Foot deformity with displacement and bony prominence of the big toe is one of the most common orthopedic pathologies.Initially, the disease appears as a cosmetic defect and does not cause any particular problems, but if left untreated, it worsens with age.The legs quickly tire when walking, pain begins, problems arise with the choice of shoes, and it becomes increasingly difficult to correct the defects even with surgery.So start treatmentHallux valgus (foot turned out)Treatment is necessary as soon as the first signs of the disease appear.
Causes of hallux valgus
It is a multifactorial disease that occurs due to genetic predisposition, other diseases of the musculoskeletal system, neuropathological and metabolic disorders, and external factors.
Internal reasons:
- Genetic predisposition to bunion valgus
- Lateral and vertical flat feet
- Inflammatory processes (mainly arthritis: psoriatic arthropathy, gout, rheumatoid arthritis)
- Congenital foot biomechanical instability
- Hyperelastic syndrome, connective tissue dysplasia
- Neuropathy of various origins
- Knee and hip deformities
External triggering factors:
- Foot and ankle ligament sprains, joint injuries, and foot bone fractures
- Wearing non-anatomically correct high heels with narrow toes
- Occupational risks: carrying heavy objects for a long time, standing for a long time
A genetic predisposition to bunion itself is not considered a cause of the condition, but it is an increased risk factor that is almost always triggered by negative external factors.
What happens with bunion valgus?
Valgus deformity- Not just an aesthetic defect, it causes a lot of inconvenience for women due to limited shoe choices (the disease is more common in women than men).The entire musculoskeletal system of the foot undergoes changes that proceed gradually and, after a period of time, enter an irreversible stage.What happens to the feet?
- The foot spreads, changing its anatomical shape and reducing flexion.
- The first metatarsal is displaced and the angle between it and the second metatarsal increases.
- An angular deviation of the big toe from the first metatarsal, with its head taking the form of a prominent bump (hence, bunion valgus is often called a bump or bunion).
- Subluxation of the metatarsophalangeal joint, causing rotation of the sesamoid bones.
- Violation of biomechanical indicators: decreased movement and support function indicators.
- Changes in bones, cartilage tissue, and overall joints.First, the head area of the first metatarsal is affected: the tissues become more sensitive, the bones become inflamed and injured, bursitis may occur, and the cartilage is destroyed.The joint space lumen is narrowed, and there are focal cysts and localized osteoporosis.
Symptoms of bunions
The disease does not develop in a week or a month; it can take more than ten years from the onset of clearly visible lesions (the first stage, when the toe deviates 20-30° from its normal position) to the third degree of hallux valgus (the big toe deviates by more than 40°, often superimposed on the second degree).
External manifestations of disease:
- The big toe is deflected to one side (outward from the inside surface of the foot) and the bone protrudes.
- Hammerfoot (the 2nd and 3rd toes are deformed and become hammer-shaped, that is, the joints are bent).
- Tiredness and pain in the legs, usually worse in the evening and at night.
diagnosis
The diagnosis is made based on data obtained from external examination and X-rays of the foot.In order to find out the cause of the disease, the orthopedic surgeon collects the patient's medical history (during the interview he asks about the patient's occupation, genetic diseases, previous injuries, lifestyle, habits), makes referrals for laboratory tests and consults other specialists.In fact, bunions can be caused by autoimmune and systemic diseases (such as rheumatoid arthritis), metabolic disorders, and neurological disorders.Following the examination, concomitant diseases are usually diagnosed and then treated.
Treatment methods for bunion valgus
In the initial stage of the disease (level 1 hallux valgus), conservative treatment is adopted: gymnastics, wearing individual orthopedic insoles to prevent flat feet, massage, foot baths and medication.It is also recommended to wear an elastic retainer (protector of the first metatarsal head) called a valgus splint.For inflammation, physical therapy is required: magnetic therapy, electrophoresis, paraffin therapy, etc., analgesics.
If necessary, the orthopedic surgeon will provide recommendations for lifestyle and nutritional changes.For example, many patients need to switch to diet foods in order to lose excess weight without causing disease.It is also recommended to limit excessive physical activity, often walk barefoot on the ground and small stones, use orthopedic pads, and buy safety shoes that do not squeeze the toes so that the legs do not bend and the body's center of gravity does not shift.
However, all conservative methods can only slow down the course of the disease but cannot permanently get rid of the pain.Therefore, surgical treatment is required in difficult cases.Over 100 different proprietary methods of treating bunions have been developed.All surgeries are based on distal angulation osteotomies and proximal osteotomies with reconstruction of the foot to correct the deformity.For surgery, the first metatarsophalangeal joint is exposed through a skin incision.Next, the surgeon cuts the bone and places it in a functionally correct position.With the help of osteotomies, you can not only correct deformities caused by deviations of the fingers, but also lengthen or shorten the bones in the case of accompanying pathologies.This can achieve long-term compensation or complete elimination of lesions, and maintain or restore joint function.
Basic methods of surgical correction of bunions:
- First metatarsal corrective osteotomy (V, wedge, SCARF+Akin (resection and rotation), Lapidus arthrodesis.
- Osteotomies were performed using bioabsorbable implants.
The final choice of treatment can only be made after examination and determination of the degree of deformation and the individual clinical and radiological picture.
After corrective osteotomy, the supporting function is restored, pain disappears, corns and calluses no longer form, soft tissues no longer swell, all deforming components are eliminated: the fingers return to their anatomically correct position, the cartilage is not destroyed, and the joints are not deformed.Patients can live a full life, exercise, walk, run, and wear comfortable shoes.