What is hallux valgus 1st degree. Valgus deformity of the big toe: causes and clinical picture

Valgus deformity thumb foot is the most common orthopedic disease. Its main symptom is the curvature of the 1 metatarsophalangeal joint. On early stages appears as a small growth near the thumb. Pathology is characterized by slow development, therefore, to diagnose it on early stages It's hard enough. IN further patient begins to experience pain when walking.

Valgus deformity is often combined with impaired blood supply to tissues, which leads to the development of arthritis or arthrosis. If left untreated, an acute inflammatory process occurs in the joint of the thumb, called.

What contributes to the curvature of the finger?

The causes of hallux valgus can be different, the main among them are:

flat feet;
congenital pathologies of the metatarsophalangeal joint;
muscle weakness, leading to pathological mobility of bone surfaces;
leg injuries;
cartilage destruction due to arthritis or arthrosis.

Wearing uncomfortable shoes is not a direct cause of the disease, but it can accelerate the development pathological process. Therefore, hallux valgus is most often found in women.

There are others pathological causes, along which the first toe can be bent. develops when calcium is leached out of the bones, causing them to become less dense. This is what leads to a change in the shape of the joint. Almost every person who has symptoms of hallux valgus has one of 2 types of flat feet. Endocrine disorders contribute to a decrease in the strength of the ligaments, because of which they cannot hold the joint in the correct position. The risk group includes women who are used to walking in high-heeled shoes. The provision of increased loads on the toes accelerates the process of curvature of the joint.

The ballet dancers are forced long time stand on toes, which can lead to deformation of the feet. It is believed that the risk of developing the disease increases as the body ages. So, hallux valgus is found in only 3% of people under 30 years old, while among the elderly similar problem has every 5 people. This disease is most often found in patients whose parents had pathologies of the musculoskeletal system.

Clinical picture of the disease

The curvature of the big toe in the initial stages is quite difficult to notice. A person notices that it becomes uncomfortable for him to walk in his usual shoes. After a long stay in a standing position, pain occurs. Over time, the main sign of pathology appears - the deviation of the first metatarsophalangeal joint towards the second with the formation of the so-called bump. The remaining fingers take the form of hammers. The patient may experience chronic fatigue and difficulty fitting shoes. Over time, corns appear on the skin of the feet, bringing a lot of inconvenience to a person.

The most common signs of hallux valgus are pain associated with inflammation. synovium. A soft seal appears in the area of \u200b\u200bthe first finger. The skin of the affected area turns red and swells. The shape of the thumb is changing. Over time it forms callus irritating soft tissues. Appear severe pain while walking. The mobility of the joint is limited, the pathological process can cover all the toes.

There are several degrees of hallux valgus, each of which has its own symptoms:

Hallux valgus 1 degree is characterized by a curvature of the finger by no more than 20 °. Pain is not observed.
With a disease of the 2nd degree, the joint is displaced by 21-30 °. Unpleasant sensations are mild in nature, the mobility of the finger is not disturbed.
With valgus deformity of the 3rd degree, the angle of curvature exceeds 30 °. Pain in the affected area become permanent. They prevent a person from wearing habitual shoes, walking and playing sports.
At stage 4 of the disease, the joint is displaced by more than 50 °. Deformation of this degree is characterized by severe pain, difficulties with choosing shoes, and the formation of calluses.

How is this disease diagnosed?

To establish a preliminary diagnosis, an examination of the foot and the collection of anamnesis are performed. The physician must:

assess the severity of changes in gait;
the degree of curvature of the joint;
the presence of corns;
bone lump.

Confirm the diagnosis with x-ray examination in multiple projections. Computer plantography is a procedure in which the patient's foot is placed on a platform, the correct distribution of the load is determined by the nature of the print obtained. Podometry reveals early signs valgus deformity. When staging final diagnosis it is necessary to exclude diseases such as osteoarthritis and gouty arthritis. How to treat hallux valgus deformity of the big toe?

Main therapeutic measures

The choice of one or another technique depends on the degree of joint deformity and the severity of the pain syndrome. Most effective treatment valgus deformity of the big toe is in its early stages. Therapy can be both conservative and surgical. In addition, wearing orthopedic shoes helps to stop the development of the pathological process, which contributes to the correct distribution of the load and prevents the appearance of corns. To reduce pressure on the affected area, special insoles and pads are used.

With a disease such as hallux valgus, treatment involves the use of anti-inflammatory drugs. Intra-articular injections of glucocorticosteroids help to quickly get rid of the pain syndrome. to the drugs of this pharmacological group relate:

Kenalog;
Diprospan;
Hydrocortisone.

Due to the large number side effects these tools are not suitable for long-term use. Medical therapy cannot completely save a person from hallux valgus. With its help, you can only eliminate pain and signs of inflammation.

For the treatment of the disease, physiotherapeutic procedures are often used - diathermy or ultrasound. However, these methods provide only temporary relief. The most effective is the use of orthopedic devices, which are made taking into account individual features feet. The use of arch supports in the early stages of the disease prevents further deformation of the joint. With advanced forms of the disease, orthopedic devices make walking more comfortable. With the help of special insoles, you can eliminate the main cause of the curvature - flat feet.

Prevention of hallux valgus is a constant visit to the orthopedist. Wearing tight shoes with high heels should be avoided. Recommended use orthopedic insoles. Prolonged standing is prohibited.

Valgus deformity - enough serious illness, which can worsen the quality of life of the patient, so treatment should begin in its early stages.

Halus valgus is an unpleasant and painful disease. Often it is preceded by transverse flat feet, but it can also develop under the influence of other factors: excess weight, wearing uncomfortable shoes, excessive loads on your feet. In the early stages, the disease is cured by conservative therapy, but final stages do not avoid surgery.

Hallux Valgus (from Latin hallux - finger, valgus - deviation) is an ailment that is characterized by a pathological deviation of the big toe. Women are often affected by this pathology, but it can occur in men and even in children. The disease is characterized by the expansion of the forefoot and the elevation of the head of the big toe above the surface of the skin of the leg.

At stage I of the disease, redness and thinning of the skin in this area is observed, but over time, due to progressive bursitis and mechanical injuries, it coarsens. Due to the slow deviation of the first finger, it first subluxes, and then dislocations with entry under the second phalanx. Further, corns and corns are noted on the sole, which hurt, disfigure legs and hinder human movement.

Causes of pathology

Such a disease occurs different reasons, but often note the hereditary nature of the pathology. The disease usually affects women. It is believed that this state of affairs is facilitated by wearing uncomfortable and even unhealthy feet shoes with a narrowed or excessively shortened toe and high heels. Nevertheless, not always an increased load on the legs, in particular, on the feet, leads to.

A significant provoking factor can be called failures in endocrine system to which women are more susceptible. Problems in this area can arise against the background of emotional overload, stress, as well as due to certain changes in a woman’s life ( puberty, menopause, pregnancy).

So, metamorphoses of the hormonal background can lead to the development of osteoporosis, weakness and loosening of the bone and connective tissue, which can provoke changes in the biomechanics of the foot. Another important factor in the development of hallux valgus is excessive body weight and the presence of transverse flat feet.

Hallux valgus, the symptoms of which at first come down only to the rapid fatigue of the legs after walking, their pain, redness and swelling of the first metatarsophalangeal joint, as well as its bulging, is also dangerous because diseases such as arthritis, arthrosis, joint bursitis develop against its background . With further development, the disease acquires other signs. These include: an increase in the size of the protrusion of the finger; the thumb leans inward more and more intensively; there is a curvature of the other toes; soreness and inflammation continue to increase.

Stages of the disease

There are certain stages in the development of the disease. As a rule, the degree of deformation in case of an ailment is determined by measuring the angle between the 1st finger and the 1st metatarsal bone. Especially important indicator to identify the stage of the disease, the intertarsal angle (between the 1st and 2nd metatarsal bones) can be called.

Based on the measurement of this angle, 3 stages of hallux valgus are distinguished:

Stage I: the inter-tarsal angle is less than 12 degrees, and the angle of deviation of the thumb is less than 25 degrees;

Stage II: indicators are less than 18 degrees in the first case and more than 25 degrees in the second;

Stage III: more than 18 degrees and less than 35 degrees, respectively.

Diagnosis and treatment of pathology

If hallux valgus is suspected, especially if the presence of stage II and III of the disease is suspected and surgical treatment of hallux valgus is planned, examinations are prescribed to help verify the diagnosis and identify the stage of the disease. For this purpose, the doctor may prescribe X-ray, CT and MRI. However, the main method of diagnosis is still X-ray.

X-ray helps to see subluxation or dislocation of the first phalanx, divergence of metatarsal heads, and bursitis. All further treatment will depend entirely on research indicators.

Conservative treatment

As a rule, at stage I of the disease, its treatment is reduced to conservative therapy, which includes the following steps:

making changes in lifestyle (weight loss, physical education is connected);
worn orthopedic shoes to eliminate interaction in zone I of the metatarsophalangeal joint;
special insoles and arch support are used, which correct the arch of the foot;
orthopedic orthoses for thumbs are used;
wearing interdigital pads;
night bandage is practiced.

Therapy with medication often comes down to taking NSAIDs and physiotherapy. In addition, treatment without surgery may include sessions of shock wave therapy. However, with the low effectiveness of such treatment, as well as II and III stages ailment, a prompt solution to the problem is offered.

Surgery

Now there are many methods of surgical correction of pathology, which indicates the seriousness of the problem and the absence of a universal method for treating this disease. At present, any self-respecting clinic offers the following main types of operations: laser exposure; traditional operation; endoscopic intervention.

Both laser exposure and endoscopic intervention are minimally invasive operations, which are characterized by small loss blood, almost imperceptible traces of the operation, a short postoperative period and fast rehabilitation. Often, in both cases, the operation itself occurs under local anesthesia. Moreover, when using a laser, the very possibility of infection during the operation is excluded, since there is no contact between the instrument and tissues as such. That's why everything large quantity specialists prefer just such a pathology-correcting method.

If we talk about traditional operation, then it still exists. They can operate both with local and with general anesthesia. First, a small incision is made and the bone growths in the area of the metatarsus are eliminated, after which the correct angle of the metatarsophalangeal joint is created, to fix which a separate device is used. Further, the "bump" is eliminated in the same way. In total, this operation takes about one hour.

rehabilitation period

As a rule, after a traditional operation (when exposed to laser and endoscopic intervention rehabilitation period significantly less) the person stays in the clinic for another 2-3 days. It depends on the general condition of the patient and the severity of his illness. Subsequent recovery after surgery takes place at home. The sutures are removed 1-2 weeks after the intervention. For a certain period in the foot area, both swelling and soreness can be observed. That is why exercise therapy exercises, in general, should be gentle.

An integral part of rehabilitation is special shoes after surgery. Wearing Baruk shoes, which resemble platform sandals, for 4 weeks is a mandatory part of recovery. In the future, a person is recommended to wear individual orthopedic insoles. It is important to remember that after the operation, patients are forbidden to wear uncomfortable shoes, as they can provoke a recurrence of the disease. If we talk about returning to the usual rhythm of life, then it is possible in 1-2 months after the intervention. The duration of rehabilitation will depend entirely on the further load on the legs.

However, there are contraindications to the operation. It is better to refrain from corrective intervention: with immunodeficiency; if available diabetes; with problems of blood clotting; when malignant tumors; in the presence of infectious diseases.

Alternative Treatments

Treatment with folk remedies for this pathology is a very common phenomenon. However, looking for another folk recipe, it is important to understand that such therapy does not eliminate the problem, but only relieves unpleasant symptoms, for example, soreness and swelling. In addition, it must be remembered that any folk remedy must be previously agreed with the attending physician in order to avoid aggravating the condition.

Among the most popular means in the treatment of "bones" can be called medicinal herbs. As a rule, they resort to the help of dandelion, burdock and madder dye. A decoction is often prepared from the last herb (1 tsp per 1 cup of boiling water). To do this, a vessel with steamed grass is placed on water bath. Then, after 10 minutes, the broth is filtered and allowed to cool. Use it 2 times a day for half a glass until the elimination of unpleasant symptoms.

If we talk about dandelion, then an external remedy is prepared from it. For this purpose, 100 g of pre-crushed dandelion flowers are taken and poured with iodine so that it covers the flowers. Next, the container with the product is removed in a dark place for 4 days. The resulting infusion is used in this way: the pre-steamed legs are wiped dry, and then with its help they “draw” a mesh on the bones.

In addition excellent remedy considered burdock. Its large leaves are used, which are pre-lubricated with turpentine. These leaves are wrapped around the legs from the foot to the knee, after which they are wrapped with cling film and woolen cloth. When carrying out the procedure, care must be taken, as turpentine can cause burns. Such healing sessions carried out daily for 3 months.

Often, potatoes are also used in the treatment of bumps on the legs. However, preparing it remedy not from raw tubers, but from their peelings. To do this, fill a small saucepan 2/3 with cleanings, fill them with water and boil for 15 minutes. After that, a decoction just removed from the fire is poured into a bowl of water, then the legs are placed in for half an hour. Such procedures are carried out from 7 to 10 days. However, no matter what additional folk remedy no matter how a person decides to resort, it is important to remember that you first need to discuss it with a specialist.

Hallux valgus is a pathology with the extension of the big toe in the metatarsophalangeal joint. The finger moves outward at an angle as to the rest. Female patients get sick more often, about 10 times. Rare, but seen in childhood.

The curvature is formed gradually, for a long time. It usually becomes noticeable old age. different degrees hallux valgus give distinguishable signs.

The main reason is a defect in the strength of the connective tissue, due to which a transverse flat foot is formed.

Additional reasons:

great joint mobility;
varicose veins;
burdened heredity according to the degrees of Hallux valgus.

A secondary aggravating factor is walking in overly tight stilettos. Sometimes the cause is a disease that affects the normal nervous work limb muscles.

An important role in the development of the pathological process is played by uneven muscle tension, which ensures the adduction and abduction of the finger. With the formation of exostosis, muscle imbalance becomes aggravated, the metatarsophalangeal joint loses stability. The build-up is a consequence of the constant pressure of the shoe on the side surface. The pressure is redistributed to the heads of the III and II metatarsal bones, which are overloaded during walking.

The degree of development of hallux valgus

Diagnosis is made based on face-to-face consultation, symptoms and x-ray, where 1 finger and adjacent anatomical structures are assessed. The severity of hallux valgus with the determination of the degree is established by comparing 2 factors: the angle formed by the II and I metatarsal bones, and the angle of departure of the thumb to I metatarsal. When analyzing images, the stage of arthrosis is determined. In some episodes, x-rays are supplemented by magnetic resonance or computed tomography.

1 degree

The main characteristics of this stage of hallux valgus are that the angle of the anomaly of the big toe is less than 25 degrees, and the angle between the metatarsal bones is not more than 12 degrees. The pain is not expressed, discomfort may be present. At this stage, in young people (in the elderly - with any development of valgus) conservative therapy to stop the progression of pathology and minimize pain.

achievement optimal weight for elimination high pressure on your feet;
use of special orthopedic footwear products;
separators between I and II fingers to slow down the deflection.

Sometimes the initial stage of the bone on the leg, in which it quickly forms, is subject to surgical treatment. In one method, the adductor tendon of the 1st finger is transected or displaced. The goal is to resume the normal functioning of the adductor and abductor muscles. Sometimes soft tissue interventions are combined with surgical destruction of exostosis and removal of the bursa using the Shede method.

2 degree

The angle of the ratio of the metatarsal bones is below 18 degrees, the angle of departure of the first finger exceeds 25 degrees. Pain becomes more pronounced, occurs after intense load. At this stage, it is possible to be operated on as planned in a hospital setting.

3 degree

The angle between the metatarsal bones goes beyond 18 degrees, the angle of departure of 1 finger exceeds 35 degrees. The foot looks deformed, spreads out, 1 finger is superimposed on the second, forming the so-called "bump". This cosmetic defect forces patients to choose shoes that fit the shape of their feet.

The growth is implicitly hyperemic, insensitive to palpation. The skin on it can be compacted like a hard callus, corns. A slight swelling may be present.

The final stage is manifested by pain during activity, pain is likely at night. In the I metatarsophalangeal joint, a sharp limitation of motor volume is possible. With intense pain, anti-inflammatory analgesic gels, ointment preparations are indicated. With accompanying arthrosis in the stage of subsiding of the acute process, physiotherapeutic procedures are prescribed: ozocerite, paraffin applications, electrophoresis with drugs.

In terms of an operative solution, chevron and Scarf-type osteotomies are performed. At the first, a small V-shaped fragment is removed in the remote part of the I metatarsal bone. With Scarf, a cut is made in the form of the letter Z at the level of the entire metatarsal bone I, after the part they are connected, fixing the fragments with screw devices. At the end it is applied sterile dressing. During rehabilitation, an orthosis is prescribed for one and a half months (how much exactly, the surgeon will tell). The leg can be loaded immediately after operational phase treatment, but dosed, periodically giving rest in an elevated position.

General contraindications for interventions: blood clotting disorders, severe pathologies of cardio-vascular system, thrombophlebitis of the lower extremities.

Possible complications and prevention

A cone as a conspicuous defect causes dissatisfaction with its appearance, the imposition of the fingers makes you look for the optimal shoe. The metatarsophalangeal joints become vulnerable to the development of arthrosis with severe pain syndrome. All this leads the patient to surgery, which is rarely complicated.

Complications:

thrombosis;
tissue infection;
aseptic necrosis;
neurological disorders.

Algorithm:

Grab your thumb with your hand and twist gently clockwise - 1 minute.
Then against her.
Roll the bottle with your foot.
Pick up small objects with your toes.

In the initial stages, orthopedic insoles, separators are useful, sports should be practiced in special shoes.

A disease with the formation of a "bone" on the foot is common. It is not possible to cure it with available (folk or medication) remedies at home. You can only radically get rid of surgically. Attention should be paid to education prevention. To do this, you need to keep the weight normal, eat right and varied. Do not neglect gymnastics and rest with elevated legs, especially when working, which requires a lot of time to spend standing. The issue of military service is decided individually by doctors. The violation of the statics of the foot, the presence of pain and the ability to wear military-style shoes are assessed and compared.

The normal position of the leg corresponds to a conditional line drawn through the first gap between the toes, the middle of the knee and the hip joint. Deviation from this line is considered a deformation (violation normal location, curvature), which can be varus and valgus.

With varus deformity (O-shaped) middle part lower leg visually deviates outward, with hallux valgus(X-shaped) lower leg moves inward, legs resemble the letter X.

femoral neck

Valgus deformity of the femoral neck is characterized by a change in the cervical-diaphyseal angle, its increase. Most often it is combined with valgus deformity of the legs and flat-valgus deformity of the feet. In most cases, this disease is congenital pathology due to hip dysplasia, but can also develop as a result of trauma or damage to the nervous system. May lead to the development of coxarthrosis (damage to the hip joint).

Legs

Deviation of the axis of the leg, in which the distance between the inner ankles is visually determined by about 5 cm, the knees are tightly compressed.

Valgus deformity of the legs appears in childhood as a result of premature allowing the baby to stand, a long stay in a standing position (in the arena), crawling disorders. This is due insufficient force muscles and ligaments, and increased load on them. TO significant reasons this pathology can be attributed to rickets, dysplasia hip joints, knee injury. The main changes initially affect the knee joints, there is some overextension of them, the appearance of flat-valgus flat feet. The child complains of fatigue of the legs, asks for hands, notes pain in the legs during long walking. With an asymmetrical curvature of the legs, there is a risk of developing scoliosis (curvature of the spine).

Ankle joint

Valgus deformity ankle joint characterized by the displacement of the heel outward and the collapse of the foot itself inward. Often leads to the development of flat-valgus flat feet.

Foot

Plano-valgus deformity of the foot (flatfoot) is the most common type of valgus deformity of the foot. It is characterized by a change in the direction of the axis of the foot, and a decrease in its arches. Most often occurs in childhood.

Main reasons:

congenital disorder;
traumatic flat feet with a bone fracture, damage to the ankle joint, ligament rupture;
static flat feet due to increased stress on the joints as a result of excess weight, etc .;
rachitic flat feet;
paralytic flat feet as a complication of osteomyelitis.

Valgus deformity of the first toe (Hallux valgus)

With a hallux valgus deformity of the big toe, the metatarsophalangeal joint changes, as a result of which the big toe moves inward. In this case, the position of the remaining fingers is also violated.

Possible causes of deformity of the big toe

Among the causes of valgus deformity of the big toe:

endocrine changes;
genetic predisposition;

With this pathology, weakness of the ligamentous and muscular apparatus of the foot is observed. Deformation and arthrosis of the joint of the first toe is caused by an increased and uneven load on the forefoot, which is aggravated by wearing shoes with narrow nose and/or high heels.

Symptoms

The manifestations of this disease are the appearance of a "bone" in the area of the altered joint, a change in the position and shape of the remaining fingers. This is accompanied by pain in the joint and foot, rapid fatigue of the legs. In the area of \u200b\u200bthe "bump" there is redness, slight swelling.

Degrees of severity of deformity:
1. Deviation of the thumb outward to 15 o .
2. Deviation of the thumb from 15 to 20 o .
3. Deviation of the thumb from 20 to 30 o .
4. The deviation of the thumb is more than 30 o .

With 3 and 4 degrees of deformation, the development of complications is possible, such as:

hammer-shaped curvature of the fingers;
painful corns and callusesprone to inflammation;
pain when walking;

The curvature of the finger is preceded by the inconvenience of wearing shoes and the appearance of pain when walking. Due to the deformation of the joint, a change in the foot occurs, the appearance of an elevation in the middle, where painful calluses and corns are easily formed. The second toe also changes, takes the form of a hammer, and a corn also forms on it.

Similar symptoms can occur in some other diseases: deforming osteoarthritis, arthritis, gout. To find out the cause of the appearance of "bumps" and pain, you need to consult an orthopedist. After the examination, the doctor will prescribe you an X-ray examination (a picture of the foot in three projections) and plantography.

As a result of the further development of the pathological process with untreated valgus deformity, many patients develop chronic bursitis (inflammation of the periarticular bursa) and Deichlander's disease (change in the structure of the bones of the metatarsus).

Treatment

flat feet

Treatment of flat feet is a long and laborious process. At the same time, it is necessary to constantly wear orthopedic shoes with a hard back, special orthopedic insoles (preferably custom-made), regular massage courses and physiotherapy exercises.

Treatment of valgus deformity of the big toe

Conservative treatment
Non-surgical methods of treating hallux valgus include wearing orthopedic insoles and night splints, insoles, interdigital pads, physiotherapy, therapeutic exercises for the toes and feet. To reduce inflammation, intraarticular administration of diprospan, hydrocortisone (hormonal drugs) is used.

Conservative treatment does not lead to full recovery, is used only in the early stages, and as a preoperative preparation.

Surgery
Exists a large number of(more than 100) methods of surgical treatment of hallux valgus. The main ones are presented below:

Exostectomy (excision of some part of the head of the metatarsal bone).
Osteotomy, or removal of part of the phalanx of the finger or metatarsal bone.
Creating a state of immobility of the joint of the big toe (arthrodesis).
Restoration of ligaments around the metatarsophalangeal joint of the big toe, and their comparison.
Resection arthroplasty, or resection (removal) of a part of the metatarsophalangeal joint from the side of the metatarsal bone.
Replacement of the affected joint with an implant.

However, it should be noted that some patients experience re-education"bones". In the postoperative period, patients are forced to limit physical activity on the foot for a long time. This creates some inconvenience.

Currently, less traumatic methods of surgical treatment of hallux valgus are used, in which the period of postoperative rehabilitation is significantly reduced.

Rehabilitation after surgery

On the second day after the operation, you are only allowed to move your fingers. You can walk without stepping on the operated area after 10 days. The load on the entire foot can be given only one month after treatment. Six months later, with a favorable course postoperative period it is allowed to play sports with a load on the legs, and wear shoes with heels.

An effective method for facilitating rehabilitation after surgical treatment of hallux valgus is considered shock wave therapy, the action of which is aimed at improving blood circulation in the tissues, as well as reducing swelling and pain at the site of surgery.

Shoes

With hallux valgus deformity of the first toe, shoes should be soft, with wide nose and low heels (up to 4 cm).

With flat-valgus deformity of the foot, it is necessary to wear new shoes with a high and hard back, 3 cm above the heel, with a dense and high arch support.

Orthopedic insoles

Used to correct foot deformities different kinds insoles and semi-insoles. Insoles made according to custom order. With their help, the load on the joints of the legs is reduced, the blood circulation of the foot improves, and the feeling of fatigue in the legs is reduced.

Sometimes insoles are hard to fit in shoes, especially standard ones. Therefore, in order to correct pathological disorders in the foot, half insoles can be used - a shortened version of the usual insole (without the anterior section).

In some mild cases, the orthopedist may allow the wearing of orthopedic heel pads.

Massage for hallux valgus deformity

1. The course of massage is from 10 to 20 procedures, with an interval of about 1 month. Massage affects not only the legs and feet, but also the back and thighs, because. of no small importance is the state of the entire muscular apparatus involved in the movement.
2. You should start from the lumbar region. Movements - stroking and rubbing, from the center outwards.
3. Next, you should go to the buttocks area, where circular stroking, rubbing and kneading, tapping and stroking are used.
4. On the back of the thigh, intensive rubbing is performed from the knee joint up the thigh, chopping and stroking.
5. On the lower leg, massage should be carried out in different ways, on the inside and outer surface. All techniques (rubbing, kneading) are carried out intensively inside, and softly outside. This allows you to stimulate internal muscles and relax the outer, leading to correct installation feet.

Valgus deformity of the foot in children

Valgus deformity of the foot in children is represented mainly by flat-valgus flat feet. In this case, there is a deviation of the heel outward, the appearance of pain during long walking and increased fatigue. With early and regular treatment, it is possible to achieve full recovery foot condition. To determine the degree of violations and determine the methods of treatment, it is necessary to consult an orthopedist.

Treatment

For the treatment of hallux valgus in a child, attention should be paid to the posture little patient: in a standing position, the legs should be closed - this reduces the load on the joints and foot. Walking time should be limited. Good effect on the installation of the legs:

swimming;
a ride on the bicycle;
walking barefoot (especially on sand, grass and pebbles);
football game;
classes on wall bars;
climbing stairs.

To correct the installation of the legs, orthopedic shoes with a high hard back or insoles should be worn. Your orthopedic surgeon will help you choose the right one. Shoes should fit well on the foot. Shoes that have already been used must not be worn. At home, you can walk without shoes.

Massage is the best way to influence the healing process. It needs to be done on a regular basis. Physical therapy is also very important, exercises should be carried out daily. It is better to present it in the form of a game, so that the child performs them with pleasure. Of the exercises, it should be noted lifting small items and wrinkling the towel with the toes, rolling the stick with the foot, getting up from the Turkish position.

If treatment fails, resort to surgical operation. For this purpose, a varus osteotomy is performed. During the operation, a wedge is cut out of the bone (with valgus deformity of the lower leg - this is the thigh). The bone is connected with screws. After the operation, devices are used to external fixation bones, osteosynthesis according to the Ilizarov method.

Before use, you should consult with a specialist.

The deformity of the first toe is a common pathology among women of middle or older age. She is not given importance for a long time, starting to the point that she reduces the quality of life, although with Hallux Valgus treatment without surgery is quite possible.

Symptoms of pathology range from discomfort when walking and the formation of a small protrusion at the base of the thumb to a significant deformity that causes gait disturbance and constant pain.

The causes of the development of pathology are associated with weakness of the muscular-ligamentous apparatus, which, against the background contributing factors leads to pathological deviation thumb. To diagnose the disease, an external examination is sufficient, and exact reasons pathologies are identified using additional methods. The degree of hallux valgus is distinguished by the angle of deviation of the finger.

Description

Hallux Valgus (in Russian transcription Halus Valgus) is a widespread orthopedic pathology. Valgus deformity of the foot affects both sexes, but women 10 times more men. As a result of the change relative position bones, deformation of the foot is observed, corns, corns are formed, unpleasant sensations appear when walking, difficulties in choosing shoes. The peak incidence occurs in women over 35 years of age. hereditary predisposition.

Foot deformity develops due to the extensibility of muscles and ligaments, for which there may be several reasons:

Hereditary weakness (dysplasia) of the connective tissue;
Consequences of injuries, certain diseases (for example, rickets, poliomyelitis);
Lack of adequate physical activity, obesity;
Excessive physical activity;
involutive processes;
congenital anomalies development.

When wearing uncomfortable shoes (tight toe, high heels) or staying in vertical position the load on the joint between the first metatarsal bone and the main phalanx of the finger changes. The absence of special physical activity, hereditary predisposition or the consequences of diseases lead to a decrease in muscle tone, ligament extensibility, capsular apparatus, aponeurosis. As a result, a fan-shaped divergence of the bones of the metatarsus and a pathological reversal of the first metatarsal bone are formed. This causes instability of the joints, so the bone is gradually displaced inwards. The transverse arch flattens, the foot expands, the thumb turns outward.

The constant friction of the inner surface of the extended foot against the shoes leads to the appearance of corns, and in the long term - to the growth of cartilage and bone tissue with the formation of exostosis (a characteristic "bump"). A change in the distribution of the load on the parts of the foot leads to pressure overload of the II and III metatarsal bones, which is initially manifested by pain and the appearance of corns, and then by the development of arthrosis. The displacement of the thumb affects all other fingers, causing them to deviate outwards or form a malleus deformity of the second finger.

At the initial stages of deformation, there is It's a dull pain, intensifying in the evening. During the night, the pain disappears, at this time, with Hallux valgus, the bandage works especially effectively. The deformity of the foot is not pronounced. The friction of the inside of the foot against the walls of the shoe is manifested by redness and minor skin injuries. Irritation of the periarticular tissues leads to frequent exacerbations of bursitis.

Further deviation of the toe and metatarsal bone causes prolonged intense pain after a short walk. It is possible to pinch the nerves, which is manifested by a sharp burning pain. Significant deformity of the foot. The pressure of the shoes causes the formation of calluses, the skin becomes rough, and the bursitis becomes chronic. Perhaps traumatic growth of exostosis, subluxation of the I metatarsophalangeal joint. Calluses appear on the sole - evidence of a redistribution of the load on the foot.

Severe deformity of the foot makes it difficult to wear shoes. The pain becomes constant, gait is disturbed. The skin in the places of contact with the shoes is rough, exostosis is pronounced. In the projection of the metatarsophalangeal joint, redness and swelling of the skin are revealed, sometimes ulcers, suppurations appear, up to the development of osteomyelitis. Observed sharp pains on the sole due to compression of the plantar nerve III metatarsal bone. Movement in the metatarsophalangeal joint is difficult.

With Hallux valgus, the severity of the deformity is determined by two angles: between the I and II bones of the metatarsus and between the metatarsal bone and the main phalanx of the thumb. According to the first, the magnitude of the deviation of the metatarsal bone becomes clear, according to the second, the magnitude of the deviation of the finger. The angles are calculated from the X-ray data. There are such degrees:

Grade I: intermetatarsal angle 5-20º, metatarsophalangeal angle 10-40º;
Grade II: intermetatarsal angle 20-30º, metatarsophalangeal angle 40-70º;
Grade III: intermetatarsal angle >30º, metatarsophalangeal angle >70º.

Each degree is characterized by different clinical manifestations. At the first degree, tissue changes are minimal, conservative treatment started on time is most effective. At the second degree, manifestations are observed medium degree gravity. The third degree is a severe variant of hallux valgus.

Diagnosis of the disease

Already at initial examination even a general practitioner can make a diagnosis. The foot is flattened, there is a deformity of the big toe, exostosis is located on the inner surface of the foot, areas of rough skin are observed. Palpation of the metatarsophalangeal joint is usually slightly painful. Movement is preserved, but somewhat limited.

To determine the tactics of treatment, it is necessary to consult an orthopedist, a traumatologist, and if the nerves of the foot are involved in the process, a neuropathologist. The doctor finds out the presence of predisposing factors, prescribes radiography to calculate the angles between the bones, ascertain the degree of their changes. The radiograph reveals:

exostosis;
fan-shaped divergence of the metatarsal bones;
subluxation / dislocation of the thumb;
deviation of the first metatarsal bone inside;
abnormal location of sesamoid bones;
arthrosis of the metatarsophalangeal joints.

For additional diagnostics CT/MRI may be ordered.

Surgery for Hallux Valgus

About 300 surgical methods for the treatment of this pathology are known. With Hallux Valgus, surgery can be performed at any stage of the disease in the orthopedic / trauma department. If the general condition of the patient is very severe, then a corrector is used for Hallux valgus, and surgery do not use. Depending on the severity of the deformity, they operate:

only soft tissues;
only bone structures;
bones and soft tissues.

At the I degree, interventions on soft tissues will be effective in order to restore the traction of the muscles of the foot. Operations are performed by Silver (cutting off the tendon of the adductor muscle), McBride (moving the tendon of the adductor muscle), Shede (one of the above options in combination with exostectomy and removal of tissues of the periarticular bag).

At II and III degrees perform operations on bones or combined interventions on soft tissues and bones. A chevron osteotomy is performed (removal of a V-shaped section of the bone with restoration of the axis) or Scarf osteotomy (bone cut into several sections with their reposition and subsequent fastening with metal screws). In case of very severe damage to the joint, arthrodesis (creation of ankylosis) or the installation of an artificial prosthesis is indicated.

After the operation, a long (several weeks) wearing of a special orthosis is required or plaster cast, it is not recommended to load the leg, the weight of the body should be transferred to the heel. During rest, the leg should be given an elevated position. After removal of the cast/orthosis, the patient should wear custom-designed orthopedic shoes, use liners/insoles to form the arch of the foot and prevent re-deformity. The operated foot should be loaded gradually, perform physiotherapy exercises to carry out physiotherapy.

Held at Hallux valgus treatment should mainly be aimed at eliminating the pathological load. Doctors advise to avoid wearing tight shoes, high heels, avoid long walking and standing on your feet, lose weight. All conservative methods are very effective in the early stages of the disease. With pronounced deformations, they provide preparation for surgical intervention or alleviate the condition of those for whom surgical treatment is not indicated.

To relax overworked muscles in the evening, it is recommended to carry out baths with warm water And essential oils(for example, with lavender oil). It will also be effective in the fight against corns and calluses. Shown throughout the day physiotherapy to strengthen the muscles: moving the foot of small objects (sticks, pencils), walking on an uneven surface (sand, pebbles), rolling the ball, practicing on the Swedish wall, picking up a piece of fabric into folds and others.

To tone the muscular-ligamentous apparatus and reduce inflammation, ultrasound treatment (ultraphonophoresis of medicinal substances), electric (UHF therapy) and magnetic fields (inductothermy, magneto-laser therapy, local magnetotherapy), heat therapy (paraffin therapy, ozokerite therapy), electrophoresis, as well as professional massage and foot massage. Special orthopedic devices that should be bought for Hallux valgus are liners, insoles, interdigital bolsters, ties, correctors, bandages, orthopedic shoes. They help to fix the physiological position bone structures and soft tissues, reduce the degree of deformation even in severe cases. For maximum effect it is important to use them around the clock.

At inflammatory processes(bursitis, arthritis) or severe pain, local anti-inflammatory ointments and gels (based on diclofenac, ibuprofen, nimesulide) should be used. Arthrosis changes are treated with chondroprotectors and physiotherapy. Bacterial complications may be a reason for prescribing local funds with antiseptics/antibiotics. Nerve pathology should be treated in conjunction with a neurologist.

Elimination of Hallux Valgus with a night bandage (valgus splint)

The use of orthopedic splints is indicated for conservative treatment hallux valgus or for postoperative recovery. They gradually correct the position of the finger, thereby eliminating pain and discomfort. The night bandage is not designed to be worn while walking, it is used either during sleep or at rest (when the patient is sitting or lying down). It is worth starting use from a few hours, gradually leading up to the whole night.

In the treatment of Hallux valgus, reviews indicate that the rigid construction of the splint provides better fixation of the tissues; it does not interfere at all during sleep. The only contraindication for the use of any type of orthopedic correctors is damage to either infectious lesions foot skin.

Take care of your legs and do not bring the case to surgery. Rather buy valgus splint and use it every night. The results will not be long in coming. Be healthy!