Hallux valgus is a disease in which the first toe of the foot is deformed at the level of the metatarsophalangeal joint and deviates outward. The pathology is accompanied by progressive arthroarthritis of the first metatarsophalangeal joint. The disease develops gradually and usually worsens with age. It is manifested by pain when walking, night pains are possible. With severe deformation, there is a restriction of movements in the I metatarsophalangeal joint. The diagnosis is made on the basis of clinical signs and radiography data. Treatment in the early stages is conservative, symptomatic. In case of significant deformation, surgical correction is performed.
M20.1 External curvature of the thumb (hallus valgus)(purchased)
Hallux valgus is a valgus deformity of the first toe in the metatarsophalangeal joint. Due to deformation, the finger is deflected outward at an angle to the rest. The disease is widespread in traumatology and orthopedics, it is detected in women 10 times more often than in men. It is assumed that the reason for this difference is the weakness of the ligamentous apparatus in the fairer sex, as well as wearing uncomfortable narrow shoes with high heels. Pathology is widespread, it is diagnosed in people of all ages.
The main cause of the development of Hallux valgus is usually connective tissue insufficiency, which can be manifested by transverse flat feet, excessive joint mobility, varicose veins, increased extensibility of ligaments, fascia and skin. Hereditary predisposition is revealed – as a rule, in the closest relatives of patients (mothers or grandmothers) there is also this deformation.
Other factors: high heels, walking in uncomfortable narrow, tight or short shoes are secondary and only contribute to the formation of hallux valgus. The second group of causes of pathology is congenital deformities of the feet, injuries and some other pathologies. In particular, this group includes a number of diseases in which there is a violation of the nervous regulation of the muscles of the lower leg and foot (for example, polio).
Along with the weakness of the ligaments, an uneven tension of the muscles leading and withdrawing the I finger plays a certain role in the development of Hallux valgus, as well as a genetic tendency to form exostosis on the inner surface of the head of the I metatarsal bone. When deformity is formed, the imbalance in muscle tension is further aggravated, the metatarsophalangeal joint becomes unstable.
The inner surface of the joint is constantly irritated by contact with shoes, as a result of which the displacement of the head of the I metatarsal bone is supplemented by the formation of a bone growth, which further aggravates the deformation. Due to the change in the shape of the foot, the load is redistributed – the area of the heads of the III and II metatarsal bones is constantly overloaded during walking. This leads to the occurrence of pain and the formation of arthrosis not only in the area I, but also in the area II and III of the metatarsophalangeal joints.
The severity of the pathology is determined taking into account two values: the angle between the II and I metatarsal bones (Intermetatarsal angle) and the angle at which the I finger is deflected in relation to the I metatarsal bone (Hallux valgus angle). Degrees of Hallux valgus:
- Degree 1 – the angle between the metatarsal bones is less than 12 degrees, the angle of deviation of the I finger is less than 25 degrees.
- Degree 2 – the magnitude of the angle ranges from 12 to 18 degrees, I the finger deviates by more than 25 degrees.
- Degree 3 – the angle between the metatarsal bones is more than 18 degrees, the angle of deviation of the first finger reaches more than 35 degrees.
Patients complain of pain in the area of the I metatarsophalangeal joint. The pain increases after prolonged walking or prolonged standing and decreases at rest. Night pains are possible, especially after a significant load on the foot. Pain syndrome can vary significantly both in nature and in strength – from a feeling of discomfort (usually in the early stages) to a sharp burning or constant aching pain.
The severity of pain does not always clearly correlate with the severity of arthrosis and the amount of deformation, although with a significant displacement of the head of the I metatarsal, the symptoms are usually more vivid. As the deformation of the foot develops, it loses its normal shape more and more, expands and flattens, the I finger “falls” on the II, concomitant deformities of the II finger (hammer-shaped finger) often occur.
All of the above in combination with the “bump” in the projection of the I metatarsophalangeal joint significantly affects the appearance of the foot. Therefore, along with pain, the reason for the treatment of patients with Hallux valgus to orthopedists is often a cosmetic defect and problems with the selection of shoes. Especially often such complaints are made by young women.
The diagnosis of hallux valgus is made by an orthopedic traumatologist. When establishing a diagnosis and determining the severity of pathology, the specialist focuses on the external examination data and the results of visualization techniques. The following research methods are used:
- External inspection. The foot is flattened. Visible deformation and slight or moderate hyperemia in the projection of the I metatarsophalangeal joint are revealed. The first finger is deflected outward at an angle to the rest. Palpation is painless or not sharply painful, bone exostosis and skin compaction are determined on the inner surface of the I metatarsophalangeal joint. Movements are usually limited, with the maximum extension of the I finger, pain may occur.
- Radiography of the foot. It is the main diagnostic method for Hallux valgus. The radiologist makes special measurements, on the basis of which he determines the degree of pathology. Along with the degree of deformation, the severity of arthrotic changes is assessed when studying X-rays. The presence of osteoarthritis is indicated by narrowing of the articular gap, deformation of the articular area, marginal growths and osteosclerosis of the subchondral zone.
- Tomography. It is used in some cases. If necessary, to detail the listed changes, the patient is referred to a CT scan of the foot. According to the indications, an MRI of the foot is prescribed for soft tissue examination.
The disease cannot be eliminated without surgery. Nevertheless, conservative treatment is recommended in the early stages of the disease in young patients, as well as in any degree of deformation in old age or old age. The main goals are to eliminate the pain syndrome and prevent the progression of the disease. Treatment is carried out in an outpatient setting. In case of pain, anti-inflammatory and warming ointments are used. During the period of remission, they use:
- phonophoresis with hydrocortisone;
- electrophoresis with novocaine or trimecaine.
If there are signs of inflammation, the patient is referred to UHF or magnetic therapy. Patients are advised to lose weight (if they are overweight). It is necessary to optimize the load: perform a set of exercises to strengthen the ligaments and muscles of the foot, if possible, exclude prolonged standing and walking. It is necessary to use special orthopedic shoes and inserts to eliminate excessive pressure on the area of the I metatarsophalangeal joint and prevent further valgus deviation of the I finger.
If conservative therapy is ineffective, surgical treatment performed in a hospital setting is indicated. There are about 300 options for operations with Hallux valgus. All methods can be divided into 3 groups:
- On soft tissues. They are effective only at the I degree of deformation. It is possible to use the Silver technique, in which the tendon of the adductor muscle of the I finger is cut off, or the McBride operation, in which this tendon is moved. The purpose of treatment is to restore the uniformity of traction of the adductor and abductor muscles.
- On bone and soft tissue structures. Often, these surgical operations are performed in combination with excision of the bone growth and subcutaneous mucosa of the sac in the area of the I metatarsophalangeal joint (Shede operation).
- On the bones. In the treatment of grade II and III Hallux valgus, the choice is made between two methods: chevron and Scarf osteotomy. With a chevron osteotomy, a small V-shaped fragment in the distal part of the I metatarsal bone is removed. With Scarf osteotomy, a Z-shaped incision (saw) is performed almost throughout the I metatarsal bone, and then the fragments are “shifted” in order to eliminate the angle between the I and the rest of the metatarsal bones. The fragments are fixed with screws.
In the postoperative period, the patient is immediately allowed to load the leg in a special orthosis, which is mandatory for wearing for 6 weeks. During this period, it is recommended to keep the leg in an elevated position more often and avoid overloads. In the future, you should wear wide shoes, perform a special complex of physical therapy and self-massage the arch of the foot using a tennis ball.
The prognosis is determined by the stage of the disease. With minor deformity and the absence of pronounced arthrotic changes, conservative therapy and compliance with medical recommendations can eliminate the pain syndrome, significantly slow down the development of the disease. In the later stages, these measures are ineffective, but the operation provides a good functional and cosmetic result. If the doctor’s recommendations are not followed in the long-term period after the intervention, relapses are possible.
Preventive measures include the selection of comfortable shoes, reducing periods of standing and long walking. People who have a predisposition to this disease (revealed transverse flat feet, the presence of Hallux valgus in their closest relatives) should use orthopedic insoles, abandon high-heeled shoes, perform special sets of exercises.