Deformity of the big toe is observed in Hallux valgus, gout, arthrosis of the I metatarsophalangeal joint, rigid first finger, progressive ossifying dysplasia. In the latter case, it has an innate character, in the rest it is caused by a change in the angle between the metatarsal bone and the main phalanx, bone growths, edema and inflammation. The cause of deformity of the big toe is established according to the survey, physical examination, radiography, plantography, laboratory tests. Until the diagnosis is clarified, it is sometimes possible to use analgesics and NSAIDs.
Causes of deformity of the big toe
Hallux valgus is the most well-known and most widespread cause of deformation of the I toe. Due to the weakness of the ligaments of the foot, combined with transverse flat feet. It is more common in middle-aged and older women. The thumb is deflected outward, as a result, an angle is formed between it and the I metatarsal bone.
Over time, the deformation often progresses. Violations of the aesthetics of the foot are aggravated by fibrous growths, callosities and concomitant arthroarthritis. The second finger bends, becomes hammerlike, is superimposed on the first. After a long stay on the legs and in the phase of exacerbation of arthroarthritis, the deformation is somewhat aggravated due to soft tissue edema.
Arthrosis of the 1st metatarsophalangeal joint
Osteoarthritis develops after injuries, against the background of other diseases or due to anatomical features of the foot. Post-traumatic arthrosis can be diagnosed at any age, other types of the disease are more often detected in the second half of life. A noticeable deformation appears with a prolonged course, due to the formation of osteophytes, concomitant fibrous changes in soft tissues.
Occurs against the background of osteoarthritis. It is accompanied by an increasing decrease in mobility in the 1st metatarsophalangeal joint. In the later stages, the movements are rocking, patients have difficulty walking in any shoes. The cause of deformation of the thumb is large bone growths and inflammation of soft tissues.
The defeat of the thumb joint is characteristic of gout. In the initial stages, the deformation occurs during a gouty attack. Sharp, sharp, unbearable pains suddenly appear in the joint. The affected area swells, the skin above it becomes hot, bright red. After a few days, all manifestations disappear, the shape of the foot is restored.
Subsequently, the attacks are periodically repeated. During the inter – approach period , topuses are detected under the skin at the base of the thumb – painless nodules up to 2 cm in size . Over time, patients may develop secondary deforming arthrosis, the deformation in such cases becomes permanent.
Progressive ossifying fibrodysplasia
A distinctive feature of this genetic disease is clinodactyly of the first toes. The fingers are shortened, because of the valgus or varus curvature, their axis does not fall with the axis of the foot. This is a rare type of clinodactyly – usually this congenital anomaly affects the little fingers, not the thumbs. Detection of the sign allows you to suspect fibrodysplasia even before the appearance of other symptoms of the disease.
Temporary deformation occurs with bruises and fractures. Bruises are characterized by moderate swelling, rapidly subsiding pain, preservation of limb function. For finger fractures, pronounced swelling, cyanosis, and bruising are typical. With fractures of the nail phalanx, subarticular hematomas occur. With damage to the main phalanx due to significant swelling, the thumb resembles a sausage.
With lesions of the metacarpal bone, the zone of maximum edema and pain are localized in the distal part of the foot, swelling passes to the finger. All fractures are accompanied by a significant violation of the functions of the foot. Support on the inside of the foot and rolling becomes impossible. When the fragments are displaced, the deformation is aggravated by shortening or violation of the axis of the finger.
Diagnostics of deformity of the big toe
Diagnostic measures for deformities of the thumbs of the feet are carried out by orthopedic traumatologists. If there are indications, patients are referred for consultation to rheumatologists. The survey plan consists of the following procedures:
- Survey. The doctor finds out when the deformity appeared, whether there were other symptoms, how the disease developed. Studies family and personal history. Determines the factors that could contribute to the development of pathological changes.
- Physical examination. The specialist studies the appearance of the foot, assesses the local temperature, joint mobility, skin and soft tissue condition, detects swelling and inflammation, checks pulsation on the arteries.
- Radiography. The pictures of the finger and foot show fractures, valgus or varus deviation of the finger. Signs of arthrosis are visualized: narrowing of the articular gap, osteophytes, bone deformities, osteosclerosis. With a prolonged course of gout, manifestations of arthritis are visible: osteoporosis, destruction of the epiphyses.
- Plantography. It is recommended for detecting and assessing the severity of flat feet, especially in the presence of Hallux valgus. Additionally, podography and podometrics can be performed.
- Laboratory tests. In patients with gout, microcrystals of sodium urate are detected in the synovial fluid, uric acid crystals are detected in biopsies of tofuses. If progressive ossifying fibrodysplasia is suspected, a genetic analysis is shown to detect mutations in the ACVR1 gene.
Treatment of deformity of the big toe
Victims with fractures should be provided with an elevated position of the foot. The leg should be fixed with a splint, in case of a fracture without displacement, an immobilizing soft bandage is allowed. To reduce swelling, cold should be applied to the foot. To reduce the intensity of the pain syndrome, patients with injuries and an attack of gout can be given an analgesic or NSAIDs.
In case of fractures, a reposition is made, a plaster is applied. With gout, a special diet is prescribed. Therapeutic tactics for most pathologies include the following measures:
- Protective mode. Patients are advised to limit standing and walking, use comfortable shoes. If you stay on your feet for a long time, you need to take regular breaks to unload your feet.
- Orthopedic devices. It is possible to use orthopedic insoles, interdigital inserts, corrective tires and other products. Some patients are shown wearing orthopedic shoes.
- Drug therapy. Patients with intense pain, signs of inflammation are prescribed NSAIDs of general and local action. Sometimes chondroprotectors are added to the treatment regimen. Persistent pain syndrome, resistant to other methods of treatment, is eliminated by intra-articular blockades with glucocorticoids.
- Non-drug methods. Physical therapy, massage and self-massage are effective. In some cases, the condition of patients improves after taping.
- Physical therapy. The number of physiotherapeutic methods for deformities of the feet includes medicinal electrophoresis, UFO, laser therapy, ultrasound, magnetotherapy, shock wave therapy.
A large number of surgical techniques have been developed for the treatment of Hallux valgus: Shede, McBride, chevron osteotomy, Scarf osteotomy and others. The method is chosen taking into account the severity of the pathology, the age of the patient and other factors. In addition, with deformities of the first toe, the following interventions are performed:
- removal of osteophytes;
In the postoperative period, analgesics and antibiotics are prescribed, and wearing Baruk shoes is recommended. Rehabilitation measures are carried out from the first days after the operation. In the future, it is advised to wear comfortable shoes, use orthopedic insoles.