Hallux valgus deformities are most often congenital. However, in some cases – with paralysis, traumatic lesions – may appear already in the mature period of life. The main symptoms of the pathology are pain in the feet and lower leg muscles, a visible violation of the shape of the feet, as well as a change in gait. Diagnosis of the disease is carried out using a clinical examination, x-rays, electromyography, as well as photoplantography. Treatment includes conservative and surgical methods. However, proper efficiency is observed only during reconstructive operations.
What is this disease?
Hallux valgus is called curvature of the foot, characterized by a flattening of its longitudinal arch. Usually the inner edge of the foot drops (“sagging”), and the heel turns outward.
The foot of a person, by virtue of its location, takes on the pressure of the entire body mass of a person. For this reason, it has a special anatomical structure that allows you to absorb, balance and stabilize movements. However, the correct stop form is an important component for the implementation of these tasks.
Today, the most important problem of traumatology and orthopedics is hallux valgus deformity of the foot. The incidence of this pathology is estimated at 30-58%, where 2/3 of the cases are congenital disorders.
Pathology is largely socially significant, because covers all age groups of the population, and also promotes curvature of the spinal column, early development of osteochondrosis and arthrosis of the joints of the lower extremities.
When reducing the feet (if you look at them from behind) at the ankle level, an X-like deformation is formed: the ankles touch, while the heels are 5-6 centimeters apart.
Most often, the pathology is congenital in nature and is diagnosed in children even in the hospital (or immediately after the start of walking). A similar condition is corrected up to 5 years, after which (in the absence of proper treatment) the child develops flat feet.
Why does it arise?
It is believed that the main reason for the appearance of hallux valgus deformity of the foot is the inadequate function of the posterior tibial muscle or the weakness of the ligamentous apparatus.
Today, other factors for the development of pathology are distinguished:
- Congenital malformations with improper location of the bones of the feet or shortening of the tendons (vertical talus, short calcaneus tendon);
- Violations of posture, when the deformation of the feet compensates for the curvature of the spinal column;
- Traumatic lesions (fractures of the bones of the feet, lower leg, thigh or knee, tears of the ligament and tendon apparatus);
- Paralysis (immobilization) due to damage to the nervous system in case of encephalitis, poliomyelitis, stroke, infringement of the spinal roots during hernias, etc .;
- Spasm (constant contraction) of the leg muscles;
- Concomitant diseases: pathology of the skeletal system with vitamin D deficiency (rickets), diabetes mellitus, osteoporosis (decreased bone density), impaired thyroid and parathyroid glands, etc .;
- Increased body weight, including rapid weight gain in postmenopause or during pregnancy.
Improper footwear or excessive correction of clubfoot in childhood also contributes to the development of pathology.
Degrees and stages of the disease
The severity of the pathology (the strength of the manifestation) is divided into degrees:
- Light with an arch height of 1,5-2 centimeters and a heel angle of up to 15 °;
- Medium, when the arch is flattened to the first centimeter, and the angle decreases to 1 about;
- Severe at an arch height of up to 0,5 cm and a heel angle of 5 °.
Depending on the involvement of certain structures, the following stages of curvature are distinguished:
- I – there is no deformation of bones, pain is determined along the inner surface of the ankle (in the area of attachment of the posterior tibial muscle);
- II – a slight curvature, the calcaneus is somewhat rejected;
- III – the foot is allotted, and the deformation is fixed (not corrected passively);
- IV – curvature is observed not only in the foot, but also in the ankle joint.
At the first stage of the patient, periodic aching pains after long walks or long vertical loads (standing or sitting with support on the feet) are disturbing. As a rule, pain is worse when walking in improperly selected shoes.
The next stage of the disease is associated with the occurrence of curvature of the foot: patients in a standing position do not rest on the outer edge of the foot, but on its entire area. A slight change in gait is observed.
At the third stage, the protrusion of the talus is determined (noticeably lower than the ankle on the inner surface of the ankle), as well as the strong abduction of the heel (the patient stands, resting on the inner edge of the calcaneus).
Running valgus deformity of the feet is characterized by a pronounced curvature of both the foot itself and the ankle joint. Patients complain of burning pains in the muscles of the leg, as well as a significant violation of the gait: the knees rub against each other, while the right and left feet are located at a certain distance.
Severe curvature of the feet is often complicated by deformation of the spinal column (scoliosis with different positions of the shoulders and wings of the pelvis), osteochondrosis (damage to the intervertebral disc with the formation of a hernia), or arthrosis (premature wear of the articular cartilage in the ankle, knee and hips).
How to diagnose?
Diagnosis of foot curvature consists of:
- A clinical examination, during which the orthopedist discovers a decrease in the arch of the foot, deviation of the calcaneus and talus, visible “disappearance” of the outer and protrusion of the inner ankles.
- Radiography is an accessible and informative method by which you can determine the change in the angle of inclination of the bones and linear parameters of their relationship. These indicators are necessary for making a final diagnosis and clarifying the degree of deformation.
- A podography aimed at determining the exact functional state of a limb. The method consists in recording the support time of individual parts of the foot when performing a step. The study also examines the phases of foot roll, which reflect the balance of the muscles of the lower limb.
- Dynamic electromyography, recording the electrical activity of the studied muscles and its dependence on the phase of the step.
- Photoplantography with digital processing, which allows to obtain all standard indicators and determine the type / degree of curvature with high accuracy.
You may also need additional consultation by a neurologist (for deformities due to spasms or paralysis), an endocrinologist (in case of diabetes or thyroid / parathyroid gland dysfunctions) and a gynecologist (in case of postmenopausal period). If the curvature of the foot appeared against the background of osteoporosis, densitometry is necessary – a study of bone density.
Among the main methods of treating hallux valgus curvature, conservative and operative are distinguished.
This type of help is aimed at getting rid of the symptoms of the disease, but does not eliminate the root cause of the pathology.
The technique includes:
- the use of orthopedic insoles to support the I metatarsal bone, arch of the foot, as well as the elimination of hallux valgus lesions of the middle and hindfoot;
- taping – fixing the foot and ankle with the help of special adhesive tapes with proper elasticity. Tapes are worn around the clock for 3-5 days, after which they are replaced;
- tailoring of orthopedic shoes by individual standards;
- the use of orthoses and other fixing devices on the foot and ankle.
Conservative methods also include physiotherapeutic procedures (ozokerite, paraffin baths, electrophoresis, magnetic exposure), massage and a physiotherapy exercise package designed for a specific clinical case.
Be careful! Today, most specialists prefer surgical treatment methods, as conservative therapy is ineffective (according to statistics, it is useless in 60% of cases).
The volume of the operation and its type depend on the immediate stage of the disease. So, the first degree of hallux valgus is treated with a synovectomy (removal of the tendon membrane to correct the overall tension) or osteotomy (dissection) of the calcaneus in order to return it to the anatomically correct position.
At the second stage of the development of the disease, transplantation of the flexor tendon of the toes of the toes is used. Such an intervention is usually carried out against the background of a dissection of the calcaneus or talar-scaphoid arthrodesis (surgical immobilization of the joint between the talus and scaphoid bones).
Curvatures of the III degree require arthrodesis of several joints of the foot at once: the metatarsal, tarsal, heel-cuboid, and ram-navicular. Such three-joint immobilization is often supplemented by dissection of the calcaneus.
At the IV stage of pathology, reconstructive operations are necessary not only on the foot, but also on the ankle. In this case, the instability of the ligamentous apparatus is corrected with the help of grafts (from one’s own body or artificial materials). The volume of operations on the foot itself is the same as with the third degree of curvature.
Rehabilitation includes walking without reliance on the operated leg for 2 months. In this case, the patient must wear a removable plaster cast from 1,5 to 3 months.
Active movements in the operated foot are recommended to begin after 1,5 months after surgery. By the 3rd month a complex of strengthening physical education is introduced. However, in subsequent patients walking on bumpy terrain and active sports activities are prohibited.
It is worth noting that it is possible to judge the final result of surgical intervention only after six months.
Prevention of hallux valgus deformities includes the following measures:
- Early correction of congenital anomalies with incorrect location of the foot bones or shortening of tendon cords (vertical talus, short calcaneus tendon);
- Correction of posture disorders (scoliosis, etc.);
- Timely treatment of traumatic injuries (fractures of the bones of the feet, lower leg, thigh or knee joint, ruptures of the ligament and tendon apparatus);
- Proper rehabilitation after paralysis (immobilization) due to damage to the nervous system with encephalitis, polio, stroke, infringement of the spinal roots with hernias, etc .;
- Relieving spasm (constant contraction) of the calf muscles;
- Therapy of concomitant diseases: bone pathology with vitamin D deficiency (rickets), diabetes mellitus, osteoporosis (decreased bone density), impaired thyroid and parathyroid glands, etc .;
- Decrease in body weight to normal (especially with rapid weight gain in postmenopausal women or due to pregnancy);
- Selection of orthopedic shoes or the use of insoles-arch supports;
- Moderate correction of clubfoot without “hypercorrection” – excessive treatment leading to secondary valgus-curvature of the feet.
Prevention of the progression of the disease consists in the use of conservative techniques and early reconstructive operations. At the same time, physical activity is limited in order to prevent the destruction and curvature of the ankle joints.
Remember, timely treatment of hallux valgus deformities not only improves the quality of life of patients, but also prevents the development of osteochondrosis and arthrosis of the knee or hip joints!
Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.
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