearing patterns with wide toe stops further development of disease).
Your doctor may recommend the use of:
- special gaskets for Bursa (joint capsule) of the thumb, which reduce the pressure of shoes;
- spacer orthopedic products, chinaswamy finger and changing the load distribution on the foot;
- arch support, proofreaders toes between finger ridges, prevents further deformation.
When severe deformation of the orthopedic products are able to reduce the pain, but to relieve the pain of the application of these products not.
Treatment with the inflammatory process include:
- the use of nonsteroidal anti-inflammatory drugs;
- corticosteroid injections;
- physiotherapy (electrophoresis with calcium, paraffin-paraffin baths, phonophoresis of hydrocortisone);
- shock-wave treatment.
It is also recommended that:
- massage, eliminates spasms and restoring mobility of the joint;
- special exercises;
- walking and running barefoot.
Exercises to correct hallux valgus big toe include:
- lifting toes a small object from the floor (pencil, pen, etc.);
- the voltage of the arches of feet and hold them in this position for a few seconds;
- alternate flexion and extension of the toes (to fatigue);
- squeezing into a ball lying on the floor of a sheet of paper (done with toes);
- rolling with the foot rolling pin or bottle of water for 2-3 minutes;
- breeding toe to side and hold them in this position for at least minutes.
In the presence of metabolic, hereditary and systemic diseases in need of treatment of the underlying pathology (involved an endocrinologist, a rheumatologist and other specialists).
Surgical treatment is used for moderate to severe disease and failure of conservative treatment (as the disease is a chronic, slowly progressive nature, surgical methods are recommended even in mild hallux valgus).
To eliminate pathology applied a set of operational methods, which are aimed at:
- removing a bunion of the first toe;
- the engineering of the bones that make up the big toe;
- the trim is located around the joint muscles to prevent relapse.
With moderately severe deformation during the surgical intervention can be removed only the outgrowth of the articular capsule. During the operation the growth is removed through a small incision in the area of bursitis by using a special surgical drill bits, after which the bone is aligned and the incision is closed with sutures.
Prevention of hallux valgus include:
- Improve the blood flow in a foot bath with the addition of herbal decoctions or sea salt.
- Wearing comfortable shoes (for the correct position of the joints during walking deformity is rare) or the use of orthotic insoles.
- Proper nutrition (joint damage can be due to overweight or eat certain foods for gout).
- Physical exercise helps to maintain tone legs.