Big toe deformity: treatment

Static foot deformity is a degenerative disease of the bone that severely impairs its supporting function.As a rule, the load is not evenly distributed over the entire area of the sole, but along the main points and axes - from the heel tubercle along the outer edge to the toes.This structure ensures the formation of the arch of the foot - a set of bony structures and soft tissues with shock-absorbing properties.

Therefore, damage to this structure can lead to a fairly common condition - flat feet.When it is mentioned, people usually think of the longitudinal variant of pathology, which causes the arch to drop along the medial edge.But the transverse form of the disease, with the characteristic curvature of the big toe, also refers to flat feet.

This type of pathology occurs mainly in mature and older women and is usually an acquired disease.It is associated with wearing uncomfortable or ill-fitting shoes, which over time can cause the bones of the forefoot to shift.The result of bunions is persistent unpleasant symptoms when people wear familiar shoes and walk normally.

concept

In orthopedics, valgus deformity is a deviation of any part of the musculoskeletal system outward from the midaxis.In this case, bending may also occur in the joints - the direction of the angle between the bones is then assessed.The development of transverse flatfoot corresponds to this mechanism, ultimately leading to irreversible damage to the metatarsophalangeal joint of the first toe.

Although the condition often lasts for decades, patients seek help in its later stages.Therefore, it is necessary to point out the inherent characteristics of hallux valgus:

1. The first and main symptom is a bending of the first metatarsophalangeal joint, creating an angle that opens outward.The development of pathology occurs gradually, but progression is irreversible.In the later stages of the disease, the deformity of the big toe reaches such severity that the angle of the joint becomes almost 90 degrees.
2. The next important sign is the formation of the characteristic "bone" located on the inner edge of the foot, usually with the head of the metatarsal bone slightly protruding.Its appearance is related to the compensatory inward deviation of this bone under the action of gravity.
3. The latest manifestation is a hammer-like bend in the second finger, also caused by pathological pressure on adjacent joints and surrounding soft tissues.

Bunions are characterized by the development of additional (non-permanent) symptoms - pain in the forefoot, gait disturbance, dense corns on the sole of the foot under the middle toe.

Formation mechanism

Like other degenerative bone diseases, transverse flatfoot develops through two stages.In the first stage, the soft tissue undergoes only functional changes, resulting in a decrease in its supportive and elastic properties.In the second stage, deformations of the joints or bones themselves have developed:

• The trigger is always undue loading on the forefoot from wearing ill-fitting shoes, especially those with narrow toes and heels.
• This can lead to chronic damage to the soft tissues (ligaments and muscles that hold the base of the toe and metatarsal bone in a higher position).
• Repeated trauma causes the forefoot arch to gradually drop, after which the greatest load begins to fall on the midfoot.
• In this condition, the peripheral metatarsal bones shift in the opposite direction.
• The first metatarsophalangeal joint usually bears the greatest load and therefore the greatest pathologic stress on it.Its capsule gradually stretches, causing the metatarsal bones to shift further medially.
• The stability of the joint decreases, leading to the formation of subluxation of the phalanx of the index finger.The progression of bunions is related to the ongoing and slow progression of this process.
• Over time, the deformed soft tissues (ligaments and muscles) become fixed in this position, explaining the irreversibility of the curvature.
• Chronic injury can lead to deformation of the first metatarsophalangeal joint, resulting in loss of joint function.

Further assistance strategies depend on the severity of the changes - in early stages, conservative measures are sufficient, while in advanced cases, only surgery can eliminate persistent deformities.

Conservative treatment

Valgus deformity of the big toe can be eliminated using traditional methods only if joint function is fully preserved.This is explained by the condition of the ligaments and muscles, with damage in the early stages being reversible.In this case, assistance will be provided in three consecutive phases:

1. First, the patient is prescribed a passive treatment method, which involves immobilizing the finger in the correct position.The joints are artificially restored to their normal shape through various orthopedic means.Usually this period takes at least 6 months and is necessary for the soft tissue to adapt.
2. In the second phase, the active phase begins, which involves special training techniques to strengthen the foot muscles.To achieve this, physical therapy sessions, massage sessions and physical therapy procedures are combined simultaneously.
3. This last period is uncertain because bunions are an incurable disease.Therefore, patients consolidate the results of treatment for the rest of their lives and work to prevent the progression of the disease.

The choice of treatments and methods is completely individual - taking into account the patient's age, concomitant diseases and the characteristics of the curvature itself.

Passive program

The first phase of treatment is the most difficult for the patient because the immobilization of the foot is rarely noticed by the patient.Restoration of the normal anatomy of the arch is more difficult and obvious than the development of pathology.To this end, orthopedics uses the following methods:

• The standard to start helping is to completely get rid of shoes or boots with a narrow toe box.The patient should now wear only loose-fitting shoes that are wide or open in the front.Personalized orthopedic boots are considered ideal, but it is extremely rare for patients to be able to afford this luxury.
• For minor deformities, a special bandage made of adhesive plaster can be used and applied to the instep.It is fixed in such a way as to exclude external and internal deviations of the metatarsal bones during walking.
• A more convenient and reliable option is orthopedic foot immobilization - treatment in this case is more effective.For this purpose, various types of orthotics or bandages are used, the hardness of which is chosen according to the degree of deformation.

The brace should be worn almost all the time - during the first month it is recommended that the brace be removed for no more than 2 hours during the day.

active procedure

Transition to Stage 2 is determined individually based on a doctor's assessment of symptoms and after X-rays.Since the disease is not progressing and there is at least a slight positive dynamic, we are able to start actively fighting the deformity.Use the following method for this:

• First, physical therapy procedures are gradually introduced to prepare the joints and surrounding soft tissues for the upcoming loads.Performs a warm dispersion procedure that can be used on the feet.They include lasers, magnets, application of paraffin or ozokerite, ultrasound therapy.
• After a few days, massage sessions are added, starting with superficial heating of the tissue.Gradually, the specialist should proceed to heat the actual muscles of the foot, which play an important role in eliminating the curvature of the foot.
• When symptoms of discomfort completely disappear, patients can engage in independent physical exercise.It is not recommended to include many exercises in the program at once to avoid muscle fatigue.It is best to gradually increase the load and allow the soft tissues to adapt to the work being done.

In order to achieve full results, the listed activities must be carried out every day to prevent the recurrence of pathological processes.

surgical treatment

Indications for surgery should always be justified because of the long-term recovery required after surgery.Therefore, surgery is not suitable for patients with early stages of hallux valgus because the curvature of the fingers in these patients can be corrected naturally.Surgical intervention is only required when irreversible changes have occurred in the joint or surrounding tissue:

1. Signs of fixed transverse flatfoot occur when the arch is deformed both during load testing and in the resting position.This conclusion was reached after X-rays assessing the location of the metatarsal heads.
2. Marked bending of the first metatarsophalangeal joint, accompanied by persistent dislocation between the bones forming the joint.In this case, the absolute indication is the additional curvature of the adjacent joint, which causes a change in the position of the second finger.
3. Even the first signs of arthrosis in the first metatarsophalangeal joint indicate irreversible damage to the surrounding soft tissues.The muscles and ligaments are firmly fixed in the malignant position, making correction in a conservative manner impossible.

The choice of intervention method depends entirely on the individual characteristics of the disease course - it is usually performed on the most affected part of the arch.

ligament surgery

This surgical treatment option is more suitable for patients who have not yet shown signs of direct damage to the joint tissue.Therefore, the main mechanism of their deformation becomes pathological muscle traction associated with changes in arch position.To correct it, use the following intervention options:

• The first type of surgery involves all forms of transposition (movement) of the tendons that attach to the first metatarsal bone.It is the pathological contraction of the muscles that causes their deviation from the finger bones to gradually increase.Therefore, the ligament is removed or partially split and attached to a new location - the area of the outer edge of the metatarsal bone.Changing the point of action of the muscle force allows you to gradually return it to its original position.
• The second type of surgery involves creating various types of frenulum - creating an artificial transverse arch of the foot.All of the metatarsals are fixed in the correct position, and then another piece of ligament or a synthetic prosthesis is sutured to them.But this option is only possible in the case of "slight" deformation, where the displaced bone can easily return to its original position.

Based on the observation, all surgeries on ligaments remain temporary in nature—if the pathological factors are not corrected, the displaced tendon will soon stretch again.

joint operations

If there is significant curvature in the joint, orthopedic intervention is required to eliminate the bone tissue defect.To do this, a resection—the removal of certain areas of the affected bone—is performed.This method artificially restores the joint to its normal position.Currently this type of operation uses the following options:

• The main method of eliminating deformity is the Schede-Brandes osteotomy.This intervention consists of two operations: removal of the pathological growth on the first metatarsal (small bone) and excision of the triangular fragment at its base.After the bone tissue fuses, the deformed finger returns to its normal position.
• Less commonly used is surgery to remove two areas in the metatarsal head area.Because of the severity of the injury, the risk of complications that would prevent the fragments from healing properly is too high.
• In advanced cases of the disease, palliative interventions are performed—not to restore mobility, but to eliminate pathological displacement.To do this, arthrodesis is performed - the joint cavity between the metatarsal bones and phalanges is removed and closed.

Today, these interventions are rarely performed alone—they are often combined with concurrent tendonoplasty surgery, thereby eliminating inappropriate muscle traction.

joint operation

Performing complex procedures is a priority in modern orthopedics, which leads to an increase in the frequency of combined interventions.Typically, a combination of gentle bone resection and repositioning of one of the ligaments that move the thumb is performed:

• The modified Schede-Brandes procedure involves resection of a standard portion of the metatarsal bone—resection of the head and base areas.Furthermore, the abductor pollicis muscle is transferred to its outer surface, the pressure of which causes subluxation of the joint.
• Osteotomy can also be performed in conjunction with the formation of an artificial arch.Additionally, in one surgery, not only can the metatarsal bones be restored to their original position, but the remaining structures can also be placed in their correct positions.
• In severe cases, combined interventions are performed to simultaneously eliminate deformity of the first and second metatarsophalangeal joints.

The characteristics of this type of surgery are the most severe - a large amount of destruction, the need for long healing and increased recovery periods.

recover

Completion of conservative and surgical treatment is the beginning of a recovery period that continues for the rest of such patients' lives.If special recommendations are not followed, the disease may relapse and remind itself again with unpleasant symptoms:

1. First, all patients are required to wear special orthotics with additional Seitz pads.Not only do they ensure the correct position of the foot when walking, they also provide additional support to its arches.
2. You also need to pay attention to your shoes - completely exclude any boots or shoes with a narrow front from your wardrobe.
3. You need to take care of your weight - maintaining a normal weight significantly reduces the load on your arches.
4. Regular preventive exercise routines can maintain normal muscle tone, thereby preventing the metatarsal bones from shifting.

The main difficulty faced by patients comes from physical therapy programs as most of the recent patients do not even know the exercise techniques.Therefore, in order to perform them correctly, you first need to learn from a coach, either individually or in a group.