Toe deformities is observed with flat feet, developmental abnormalities, some inflammatory, degenerative, endocrine, hereditary diseases. It is caused by edema, a change in the shape, length, location of the phalanges, rearrangement or proliferation of bones in the joint area. It can be one- or two-way, local or widespread. It is often combined with deformities of the foot. The cause of the pathology is established according to the examination data, the results of radiography, plantography, CT, MRI, and other techniques. Treatment tactics depend on the nature of the detected disease.
Causes of toe deformities
Traumatic injuries
Toe deformities are accompanied by the following injuries:
- Bruise. The change in the appearance of the finger is caused by swelling of soft tissues. Soreness, cyanosis, and sometimes hemorrhages are noted. All symptoms disappear within 1-2 weeks.
- Fracture. Toe deformities is especially noticeable when the fragments are displaced, the phalanx is bent at an angle, less often shortened. In fractures without displacement, external changes are associated only with edema, so such an injury can be confused with a bruise. A distinctive feature of the fracture is pain under axial load.
- Dislocation. The finger is sharply deformed in the projection of the joint. Movements are impossible, the attempt of movements in the affected joint is accompanied by a springy resistance.
- Frostbite. After warming, the fingers swell sharply, become purplish-cyanotic. Sometimes bubbles appear. The patient is worried about increasing burning pains. Absence of pain, blackening are a sign of severe frostbite with tissue necrosis.
Arthritis
In patients with arthritis in the early stages, the deformation is caused by edema, then by changes in the bone and joint structures of the toes. The symptom is detected in the following types of arthritis:
- Rheumatoid. The lower extremities suffer less often than the upper ones, the fingers are affected symmetrically. The pain increases in the afternoon, at night, weakens in the morning. Swelling of the joints is determined, hammer-like or claw-like deformities form over time.
- Psoriatic. Distal arthritis is combined with skin changes. Due to axial inflammation, the fingers acquire a sausage-like appearance. The lesion is asymmetrical. Flexion restrictions prevail.
- Gouty. 1 metatarsophalangeal joint suffers. The disease proceeds paroxysmally. Suddenly there are unbearable pains, pronounced swelling, an increase in local temperature. The affected area turns bright red.
With nonspecific infectious polyarthritis, short-term deformation on the background of edema is detected after acute infectious diseases. Post-traumatic arthritis develops after dislocations and fractures, proceeds chronically, affects one joint. The chronic course is also characteristic of arthritis caused by overloading of the feet due to excess weight, but in such cases, not mono-, but polyarthritis is observed. A special kind of deformation against the background of overload are the “fingers of ballerinas”.
Congenital anomalies
Toe deformities associated with changes in the number, shape and size of the toes are often combined with similar anomalies of the upper extremities, including the following malformations:
- Ectrodactyly. There is an underdevelopment or absence of one or more toes. Possible underdevelopment of the metatarsal bones. Due to the often present median cleavage, the foot may resemble a crab or crab claw.
- Syndactyly. One or several fingers are fused together completely or partially. Simple syndactyly is characterized by the fusion of unchanged fingers, complex – a combination with other malformations: shortening, reversal, increase, decrease in the number of phalanges.
- Brachydactyly. Shortening of one or more phalanges. It can be supplemented by radial deviation of the phalanges, fusion of the phalanges with each other, deformation of the nail plate, underdevelopment of the metatarsal bones.
- Polydactyly. It is caused by the appearance of rudimentary, additional (bifurcating) or full-fledged fingers. Other anomalies are often found.
- Clinodactyly. Curvature of the fingers or distortion of their position relative to the axis of the limb. As a rule, symmetrical. On the legs, in most cases, it is a minor aesthetic defect that does not require special correction. Clinodactyly of the thumbs is a sign of fibrodysplasia.
Hereditary diseases
The above-listed congenital anomalies of leg development can be formed in isolation, combined with other stigmas of embryogenesis, observed in the following hereditary diseases:
- Russell-Silver syndrome. Syndactyly of 1-2 toes is detected.
- Down syndrome. Brachydactyly is noted, a wide distance between 1 and 2 toes of the foot.
- Andersen syndrome. Brachydactyly is characteristic. Possible curvature, fusion of fingers.
- Friedreich’s ataxia. Deformities can be congenital, caused by flat feet, clubfoot, neurological disorders.
- Pfeiffer syndrome. In mild cases, the expansion of the main phalanges is determined. Syndactyly is found in many patients.
Unlike the pathologies listed above, with Ollier’s disease, toe deformities do not appear in utero, but in the first decade of life. Due to uneven growth, the formation of foci of cartilage tissue, the fingers are shortened or curved, covered with spherical “blisters”.
Deformations of the feet
Due to the redistribution of the load, the shape of the toes changes with al toe deformities, including clubfoot, hollow, horse and heel foot. The most common deformity is transverse flatfoot, therefore, the most well-known acquired disorders are associated with this pathology:
- Hallux valgus. The deviation of 1 finger is more often bilateral in nature with some asymmetry. Progresses with age. It is complicated by arthrosis, limited mobility of the 1st metatarsophalangeal joint.
- Hammer-like fingers. They are often detected simultaneously with Hallux valgus. The deformation is provoked by the pressure of the curved 1 finger, a violation of the balance of the muscles. As a rule, 2 fingers suffer, less often – 3 fingers. The main phalanx is unbent, the distal one is bent. Initially, the finger is passively brought to the correct position, subsequently the deformation becomes fixed.
- Claw-like fingers. As in the previous case, there is an imbalance between the traction of extensors and flexors. Several fingers are deformed. Pathology is aggravated by disorders of local blood circulation in vascular, endocrine, metabolic disorders.
Arthrosis
Osteoarthritis develops more often in old age. It can occur after injuries. Accompanies other deformations. The appearance of the affected joints changes over several years due to bone growths, during exacerbations it is aggravated by edema due to inflammation of soft tissues. Against the background of arthrosis of the I metatarsophalangeal joint, a rigid big toe is sometimes formed. In this case, external changes are combined with a significant restriction of movement that prevents walking.
Neuroosteoarthropathy
Develops against the background of peripheral nerve damage. The most common neuroosteoarthropathy is a type of diabetic foot – diabetic arthropathy. At the initial stage, deformities are provoked by edema. Subsequently, due to changes in the structure of bones and joints, the fingers become claw-like. Other pathologies in which neuroosteoarthropathy may occur include:
- toxic neuropathy in patients with alcoholism, other chronic intoxications;
- condition after spinal cord injury;
- polio;
- neurosyphilis;
- syringomyelia;
- leprosy.
- Local infections
Panaritium affects the legs less often than the hands. In the acute period, deformation is observed in all forms of pathology, caused by edema, accumulation of pus. With deep forms of panaritium (articular, bone, tendon), the reason for the change in the appearance of the leg is the melting of tendons and solid structures. In the outcome, extensive scars, contractures, ankylosis often form, causing permanent gross deformities.
Diagnostics
Orthopedic traumatologists are more often engaged in determining the cause of deformations of the distal parts of the legs. According to the indications of patients, they are referred to podologists, rheumatologists, and other specialists. The examination program may include the following diagnostic procedures:
- Survey, external inspection. The specialist determines when and under what circumstances the deformation appeared, identifies external changes, evaluates joint mobility, determines pulsation, evaluates the sensitivity of the foot.
- Radiography. Taking into account the peculiarities of pathology, radiography of the fingers or the entire foot can be prescribed. If necessary, snapshots are taken with a load. The method visualizes traumatic injuries, flat feet, arthrosis, chronic arthritis, deep forms of panaritium.
- Plantography. It allows to diagnose longitudinal and transverse flat feet, to identify valgus and varus deformities of the foot. To increase informativeness, it can be supplemented with podometry, podography.
- Laboratory tests. They are prescribed to determine markers of rheumatic diseases, metabolic disorders and signs of inflammation, microflora studies.
Treatment
Assistance at the pre-hospital stage
Patients with traumatic injuries, inflammatory diseases are shown rest, elevated position of the limb. In case of injuries, cold is applied to the injury site. In case of fractures and dislocations, temporary immobilization is carried out using a splint or a special bandage.
In case of frostbite, a multi-layer dry bandage is applied to naturally warm the affected areas. It is strictly forbidden to warm your feet in hot water or with a heating pad, as this can aggravate tissue damage. In some pathologies, it is possible to apply local anti-inflammatory and painkillers and painkillers.
Conservative therapy
In case of injuries, the dislocation is corrected or the fracture is repositioned, a plaster cast is applied to the leg or the diseased finger is fixed to the healthy one. Depending on the features of the pathological process , the following conservative methods are used during the treatment of patients with finger deformities:
- Protective mode. It may provide for load limitation, the use of orthopedic products, crutches, canes.
- Drug therapy. NSAIDs are recommended for pain, signs of inflammation, and antibiotic therapy is performed for infectious processes. Patients with diabetes mellitus are shown hypoglycemic agents or insulin injections.
- Non-drug methods. Massage and physical therapy play an important role in the treatment of many deformities of the fingers. Patients are prescribed UHF, laser therapy, magnetotherapy, and other physiotherapy procedures.
Surgical treatment
In pathologies accompanied by deformities of the fingers, the following operations are performed:
- Injuries: fixation of fragments with knitting needles, removal of necrotic areas and amputation of fingers during frostbite.
- Developmental anomalies: operations for syndactyly, removal of extra fingers for polydactyly, plastic interventions for ectrodactyly.
- Deformities of the foot: operations with Hallux valgus, resection of hammer-shaped toes.
- Local infections: autopsy of the panaritium.
With improperly fused fractures, osteoarthritis, severe contractures and ankylosis of various genesis, finger arthroplasty is performed to restore the functions of the foot.
