Stop lesions are becoming more and more common. One of the most common types of foot joint pathology is hallux valgus or Hallux Valgus.
What is hallux valgus?
Valgus deformity most often means a violation of the normal structure of the first metatarsophalangeal joint due to the displacement of the head of the first metatarsal bone laterally (outward from the foot) and the inclination of the proximal phalanx of the first toe inwards.
This disease of the feet develops most often as a result of wearing tight, narrow shoes. As a result, under the action of compression, a “forced” displacement of the proximal phalanx of the finger occurs. In parallel with this, sprains and tendons of the finger develop, which further aggravates the situation. Another reason for the development of deformity is a congenital predisposition to the development of this pathology.
As a result of external factors, flattening of the arches of the foot occurs, after which transverse-longitudinal flat feet develop, which leads to the curvature of the big toe.
Suffer most often women, regardless of age (usually a diseasemanifests itself in middle and late age).
Degrees of severity
Progressing, the curvature can worsen, leading to even greater deformation of the finger. The degree of severity is determined by changing two main values - the metatarsal-phalangeal and intermetatarsal (between the 1st and 2nd metatarsal bones) angles.
When the bones deviate by 12 and 25 degrees, respectively, the first degree of severity of hallux valgus develops.
If the process progresses, and the discrepancy is 18 degrees (metatarsal-phalangeal node) and more than 25 degrees between the bones of the metatarsus, the second degree of development of the disease is set in the diagnosis.
If the angles increase more than 18 and 35 degrees, respectively, you can set the third degree of severity of the disease.
Sometimes the question arises - what degree of severity should be set if a change in one angle is typical for, for example, the first degree, and the other angle is increased more than necessary. In such a situation, one should focus on changes in the metatarsophalangeal joint, since it is the change in it that is dominant in the pathogenesis of the disease.
Clinic
At the initial stage of the disease, the main manifestation of the disease will be stiffness when walking, a feeling of discomfort. With the progression of the process, the development of an inflammatory process in the joint bag (bursitis) is observed, which worsens the course of the disease. Add pain in the joint, aggravated by walking, the inability to implement the function of depreciation. As the disease progressesmay be complicated by the development of osteochondrosis, osteoarthritis (due to flattening of the intervertebral discs). There are mild, aching pains in the spine, a feeling of heaviness and numbness after a period of rest, as well as intense soreness after exercise.
At the same time, edema develops in the joint: it increases in size, the articular folds are smoothed out. When the articular cartilage is depleted, the surfaces of the bones begin to rub against each other, which leads to the abrasion of the articular surfaces and the subsequent development of osteophytes.
Diagnosis
Usually, for the diagnosis of valgus curvature of the thumb, complaints of the patient, the collected history and visual examination are sufficient. Planovalgus deformity of the feet is diagnosed using X-ray of the affected joint in order to determine the angles of deviation between the bones and the severity. Sometimes magnetic resonance imaging and scintigraphy are used.
As additional methods used for differential diagnosis, a complete blood count, a biochemical blood test,
diagnostic puncture of the joint, examination of the synovial fluid with its subsequent inoculation on a nutrient medium (to determine microorganisms). The predominant indicators, which are the main diagnostic criteria, are the definition of rheumatic factor (diagnosis of rheumatoid arthritis), uric acid (gout), as well as some specific pathogens.arthritis.
Valgus deformity treatment
Treatment of Hallux Valgus should begin with a normal lifestyle. In the presence of excess weight, it is recommended to get rid of it (flat feet and osteochondrosis worsen the course of the disease and contribute to its progression). In this case, if Hallux Valgus does occur, treatment without surgery can have a significant effect.
Shoes suspected of deformity should be discontinued if possible.
It is important to give up bad habits.
As a prevention of the development of hallux valgus, comfortable shoes with soft soles without heels should be used. It will also be useful to carry out foot baths, as well as foot massage after a strong static load on the legs. Special orthopedic pads can be placed between the fingers to prevent displacement of the phalanx of the thumb.
If such conservative methods do not help, they resort to the additional use of symptomatic drug therapy aimed at improving the condition through a syndromic effect.
Drug therapy
Various medications are often taken to treat Hallux Valgus in order to improve the condition.
The main groups of drugs are non-steroidal anti-inflammatory drugs (NSAIDs) - preparations "Nimesulide", "Meloxicam". These drugs contribute to the relief of the inflammatory process by blocking cyclooxygenase-2 - the mainpro-inflammatory mediator. Drugs can relieve inflammation, reduce local swelling, reduce pain. Can be used both for oral use and through applications (lubrication) of the affected area.
In addition to NSAIDs, solutions of electrolytes and anti-inflammatory drugs, used by electrophoresis, are widely used. This method allows you to bring the drug directly into the area of inflammation, bypassing the gastrointestinal tract. Thus, the negative effect of NSAIDs on the gastric mucosa when taken orally is eliminated.
Surgical treatment
When conservative treatment is ineffective, surgical intervention is resorted to. It is carried out most often with the advanced course of the disease in its later stages, as well as with severe deformity of the fingers.
The sooner the operation is performed, the better the prognosis.
In the initial stages, a rather difficult operation was used to treat this pathology. Hallux valgus was eliminated by massive excision of the heads of the joint. Due to this, he was significantly injured, which led to remote dysfunction. Currently, priority is given to joint-preserving operations, the goal of which is minimal intervention on the bones with maximum impact on the tendons and ligaments. Operations of Chevron, Scarf (corrective osteotomies) are widely used. With their inefficiency resort to the creation of arthrodesis. Plano-valgus deformity of the feet in severe cases canrequire replacement of the affected joint.
Operations are carried out in six variations (although there are currently more than 130 of them, but they have not confirmed their effectiveness).
In addition to the excision of the heads of the bones, the flattened arches of the feet are also corrected.
Prognosis after surgery
In the postoperative period, it is recommended to avoid significant physical exertion (they can contribute to improper joint recovery). You should not load your feet for one and a half to two months (the minimum period of joint fusion after surgery). For all this time, you should wear a special orthopedic boot. Under these conditions, the forecast is the most favorable.
If the condition was diagnosed out of time and the process progressed and led to irreversible changes, then the prognosis smoothly passes into the group of conditionally unfavorable. This disease of the feet contributes to the growth of disability, impaired walking. In this case, even the intervention of surgeons becomes ineffective, since it only slows down the progression of the process, but does not eliminate its cause.
Should I treat this condition?
This question is often asked by many people. For some, the development of such a deformation is a disaster, since this group of people sacredly protects their appearance and cannot allow an unpleasant defect to spoil their appearance. Others are calm about changing bones and are in no hurry to run to see a doctor. How to be - to treator no treatment? Should I turn to surgeons for help with the development of Hallux Valgus? Reviews about this disease are varied and specific.
On the one hand, it is best to consult an orthopedist or traumatologist with the slightest changes in the joint. Timely diagnosis of this disease allows you to get rid of it without any undesirable consequences. The later this condition is detected, the more severe the consequences for the musculoskeletal system it can turn into. That is why the question of the treatment of valgus deformity of the thumb is purely individual. Everyone decides for himself whether it is worth “going under the knife”, or it is better to leave everything as it is.
