Deformity of the big toe: treatment

Static foot deformities are degenerative diseases of the skeleton that seriously impair the supporting functions.Normally, the load is not evenly distributed over the entire area of the sole, but is located along the main points and axes - from the heel tube 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, which has shock-absorbing properties.

Accordingly, damage to this formation leads to the development of a fairly common disease - flat feet.When it is mentioned, people usually imagine the longitudinal version of the pathology, as a result of which the arch of the foot falls along the inner edge.But the transverse form of the disease, accompanied by the characteristic curvature of the big toe, also indicates flat feet.

This type of pathology occurs mainly in mature and elderly women, and is often an acquired condition.It involves wearing uncomfortable or ill-fitting shoes, which over time contributes to the displacement of the bones in the forefoot.The consequence of hallux valgus is constant unpleasant symptoms that accompany a person both when wearing familiar shoes and when walking normally.

Concept

In orthopedics, valgus deformity is the deviation of any segment of the musculoskeletal system from the central axis.In this case, curvature may also occur in the joints - this is when the direction of the angle between the bones is evaluated.The development of transverse flat feet corresponds exactly to this mechanism, which ultimately leads to irreversible damage to the metatarsophalangeal joint of the first toe.

Although this condition often develops over decades, patients seek help in the later stages.Therefore, the characteristic features of hallux valgus must be indicated:

1. The first and main symptom is the curvature of the first metatarsophalangeal joint with the formation of an outwardly open angle.Pathology develops gradually, but progresses irreversibly.In the later stages of the disease, the deformity of the big toe becomes so severe that the angle in the joint becomes almost 90 degrees.
2. The next important sign is the formation of a characteristic "bone" on the inner edge of the foot, where normally the head of the metatarsal bone protrudes slightly.Its appearance is related to the inward compensatory deviation of this bone under the influence of gravity.
3. The most recent manifestation is the hammer-shaped curvature of the second finger, which is also caused by abnormal pressure from the adjacent joint and surrounding soft tissues.

Hallux valgus is characterized by the appearance of additional (non-permanent) signs - pain in the foot, difficulty walking, the appearance of dense corns on the soles under the middle toes.

Formation mechanism

Like other degenerative skeletal diseases, transverse flatfoot goes through two stages of development.In the first stage, only functional changes occur in the soft tissues, which leads to a decrease in their supporting and elastic properties.And in the second stage, deformations of the joints or bones themselves are already formed:

• The trigger is always improper stress on the forefoot due to wearing the wrong shoes - especially shoes with narrow toes and heels.
• This leads to chronic damage to the soft tissues - the ligaments and muscles that hold the base of the toes and metatarsals in an elevated position.
• As a result of repeated trauma, the anterior arch gradually falls, after which the maximum load falls on the midfoot.
• In this case, there is a deviation of the peripheral metatarsals in the opposite direction.
• The first metatarsophalangeal joint usually suffers the maximum load, therefore the force of pathological pressure is maximum.The capsule gradually stretches, which causes the metatarsal to move further inwards.
• The stability of the joint decreases, which leads to the development of subluxation of the phalanx of the first finger.The progression of hallux valgus is precisely related to the continuous and slow course of this process.
• Deformed soft tissues - ligaments and muscles - become fixed in this position over time, which explains the irreversibility of the curvature.
• Chronic injury leads to the development of deforming arthrosis of the first metatarsophalangeal joint, which causes the joint to lose its functional capabilities.

Further tactics of help depend on the severity of the changes - in the early stages, conservative measures are sufficient, and in advanced cases, only surgery eliminates the permanent deformation.

Conservative treatment

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

1. First, the patient prescribes passive treatment methods, which include fixing the finger in the correct position.The joint is artificially restored to its normal configuration, which is carried out using various orthopedic devices.Usually, this period takes at least 6 months, which is necessary for the adaptation of the soft tissues.
2. In the second phase, the active phase begins, which includes special training techniques to strengthen the leg muscles.In order to achieve this, physical therapy classes, massages and physiotherapy procedures are combined at the same time.
3. The final period is indefinite, since hallux valgus is an incurable disease.Therefore, the patient consolidates the results of the treatment for the rest of his life and participates in preventing the progression of the disease.

The choice of means and methods of therapy is completely individual - they take into account the age of the patient, concomitant diseases, as well as the characteristics of the curvature itself.

Passive procedures

The first stage of the treatment is the most difficult for the patient, as the fixing of the leg rarely happens unnoticed.The return of the normal anatomical structure of the foot arch is much more difficult and noticeable than the development of pathology.For this purpose, the following tools are used in orthopedics:

• The principle of starting to help is to completely get rid of shoes or boots that have a narrow toe box.Now the patient should only use loose, wide or open-toed shoes.Custom fit orthopedic boots are considered ideal, but it is extremely rare that patients can afford this luxury.
• In case of minor deformities, a bandage made of special adhesive tape is used, which is placed on the back of the leg.It is fixed in such a way that the outer and inner deviation of the metatarsal bones is excluded when walking.
• Orthopedic fixation of the leg is a more comfortable and reliable option - the treatment in this case is much more effective.Various types of orthoses or bandages are used for this purpose, the stiffness of which is chosen depending on the degree of deformation.

Wearing support devices should be almost constant - in the first month it is recommended to remove them for no more than 2 hours during the day.

Active procedures

The transition to the second stage is determined individually - after the doctor has evaluated the symptoms, as well as an X-ray examination.The lack of progression of the disease, as well as at least a slight positive dynamic, allows us to start an active fight against the deformity.The following methods are used for this:

• First, physical therapy procedures are gradually introduced to prepare the joint and the surrounding soft tissues for the upcoming load.They perform warming and distracting procedures that can be used on the legs.These include the use of laser, magnet, paraffin or ozokerite, and ultrasound therapy.
• After a few days, massage treatments are added, which begin with superficial heating of the tissues.The specialist must gradually move on to warming up the actual muscles of the leg, which play an important role in eliminating the curvature.
• When the unpleasant symptoms disappear completely, the patient begins to exercise independently.It is not recommended to include several exercises in the program at the same time, so as not to cause muscle fatigue.It is better to gradually increase the load, allowing the soft tissues to adapt to the work performed.

In order to achieve the full effect, the listed activities must be performed daily to prevent the recurrence of pathological processes.

Surgical treatment

Indications for surgery must always be justified, as long-term rehabilitation is required after their completion.Therefore, it is not performed on patients in the early stages of hallux valgus, in whom the curvature of the finger can be corrected naturally.Surgical intervention is only necessary in case of irreversible changes in the joint or the surrounding tissues:

1. If there are signs of fixed transverse flat feet - that is, the front arch of the foot is deformed both during load tests and at rest.This conclusion appears after an X-ray examination evaluating the location of the heads of the metatarsal bones.
2. With pronounced curvature in the first metatarsophalangeal joint, accompanied by permanent dislocation between the bones that make it up.The absolute indication 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 the initial signs of arthrosis of the first metatarsophalangeal joint, which indicates irreversible damage to the surrounding soft tissues.The muscles and ligaments are securely fixed in a vicious position, so corrections cannot be made conservatively.

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.

Surgeries of the taste buds

This surgical treatment option is more suitable for patients who do not yet show signs of direct damage to the joint tissues.Therefore, the leading mechanism of deformation in them is abnormal muscle tension, which is associated with a change in the position of the arch of the foot.The following intervention options must be used for repair:

• The first type of surgery involves all forms of transposition (movement) of the tendons connected to the first metatarsal bone.It is the pathological contraction of the muscles that leads to a gradual increase in the discrepancy between the finger phalanx and the muscles.Therefore, the ligament is removed or partially divided and fixed in 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 position.
• The second type of operation involves the creation of various types of ligaments - the creation of an artificial transverse arch of the foot.Each metatarsal bone is fixed in the correct position and then a section of another ligament or a synthetic prosthesis is sewn to them.But this possibility is possible only in the case of "mild" deformation, when the displaced bones can be easily returned to their original place.

According to the results of the observations, the operations on the ligaments are still of a temporary nature - without correcting the pathological factors, the displaced tendons quickly stretch again.

Joint operations

If there is a significant curvature in the joint, then orthopedic interventions are necessary to eliminate bone tissue defects.For this, resections are performed - the removal of certain areas of the affected bone.This method allows the joint to be artificially returned to its normal position.The following options are currently used for such operations:

• The main method of eliminating the deformity is the Schede-Brandes osteotomy.This procedure involves two manipulations: removal of the abnormal growth on the first metatarsal bone(s) and resection of a triangular fragment at the bottom.After the fusion of the bone tissue, the deformed finger returns to its normal position.
• Operations in which both areas are resected in the area of the head of the metatarsal bone are used less often.Due to the huge damage, the risk of developing complications that do not allow the fragments to heal properly is too high.
• In advanced cases of the disease, palliative forms of intervention are performed - not to restore mobility, but to eliminate pathological displacement.For this purpose, arthrodesis is performed - cutting out and closing the joint cavity between the metatarsal bone and the phalanx.

Today, these procedures are rarely performed in isolation—they are usually combined with concurrent tendinoplasty surgery, which eliminates inappropriate muscle stretching.

Combined operations

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

• The modified Schede-Brandes operation involves the removal of standard sections of the metatarsal bone - resection in the area of the head and base.In addition, the abductor pollicis muscle is transposed on its outer surface, the pressure of which in the joint leads to subluxation.
• It is also possible to perform an osteotomy in combination with the creation of an artificial arch.Moreover, during an operation, it is not only possible to put the metatarsal bone back in its original place, but also to put the remaining structures in the right position.
• In severe cases, the interventions are combined to eliminate deformations of the first and second metatarsophalangeal joints simultaneously.

This type of surgery is characterized by the greatest severity - a large amount of destruction requires a long recovery and prolongs the rehabilitation period.

Recovery

Completion of conservative and surgical treatment is the beginning of the recovery period, which in such patients lasts for the rest of their lives.Without following special recommendations, the disease can return and remind you again with unpleasant symptoms:

1. First of all, all patients must wear special orthopedic insoles with additional Seitz insoles.They not only ensure the correct position of the foot while walking, but also provide additional support to the arches.
2. You should also take care of your shoes - completely eliminate any boots or narrow toe shoes from your wardrobe.
3. You need to take care of your own body weight - maintaining a normal body weight significantly reduces the load on the arches of the feet.
4. Regular preventive daily exercises keep the muscles in normal tone, which prevents displacement of the metatarsal bones.

The main difficulty for patients is with the physical therapy program, as most patients do not even know the exercise technique.Therefore, in order to perform it correctly, you must first study with an instructor either individually or in a group format.