Foot lesions begin to occur more and more often. One of the most common types of pathology of the joints of the foot is hallux valgus or Hallux Valgus.
What is hallux valgus?
Hallux valgus deformation 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 finger to the inside.
This disease of the feet develops most often as a result of wearing tight, narrow shoes. As a result of this, a “forced” displacement of the proximal phalanx of the finger occurs under pressure. In parallel with this, sprain of the ligaments and tendons of the finger develops, which further exacerbates the situation. Another reason for the development of deformity is an innate 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 flatfoot develops , which leads to the curvature of the big toe.
Most often, women suffer, regardless of age (usually the disease manifests itself in middle and late age).
Severity
Progressing, the curvature can be aggravated, which leads to even greater deformation of the finger. The severity is determined by changing two basic quantities - metatarsal-phalangeal and intertarsal (between 1 and 2 metatarsal bones) angles.
When the bones are deflected by 12 and 25 degrees, respectively, the first 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 the disease is diagnosed.
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 must be set if a change in one angle is characteristic of, 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, so it is the change in it that dominates 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 the inflammatory process in the joint bag (bursitis) is observed, which worsens the course of the disease. Joint pain is aggravated, aggravated by walking, and the inability to carry out the depreciation function. As it progresses, the disease can be complicated by the development of osteochondrosis, osteoarthrosis (due to flattening of the intervertebral discs). Non-intense, aching pains in the spine, a feeling of heaviness and sagging after a period of rest, and intense soreness after physical exertion appear.
Along the way, edema develops in the joint: it increases in size, articular folds are smoothed out. When 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.
Diagnostics
Typically, a patient’s complaints, history, and visual examination are sufficient to diagnose hallux valgus curvature. Flat valgus deformity of the feet is diagnosed using x-ray of the affected joint in order to determine the deviation angles between the bones and the severity. Sometimes magnetic resonance imaging and scintigraphy are used.
As additional methods used for differential diagnosis, a general blood test, a biochemical blood test, are used,
diagnostic puncture of the joint, the study of synovial fluid and its subsequent sowing on a nutrient medium (for the determination of microorganisms). The main indicators that are the main diagnostic criteria are the determination of the rheumatic factor (diagnosis of rheumatoid arthritis), uric acid (gout), as well as some specific pathogens of arthritis.
Hallux Valgus Treatment
Hallux Valgus treatment should begin with a normal lifestyle. If there is 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 supposedly leading to deformation should be stopped if possible.
Important is the rejection of bad habits.
As a prevention of the development of hallux valgus should use comfortable shoes with soft soles without heels. Holding foot baths, as well as foot massage after a strong static load on the legs, will also be useful. Between the fingers you can put special orthopedic pads that prevent the phalanx of the thumb from shifting.
If such conservative methods do not help, resort to the additional use of symptomatic drug therapy aimed at improving the condition through a syndromic effect.
Drug therapy
In order to improve the condition for treatment Hallux Valgus often take various medications.
The main groups of drugs are non-steroidal anti-inflammatory drugs (NSAIDs) - drugs “Nimesulide”, “Meloxicam”. These drugs contribute to the relief of the inflammatory process by blocking cyclooxygenase-2, the main pro-inflammatory mediator. Drugs can relieve inflammation, reduce local swelling, reduce pain. They can be used both for oral use, and by means of applications (lubrication) of the affected area.
In addition to NSAIDs, solutions of electrolytes and anti-inflammatory drugs used by electrophoresis are widespread. This method allows you to make a medicine directly into the area of inflammation, bypassing the gastrointestinal tract. This eliminates the negative effect of NSAIDs on the gastric mucosa when taken orally.
Surgery
With the ineffectiveness of conservative treatment, they resort to surgical intervention. It is carried out most often with the advanced course of the disease in its late stages, as well as with severe deformation of the fingers.
The earlier the operation is performed, the more favorable the prognosis.
In the initial stages, a rather heavy 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 long-term dysfunctions. Currently, priority is given to joint-preserving operations, the purpose of which is minimal intervention on the bones with maximum effect on the tendons and ligaments. Widely used are the operations of Chevron and Scarf (corrective osteotomy). With their inefficiency resort to the creation of arthrodesis. Flat valgus deformity of the feet in severe cases may require prosthetics of the affected joint.
Operations are carried out in six variations (although at present more than 130 of them have been created, but they have not proved their effectiveness).
In addition to excision of the heads of bones, correction of flattened arches of the feet is also performed.
Forecast after surgery
In the postoperative period, it is recommended to avoid significant physical exertion (they can contribute to improper restoration of the joint). You should not load your feet for one and a half to two months (the minimum term for joint fusion after surgery). For all this time a special orthopedic boot should be worn. Subject to these conditions, the forecast is most favorable.
If the condition was diagnosed untimely 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 helps increase 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 this condition be treated?
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 bone changes and are in no hurry to run to see a doctor. How to be - to treat or not to treat? Should I go to the surgeons for help with the development of Hallux Valgus? Reviews about this disease are diverse and specific.
On the one hand, it is best to contact an orthopedist or traumatologist in time for 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 revealed, the more serious consequences for the musculoskeletal system it can turn. That is why the question of treating hallux valgus deformity is purely individual. Everyone decides whether to “go under the knife,” or is it better to leave it as it is.