Hallux valgus clinic diagnosis treatment. Hallux valgus (valgus deformity)

Foot lesions are becoming more and more common. One of the most common types of pathology of the foot joints is hallux valgus or Hallux Valgus.

What is hallux valgus?

Hallux valgus most often means a violation of the normal structure of the first metatarsophalangeal joint due to the displacement of the head of the first metatarsophalangeal joint laterally (outward from the foot) and the inclination of the proximal phalanx of the first toe inward.

This disease of the feet develops most often as a result of wearing tight, narrow shoes. As a result, under the influence of compression, a “forced” displacement of the proximal finger occurs. In parallel with this, a sprain of the ligaments and tendons of the finger develops, which further aggravates the situation. Another reason for the development of deformation is congenital predisposition to the development of this pathology.

As a result of the influence of external factors, the arches of the feet become flattened, which then develops and leads to the curvature of the big toe.

Women are most often affected, regardless of age (usually the disease manifests itself in middle and late age).

Severity

As the curvature progresses, it can worsen, leading to even greater deformation of the finger. The degree of severity is determined by changing two main values - the metatarsal-phalangeal and intermetatarsal (between the 1st and 2nd metatarsal bones) angles.

When the bones deviate by 12 and 25 degrees, respectively, the first degree of severity of valgus deformity develops.

If the process progresses and the discrepancy is 18 degrees (metatarsal-phalangeal node) and more than 25 degrees between the bones of the metatarsus, the second degree of development of the disease is diagnosed.

If the angles increase by more than 18 and 35 degrees, respectively, the third degree of severity of the disease can be set.

Sometimes the question arises - what degree of severity should be set if a change in one angle is characteristic of, for example, the first degree, and the other angle is increased more than necessary. In such a situation, one should focus on changes in the metatarsophalangeal joint, since it is the change in it that is dominant in the pathogenesis of the disease.

Clinic

At the initial stage of the disease, the main manifestation of the disease will be stiffness when walking and a feeling of discomfort. As the process progresses, an inflammatory process develops in articular capsule(bursitis), which worsens the course of the disease. There is additional pain in the joint, which intensifies when walking, and the inability to perform the shock absorption function. As the disease progresses, the disease may be complicated by the development of osteochondrosis, osteoarthritis (due to flattening of the intervertebral discs). Mild, aching pain in the spine, a feeling of heaviness and numbness after a period of rest, as well as intense pain after performing physical activity.

Along the way, swelling develops in the joint: it increases in size, and the articular folds are smoothed out. When exhausted articular cartilage the surfaces of the bones begin to rub against each other, which leads to abrasion articular surfaces and subsequent development of osteophytes.

Diagnostics

Usually, to make a diagnosis of hallux valgus, the patient’s complaints, medical history, and visual examination are sufficient. Plano-valgus is diagnosed using x-rays of the affected joint to determine the angles of deviation between the bones and the degree of severity. Magnetic resonance imaging and scintigraphy are sometimes used.

As additional methods used for differential diagnosis, apply general analysis blood, biochemical research blood,

diagnostic puncture of the joint, examination of synovial fluid with its subsequent culture nutrient medium(to determine microorganisms). The primary indicators, which are the main diagnostic criteria, are the determination of the rheumatoid factor (diagnosis of rheumatoid arthritis), uric acid(gout), as well as some specific pathogens of arthritis.

Treatment of hallux valgus

Treatment for Hallux Valgus should begin with normalizing your lifestyle. If you are overweight, it is recommended to get rid of it (flat feet and osteochondrosis worsen the course of the disease and contribute to its progression). In this case, if Hallux Valgus does occur, treatment without surgery can have a significant effect.

Shoes that are suspected of causing deformation should be discontinued if possible.

It is important to give up bad habits.

To prevent the development of hallux valgus, you should use comfortable shoes with soft soles without heels. It will also be useful to carry out foot baths, as well as after a strong static load on the legs. Special orthopedic pads can be placed between the fingers to prevent displacement of the phalanx of the thumb.

If such conservative methods do not help, resort to the additional use of symptomatic drug therapy aimed at improving the condition through syndromic effects.

Drug therapy

In order to improve the condition, various medications are often taken to treat Hallux Valgus.

The main groups of drugs are the drugs “Nimesulide”, “Meloxicam”. These medications help relieve the inflammatory process by blocking cyclooxygenase-2, the main pro-inflammatory mediator. The drugs help relieve inflammation, reduce local swelling, and reduce pain. Can be used for both oral use, and through applications (lubrication) of the affected area.

In addition to NSAIDs, wide use anti-inflammatory drugs were also obtained using electrophoresis. This method allows you to apply the medicine directly to the area of inflammation, bypassing the gastrointestinal tract. This eliminates the negative action of NSAIDs on the gastric mucosa when taken orally.

Surgery

If conservative treatment is ineffective, surgical intervention is resorted to. It is performed most often in cases of advanced disease in its later stages, as well as in cases of severe deformation of the fingers.

The sooner the operation is performed, the better the prognosis.

On initial stages To treat this pathology, a rather difficult operation was used. Hallux Valgus was eliminated using massive excision of the joint heads. Due to this, he was significantly injured, which led to long-term dysfunction. Currently, priority is given to joint-preserving operations, the goal of which is minimal intervention on the bones with maximum impact on tendons and ligaments. Chevron and Scarf operations (corrective osteotomies) are widely used. If they are ineffective, they resort to arthrodesis. Plano-valgus deformity of the feet in severe cases may require prosthetics of the affected joint.

The operations are carried out in six variations (although more than 130 of them have been created at present, but they have not confirmed their effectiveness).

In addition to excision of the heads of the bones, correction of flattened arches of the feet is also performed.

Prognosis after surgery

In the postoperative period, it is recommended to avoid significant physical activity (they may contribute to improper restoration of the joint). You should not put any weight on your feet for one and a half to two months (the minimum period for joint fusion after surgery). During this entire time, you should wear a special orthopedic boot. If these conditions are met, the prognosis is most favorable.

If the condition was diagnosed untimely and the process progressed and led to irreversible changes, then the forecast smoothly moves into the group of conditionally unfavorable. This disease of the feet contributes to increased disability and impaired walking. In this case, even the intervention of surgeons becomes ineffective, since it only slows down the progression of the process, but does not eliminate its cause.

Is it worth treating this condition?

This question is often asked by many people. For some, the development of such a deformation is a disaster, since this group people sacredly protect their appearance and cannot allow an unpleasant defect to spoil their appearance. Others are calm about bone changes and are in no hurry to see a doctor. What to do - to treat or not to treat? Should you turn to surgeons for help with the development of Hallux Valgus? Reviews about this disease are varied and specific.

On the one hand, it is best to contact an orthopedist or traumatologist in a timely manner if there is the slightest change in the joint. Timely diagnosis of this disease allows you to get rid of it without any hassle undesirable consequences. The later this state will be identified, the more severe consequences for the musculoskeletal system it can result in. That is why the question of treating hallux valgus is purely individual. Everyone decides for themselves whether it is worth going under the knife, or whether it is better to leave everything as it is.

Bone on thumb feet, hallux valgus, hallux valgus, hallux valgus, Hallux Valgus - all these names refer to the same pathology.

Hallux Valgus (Hallux Valgus) - medial (internal) deviation of the first metatarsal and lateral (external) deviation and internal rotation (rotation around its axis) of the first toe. In fact, it is not a simple deformation of the first metatarsophalangeal joint, but complex deformation the entire medial ray of the foot. Often accompanied by symptomatic deformities of the second toe. There are two forms: hallux valgus in adults and adolescent/juvenile hallux valgus.

History of treatment of hallux valgus.

The term hallux valgus was first introduced in 1871 by Carl Heuter, who referred to the outward deviation of the first toe from the central axis of the body. In the 19th century, it was widely believed that hallux valgus was caused by an overgrowth bone tissue the first metatarsal bone and its soft tissue shell due to poorly fitting shoes. Therefore, surgical treatment most often boiled down to excision of soft tissue and removal of exostosis. For a long time, surgeons believed this pathology uninteresting, which largely explains the slow development of understanding of the causes of this disease. The first operation aimed at correcting the deformity was performed by Reverdin on May 4, 1881 in Genfer; after removing the exostosis, a wedge-shaped resection was performed on the opposite side, which became the prototype for subsequent operations to correct valgus deformity using osteotomy. Since this very first osteotomy, numerous modifications have been proposed, with the addition of lateral release, proximal osteotomy, Z-shaped osteotomy, distal osteotomy - about 150 different operations in total. Many modifications differed little from each other and might seem identical to an inexperienced specialist. But even now the search for the best osteotomy continues in order to achieve the most stable and reliable result.

Epidemiology of hallux valgus.

Hallux valgus is a widespread pathology. According to the US Department of Health, it occurs in 1% of the population. In his study, Gould found an increase in frequency with age: according to his data, 3% of the population aged 15-30 years, 9% of those aged 31-60 years and 16% of people over 60 years old have hallux valgus. There is also a predominance of Hallux Valgus among women (according to various sources, 2-4 times more often than in men), although it is quite possible that this relates to the frequency of visits, which in turn may be associated with women’s desire to wear uncomfortable shoes and cosmetic requests, and not a pain syndrome. It has also been noted that there is a genetic predisposition to Hallux Valgus, with the disease spreading in families, but specific genes responsible for the development of the disease have not yet been identified.

Etiology of hallux valgus.

Despite popular belief, high-heeled shoes and shoes with narrow toes do not cause Hallux Valgus. But, in the case when such deformation already exists, these types of shoes lead to excessive trauma to soft tissues with inside the first metatarsophalangeal joint, which provokes pain. In addition, tight shoes themselves can provoke medial pain and nerve compression. It is impossible to single out a single cause for Hallux Valgus; today experts agree that it is a multifactorial disease with a complex of biomechanical, traumatic and metabolic causes.

The most common and most difficult to understand theory is biomechanical instability. It is provoked by gastrocnemius and gastrocnemius-soleus equinus, dynamic or rigid planovalgus deformity of the foot, dynamic or rigid varus deformity of the metatarsus, dorsiflexion of the first ray, hypermobility of the sphenometatarsal joint, or a short first metatarsal bone. Most often, excessive pronation (internal rotation) in the tarsal and subtalar joints compensate for the above deformities during the gait cycle. Moderate pronation of the foot is necessary to absorb the impact of the foot on the ground when walking. However, excessive pronation creates excessive hypermobility of the tarsus, which in turn disrupts stability and prevents the reverse process of resupination in the gait cycle. This leads to the formation of a persistent lever, which makes pushing with the foot difficult.

For normal foot propulsion, 65° of dorsiflexion (dorsiflexion) is required in the first tarsometatarsal joint, only 20-30° of which occurs due to the big toe itself. The remaining 40° occurs due to plantar displacement of the first metatarsal in the sesamoid complex. For this reason, to push, you have to increase the plantar flexion of the first ray of the foot at the level of the first metatarsophalangeal joint, in the sesamoid complex. This leads to significant overload of the first metatarsophalangeal joint and provokes the development of valgus deformity of the first toe. If, due to hyperpronation of the tarsus, the joints of the foot acquire excessive mobility, a transverse spreading of the foot occurs, the 2-4 metatarsal bones begin to shift outward, and the first metatarsal bone, on the contrary, inward, the overloaded sesamoid complex continues to pull on the base of the main phalanx of the first toe, which in turn leads to outward deviation of the first toe. In the absence of such hypermobility, Hallux Rigidus is formed.

Metabolic disorders that lead to hallux valgus include gout, rheumatoid arthritis, psoriatic arthritis, connective tissue, such as Ehlers-Danlos syndrome, Marfan syndrome, Down syndrome, hyperextensibility syndrome. Neuromuscular causes include multiple sclerosis, Charcot-Marie-Tooth disease, cerebral palsy. Also, traumatic causes can lead to hallux valgus deformity: fractures of the bones of the medial ray, post-traumatic arthrosis, dislocations of the first toe, turf toe, etc. Also, provoking factors can be anomalies in the length of the metatarsal bones, varus and valgus deformity knee joint, hip retrotorsion.

Pathophysiology of hallux valgus.

Normally, during walking, the hallux and the remaining toes remain parallel to the longitudinal axis of the foot, regardless of adduction and internal rotation of the foot. This is due to the strength simultaneously transmitted through the tendon of the adductor pollicis, extensor hallucis, and flexor hallucis muscles. In case of increased mobility of the joint, the extensor of the thumb, passing more laterally (outward) from the central axis, begins to shift the first finger in its direction. In this case, the tendons, stretching while walking, work like a bowstring, leading to the arching of the entire first ray in the inward direction. The head of the first metatarsal bone, moving inwards, leaves the sesamoid bones on the outside. The sesamoid bones, located in the thickness of the flexor pollicis brevis and longus, normally act as a block that enhances muscle strength by changing the load vector, and also bear a significant proportion of body weight. When they are displaced laterally, the load falls on the heads of the first and second metatarsal bones, which leads to metatarsalgia. The medial portions of the capsule of the first metatarsophalangeal joint are tense, while the lateral portions are contracted. Next, the adductor pollicis muscle becomes the main deforming force. Continued outward deviation of the thumb causes the attachment of the adductor pollicis muscle to shift outward and plantar. From now on, instead of bringing this muscle begins to bend and internally rotate the main phalanx of the thumb.

Changing the direction of force vectors during valgus deformation of the first toe.

Symptoms of hallux valgus.

Most often, patients present with gradually increasing deep or acute pain in the area of the first metatarsophalangeal joint when walking, which indicates degenerative changes articular cartilage. The patient may also complain of pain in the head of the first metatarsal bone when wearing shoes, while the pain goes away when walking barefoot, which is associated with irritation of the soft tissues along the inner surface first metatarsophalangeal joint. Often both types of pain occur. The pain gradually progresses and at the time of treatment, many years may have passed since its onset. Along with the pain, the deformity also progresses. At this stage it is important to cut off metabolic causes the appearance of pain requiring medical treatment. To others possible symptom There may be a burning pain or tingling in the area of the dorsum of the big toe and the first metatarsophalangeal joint, which occurs when the medial cutaneous nerve is involved in the scarring process. In addition, patients often complain directly about deformation, changes in the second finger, callus formation, skin damage, sometimes without characteristic complaints of pain.

Diagnosis of hallux valgus deformity of the first toe.

Inspection. During examination, it is important to identify the main cause and leading deformity, which affects further treatment tactics. It is necessary to examine the entire lower limb: internal and external rotation of the hip, valgus and varus deformity of the knee joint, tibial torsion, dorsiflexion ankle joint, range of motion in the subtalar joint, range of motion in the tarsal joints, neutral position calcaneus, valgus/varus deviation of the hind and forefoot. It is also necessary to assess the degree of elasticity/rigidity, assess the severity of deformation without load and under load. The position of the hallux is assessed relative to the second toe, the degree of valgus displacement, internal rotation, and subluxation in the first metatarsophalangeal joint is assessed.

Next, the range of motion of the first metatarsophalangeal joint is measured; the norm is dorsiflexion up to 65° and plantar flexion up to 15°. During the assessment of range of motion, the presence of crepitus and severity are also checked. pain syndrome when moving. Such findings indicate dystrophic changes in the articular cartilage of the first metatarsophalangeal joint; pain without crepitus indicates its synovitis. The next step is to measure the amplitude of active movements, and it is necessary to pay special attention to whether the deviation of the hallux to the outside increases during movements, as this indicates an adhesive process in the area of the outer part of the joint capsule. Subsequently, the range of movements in the first wedge-metatarsal joint is assessed, the total amplitude in the plantar-dorsal direction does not normally exceed 10 mm, the amplitude of movements in the transverse plane is normally close to zero.

The next step is to evaluate skin for pressure zones. A callus in the area of the first interdigital space indicates excessive overpronation of the first toe during walking.

A callus in the area of the head of the first metatarsal bone signals equinus position of the foot, rigid plantar flexion of the first metatarsal bone, hypertrophic growths of the sesamoid bones, rigid valgus deformation of the tarsus or cavus foot. A callus in the area of the head of the second metatarsal indicates a shortened first or elongated second metatarsal, dorsiflexion of the first metatarsal, retrograde plantarversion of the second toe due to the formation of a hammertoe deformity of the second toe, or hypermobility of the first metatarsal.

Extensor hallucis longus contracture occurs only with long-term lateral subluxation of the first metatarsophalangeal joint or neuromuscular lesions.

Competing deformities such as hammertoe deformity of the second toe, hypermobile or rigid planovalgus foot are often found. Instability and deformation of the second toe often aggravates and accelerates hallux deformity as the natural obstacle to its further displacement disappears.

Very important element examination is to evaluate the foot under load: an increase in the degree of abduction of the first toe, adduction of the first metatarsal bone, the appearance of dorsiflexion indicating contracture of the long extensor of the big toe.

Instrumental diagnostic methods. To confirm the diagnosis of hallux valgus and preoperative planning, radiographs are used in direct, lateral, and sometimes oblique and sesamoid projections. The main parameters that are assessed radiographically are:

1. hallux valgus angle (normally less than 15°)

2. intermetatarsal angle (normally less than 9°)

3. Distal metatarsal articular angle (normally less than 15°)

4. Interphalangeal angle hallux valgus - the angle between the proximal phalanges of the first and second fingers (normally less than 10°)

X-ray determination of angles for hallux valgus deformity of the first toe.

Treatment of hallux valgus deformity of the first toe.

The first stage of treatment is shoe correction, making insoles, and using special inserts and devices. If conservative treatment is ineffective (pain persists when walking), as well as in the presence of overlapping fingers, hammer-shaped deformity of the second finger, neuritis of the digital nerves, sesamoiditis, inflammatory changes in the area of the deformity - it is indicated surgical treatment.

Surgical treatment methods can be divided into the following groups:

1) operations on soft tissues

2) distal osteotomy (with mild degree, intermetatarsal angle less than 13°)

3) proximal or combined osteotomy (for more severe degrees, intermetatarsal angle more than 13 °)

4) arthrodesis of the first wedge-metatarsal joint (if it is unstable or arthritis)

5) other arthrodeses (for severe deformity, spasticity, arthrosis)

6) resection arthroplasty (in the group of elderly patients with low functional demands)

In the case of juvenile Hallux Valgus, it is advisable to delay the operation as much as possible. If this is not possible, it is better to use operations that do not affect the proximal part of the metatarsal bone.

Deformation degreesHalluxValgus. The severity of the deformation is assessed using radiography, each degree corresponds to a specific surgical tactics. The need for surgical intervention is largely determined by the severity of the pain syndrome and limitations in the patient’s daily activity, rather than by a cosmetic defect.

Deformation degree	Valgus angle	Intermetatarsal angle	Additionally	Operation
			Distal osteotomies	Chevron osteotomy + McBride operation, + Akin for interphalangeal hallux valgus
			Proximal ± distal osteotomy	Chevron osteotomy + McBride operation, + Akin
				Proximal osteotomy + McBride operation
			Double osteotomy	Proximal osteotomy + Chevron osteotomy + McBride operation
				Lapidus operation + Akin osteotomy
			Elderly\with low demands	Keller osteotomy
			Juvenile hallux valgus	Sphenoid osteotomy (young age), double osteotomy (if skeletal maturity allows)

Technique of operations for hallux valgus.

Soft tissue operations. Modified McBride operation

Most often used for moderate deformity (hallux valgus angle less than 25°, intermetatarsal angle less than 15°), often performed simultaneously with resection of the internal tuberosity, osteotomy of the first metatarsal bone, arthrodesis of the first wedge-metatarsal joint (Lapidus). The essence of the McBride operation is to cut off the adductor pollicis muscle from the fibular sesamoid bone, lateral capsulotomy, and tension the medial capsule due to its duplication. The operation can be supplemented by suturing the tendon of the adductor pollicis muscle to the outer part of the joint capsule, or directly to the head of the first metatarsal bone.

Modified McBride operation for hallux valgus.

Distal metatarsal osteotomies.

Suitable for moderate deformity (hallux-valgus angle less than 40°, intermetatarsal angle less than 13°)

The most common is the Chevron osteotomy. It is possible to use more proximal and more distal options, followed by installation of the screw in an oblique longitudinal or transverse plane. (http://www.youtube.com/watch?v=pcXjb-ghohM).

Chevron osteotomy for hallux valgus

Below are other options for distal osteotomies for hallux valgus.

Mitchell osteotomy for hallux valgus.

Austin osteotomy for hallux valgus

Proximal osteotomies. Indicated for moderate severity of the disease (hallux-valgus angle more than 40°, intermetatarsal angle more than 13°). The most common are cross osteotomy, scarf osteotomy, wedge osteotomy, and Ludloff osteotomy.

Cross osteotomy - provides high stability and large room for maneuver in correcting both the medial deviation of the metatarsal bone and its length.

Ludloff osteotomy for hallux valgus

Scarf osteotomy is one of the most popular treatments for Hallux Valgus, along with chevron osteotomy. (http://www.youtube.com/watch?v=8wmvARFjZVM&index=3&list=PLYUX9ZYOBxWzyRTn_HqBMKqMynuvXp1sV)

Scarf osteotomy for hallux valgus.

Double (proximal + distal) osteotomies are used in cases of severe deformities (hallux-valgus angle more than 40°, intermetatarsal angle 16-20°).

Wedge-shaped osteotomy of the base of the first metatarsal bone. It is used in cases where it is desirable to increase the length of the first metatarsal bone. Can be performed without the use of any metal fixators. Indicated for young patients with moderate deformity.

Wedge-shaped osteotomy of the base of the first metatarsal bone.

Osteotomy of the first cuneiform is used in cases of juvenile hallux valgus when osteotomy of the first metatarsal cannot be performed due to unclosed growth plates.

Osteotomy of the first sphenoid bone.

The Akin osteotomy often complements the Chevron and other osteotomies in cases where correction of the medial deviation of the first metatarsal is not sufficient to bring the big toe into its normal position.

Lapidus operation for hallux valgus.

Arthrodesis of the first metatarsophalangeal joint. Used in the treatment of hallux valgus in cases of cerebral palsy, Down syndrome, rheumatoid arthritis, gout, severe arthritis, Ehlers-Danlos syndrome.

Arthrodesis of the first metatarsophalangeal joint.

Resection arthroplasty (Keller operation). Practically not used. Sometimes indicated for elderly patients with low functional demands.

Keller's operation for hallux valgus.

Postoperative management, rehabilitation, after operations for hallux valgus.

After surgical treatment Valgus deformity of 1 finger is followed by a 6-month rehabilitation period. It can be divided into 3 stages: acute postoperative period(0-6 weeks), recovery rehabilitation period (6-12 weeks), long-term rehabilitation period (12 weeks - 6 months).

The first day after surgery - bed rest, elevated position lower limbs, local cold - 20 minutes 5-6 times a day, analgesics.

The second day after surgery - dressing, moderate walking in special shoes,

Shoes for unloading the forefoot.

elevated position of the lower extremities, local cold - 20 minutes 5-6 times a day, analgesics.

As the pain subsides, the range of passive movements in the foot joints gradually begins to develop.

Two weeks after surgery - removal of sutures, continuing to increase the range of passive movements. Walking in special shoes. For pain - elevated position of the lower extremities, local cold, analgesics.

Six weeks after the operation - control radiography, if the picture is satisfactory - a gradual transition to regular shoes, development of the range of active movements.

12 weeks after surgery - complete transition to regular shoes, the beginning of light sports activity.

Six months after surgery - full recovery, no restrictions.

Complications during operations for hallux valgus.

The most common complication is the recurrence of deformity (from 2 to 16%). The reason may be an underestimation of the degree of deformity, insufficient correction of the intermetatarsal angle, or inadequate ligamentous balance. It can also be triggered by the patient’s failure to comply with the rehabilitation protocol.

Infectious complications occur in 1-2% of cases after surgical treatment of hallux valgus.

Avascular necrosis. A medial capsulotomy may result in disruption of the blood supply to the first metatarsal head in a small percentage of cases.

Nonunion with metatarsalgia is more often observed after Lapidus and cross osteotomy with excessive shortening of the first ray of the foot and is associated with overload of the remaining metatarsal bones.

Hallux Varus is associated with overcorrection of hallux valgus, excessive lateral release, and lateral sesamoidectomy.

Hook-shaped deformity of the first finger - associated with damage to the flexor pollicis, more common after Keller surgery.

Metatarsalgia of the 2nd metatarsal bone - often accompanies hallux valgus, can manifest itself according to the principle of pain dominance; Weil osteotomy is used for treatment.

Numbness of the first limb, paresthesia, pain in the projection of the postoperative scar, neuromas - can form in the area of the medial incision as a result of trauma to the medial branch of the dorsal cutaneous nerve.

Progression of arthrosis of the first metatarsophalangeal joint, decreased range of motion, and worsening pain may be a consequence of excessive trauma to the articular cartilage during surgery or the presence of concomitant metabolic pathology.

The article is intended to inform about the disease and treatment tactics. Self-medication poses a danger to your health.

The operation of hallux valgus is half the battle. Second after her important stage- rehabilitation. Reviews of how things went provide valuable information. Advice from those who have already left everything behind is very important for those who are about to take a step towards easy gait and return to beautiful shoes. After all, almost every person who loves himself strives for this. But the pathology that prevents you from putting on a chic model is the hallux valgus bump, popularly called the “bunion” of the big toe, and has a chronic, progressive nature. Today we’ll talk about the advanced stage of this disease, what the solution to the problem could be, and find out what role rehabilitation plays. Let's get acquainted with the set of exercises.

The main essence of the formation of hallux valgus is the development of deformation of the metatarsophalangeal joint, which leads to deviation of the big toe. Because of cosmetic defects and problems with complications, hallux valgus surgery is often recommended, rehabilitation sometimes lasts up to six months.

Stages of surgery

Of course, there are also conservative methods - wearing special braces, massage and physiotherapy. However, these methods are capable of correcting at stage 1. In other cases, they only help alleviate the condition.

In the orthopedic online store “Healthy Feet” you can purchase an inexpensive corrector for hallux valgus.

Important: traditional methods and there are no “grandmother’s” recipes for treating a bump on the leg, only orthopedic drugs or surgery.

Types of surgery

Surgical treatment can be of several types:

Minimally invasive - the entire operation is carried out through a puncture without the use of special clamps, effective for mild and medium degree gravity.
Reconstruction surgery – recommended for severe degrees hallux valgus deformity. Special fasteners are used to restore the anatomical position.
Arthrodesis - used for arthrosis changes, with the establishment of complete immobility of the joint. This helps eliminate walking pain and strain.

During treatment, the doctor restores correct position joint, removes bone growths, and also fixes the permanently deformed area.

Another type of hallux valgus is the so-called scarf operation. During the operation, a wedge-shaped section is removed from the bone of the big toe, then the edges are aligned.

Minimally invasive treatment

Tests for hallux valgus surgery

Before the day of surgery, an x-ray of the foot is taken in a standing position, projection (direct, lateral).

Advice: the day before, exclude all thermal procedures (bath, sauna, hot bath), massage, training, fatty, fried, sweet, spicy, alcohol (3 days), some types of medications (antibiotics, diuretics, hormonal) a doctor’s advice is needed.

Standard tests:

General analysis:

urine (morning);
blood (on an empty stomach).

Blood group and Rh factor.
Biochemical analysis of blood from a vein (the specific list will be specified in writing, different in all clinics).
Syphilis.
Hepatitis.
Coagulogram (analysis of the blood clotting system).
Fluorography.
Electrocardiogram with description.

How is the operation performed?

In the case of minimally invasive intervention, all manipulations are carried out under X-ray control. The surgeon’s task: through two punctures, remove the bone growth and restore the necessary axis metacarpal joints. The main disadvantage is the possibility of the pathology returning.

Results after big toe bunion surgery

During reconstructive surgery, knitting needles (in advanced conditions), screws, and plates (staples) are used. They help prevent deformation and also maintain the correct position of the bones after osteotomy.

Mostly they operate under local anesthesia into the cerebrospinal fluid of the spinal canal, but anesthesia is also given. A conversation with an anesthesiologist is required.
Duration: from 30 minutes to 1 hour.

It is important to understand that only a specialist can determine the need for surgical intervention. No matter how much you want to quickly get beautiful legs, if there is no indication for surgery, then conservative therapy will be a priority.

Indications for surgery.

The joint in the thumb area hurts.
Inflammatory processes.
Severe deformities of the bones and foot in general.

Contraindications

Despite the importance of such treatment, there are diseases for which surgery is strictly prohibited, these include:

diabetic foot;
pathology of peripheral arteries;
systemic diseases of the cardiovascular system;
the presence of purulent inflammatory processes.

The first phase of menstruation is contraindicated; anesthesia can cause bleeding.

Arthrosis changes in the joints are not a contraindication, but treatment is carried out taking into account recovery period and the possibility of complications - .

Watch a short video.

Hallux valgus rehabilitation after surgery

Postoperative period

Recovery depends on the type of operation chosen and individual characteristics person. During all the days in the hospital, a course of antibiotics and painkillers is given.

On the very first day after surgical treatment, strict bed rest is recommended. For warning severe swelling, 6 weeks, bandage the lower leg together with the foot with an elastic bandage; swelling of the foot is allowed within normal limits.

Two weeks passed

The patient is allowed to move after three days, immediately puts on special Baruk shoes, they even sleep in them and go home after 3-5 days, wear them for six months, if there are no shoes, a plaster is applied. Buying a crutch or walker to reduce the load on the operated leg will be useful in the clinic and at home.

One dressing is done in the hospital, the next ones as they get dirty, and if there is no discharge, you shouldn’t touch the bandages at all. If necessary, it can be done at home; visiting a clinic will hardly be convenient, or you can ask for the dressing to be done at home (as agreed upon). Protruding knitting needles and seams are treated with alcohol or chlorhexidine. Water procedures are allowed 3 days later, after removing the sutures and removing the needles, so as not to cause an infection.

Important: ointments, compresses on sutures, only with the permission of a doctor.

The sutures are removed after 12 days. If the fixation was performed with knitting needles, then they should be removed after 3 weeks; the procedure is not difficult, anesthesia is not required. I treat the wounds with brilliant green. With screws and plates (staples), everything is simpler; the structures are firmly attached to the tissues, so if they do not bother you, there is no need to remove them, which also reduces the recovery period during rehabilitation.

Healing process after a month

Be sure to wear a semi-rigid abduction corrector for 8 weeks (after a month) great phalanx feet to the side, then replace it with silicone interdigital separators (inserts), which will fit tightly between the 1st and 2nd phalanges of the fingers; they perform the same functions as the corrector.

During this time (3 months), choose soft, comfortable shoes with flat soles that will accommodate toes with inserts.

After six months, heels up to 5 cm are allowed, but an insole is added under the forefoot, for transverse flatfoot, the insert remains between the fingers and is worn for 7 months.

The online store has a large selection of interdigital silicone partitions.

In addition to restrictions in the postoperative period, you will have to adhere to certain rules when choosing shoes for the rest of your life; high heels are extremely undesirable.

How to change a bandage at home

You can enjoy walking without any devices after 1.5 months, and the possibility of playing sports and physical activity is decided strictly individually - it depends on the characteristics of the recovery period, the complexity of the deformity and how the operation itself went, whether there were any complications. At the same time, you are allowed to drive, ride a bike, and swim.

Basics of the rehabilitation period

Ensure maximum rest until the surgeon gives permission for activity.
The use of anti-inflammatory ointments to improve healing and shorten the recovery period.
Subsequent interventions should be carried out with a break of at least 3 weeks, subject to the need for both limbs at the same time, discussed with the doctor.
It is imperative to maintain the special position of the big toe with tight bandaging for 1.5 months, removing it for hygiene procedures and exercise therapy.
Constantly wearing special orthopedic shoes.

No matter how much you would like to wear dress shoes after surgery, it is still worth thinking about the recurrence of the disease. Beautiful fashionable shoes, especially narrow, high-heeled ones the strictest prohibitions. You should choose boots that are the right size, with sufficient fullness, and low heels (by the way, the complete absence of heels is also not recommended).

The results of the hallux valgus operation, and mandatory rehabilitation, which lasts about 6 weeks, and evaluation of the final results - 6-12 months.

Sick leave is opened at the institution where the procedure was performed. Extend sick leave and see a surgeon at your place of residence. Observation by a surgeon once every 3 months during the entire recovery period after hallux valgus surgery.

Hallux valgus - exercises

During the rehabilitation period, physiotherapy and exercise therapy help speed up healing and develop the feet faster. Gymnastics is especially important to improve blood circulation and motor functions.

The simplest exercises can be performed already on the first day after osteotomy - moving your fingers several times during the day.

Exercise 1. Alternately stretching your feet for several minutes.

Exercise 2. Self-massage - stretching and bending the thumb (without much zeal, please).

Exercise 3. Activities to activate movement - picking up a straightened towel or fabric with your fingers, rolling objects with your toes.

Exercise 4. Rolling a ball with your feet can be done either with both legs at once or alternately.

Exercises 5. Performed only with the permission of a doctor (after approximately 6-8 weeks). Rising on your toes with a stop at highest point and then slowly lowering.

Listen to your feelings and strictly follow the doctor's instructions. If pain occurs while performing gymnastics, you should stop exercising. The recommended rate is 3 times a day for 10 minutes. Combine as you choose, or better yet, consult your doctor if things don’t work out.

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This is where I will end the article; we have discussed the main surgical interventions for thumb deformity. By following the surgeon’s recommendations after surgery, rehabilitation is successful; the main thing is to take your time and be patient.

My son records his covers, listen to the gorgeous performance. Despite the fact that he found himself in music in a stroller.

Take care of yourself and your loved ones!

Deformation of the first toe is a common pathology among middle-aged or older women. It has not been given any importance for a long time, being neglected to the point that it reduces the quality of life, although with Hallux Valgus treatment without surgery is quite possible.

Symptoms of the pathology range from discomfort when walking and the formation of a small protrusion at the base of the big toe to significant deformation that causes gait disturbances and constant pain.

The reasons for the development of pathology are associated with weakness of the musculo-ligamentous apparatus, which, against the background of accompanying 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 degrees of valgus deformity are distinguished by the angle of deviation of the finger.

Description

Hallux Valgus (in Russian transcription Hallus Valgus) is a widespread orthopedic pathology. Hallux valgus affects people of both sexes, but women are 10 times more likely to more men. As a result of the change relative position bones, deformation of the foot is observed, calluses and corns form, discomfort when walking, difficulty choosing shoes. The peak incidence occurs in women over 35 years of age, and there is a hereditary predisposition.

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

Hereditary weakness (dysplasia) of connective tissue;
Consequences of injuries, certain diseases (for example, rickets, polio);
Lack of adequate physical activity, obesity;
Excessive physical activity;
Involutive processes;
Congenital developmental anomalies.

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

Constant friction of the inner surface of the expanded foot on shoes leads to the appearance of calluses, 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 initially manifests itself in pain and the appearance of corns, and then in the development of arthrosis. The displacement of the thumb affects all other fingers, causing them to deviate outward or cause the formation of a hammer deformity of the second finger.

In the initial stages of deformation, aching pain is noted, which intensifies in the evening. The pain goes away overnight, at this time Hallux valgus the bandage works especially effectively. The foot deformity is not pronounced. The friction of the inside of the foot against the walls of the shoe is manifested by redness and minor injuries to the skin. Irritation of the periarticular tissues leads to frequent exacerbations of bursitis.

Further deviation of the toe and metatarsal bone causes long-term intense pain after a short walk. Nerves may become pinched, resulting in sharp, burning pain. There is a noticeable deformity of the foot. The pressure of shoes causes the formation of calluses, the skin becomes rough, and bursitis becomes chronic. Possible traumatic growth of exostosis, subluxation of the first metatarsophalangeal joint. Corns appear on the sole - evidence of redistribution of the load on the foot.

Severe foot deformation makes wearing shoes difficult. The pain becomes constant, gait is impaired. The skin in places of contact with shoes is rough, exostosis is pronounced. In the projection of the metatarsophalangeal joint, redness and swelling of the skin are detected, sometimes ulcers and suppuration appear, up to the development of osteomyelitis. There are 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 metatarsal bones and between the metatarsal bone and the main phalanx of the big toe. According to the first, the magnitude of the deviation of the metatarsal bone becomes clear, and according to the second, the magnitude of the deviation of the finger. Angles are calculated from radiographic data. There are the following degrees:

Degree I: intermetatarsal angle 5-20º, metatarsophalangeal angle 10-40º;
Degree 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. In the first degree, tissue changes are minimal, and conservative treatment started on time is most effective. In the second degree, manifestations of moderate severity are observed. The third degree is a severe version of hallux valgus.

Diagnosis of the disease

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

To determine treatment tactics, consultation with an orthopedist, traumatologist is required, and if the nerves of the foot are involved in the process, a neurologist. The doctor determines the presence of predisposing factors and prescribes radiography to calculate the angles between the bones and determine the degree of their changes. The X-ray reveals:

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

For additional diagnostics CT/MRI may be prescribed.

Operation for Hallux Valgus

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

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

In grade I, soft tissue interventions will be effective to restore traction of the foot muscles. The operations performed are Silver (cutting off the adductor tendon), McBride (movement of the adductor tendon), Shede (one of the above options in combination with exostectomy and removal of tissue of the periarticular bursa).

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

After the operation, long-term (several weeks) wearing of a special orthosis or plaster cast is required; putting weight on the leg is not recommended; body weight should be transferred to the heel. When resting, you should give your leg an elevated position. After the cast/orthosis is removed, the patient should wear custom-designed orthopedic shoes and use inserts/insoles to shape the arch of the foot and prevent recurrence of the deformity. The operated foot should be loaded gradually, exercise therapy should be performed, and physical therapy should be performed.

Treatment for Hallux valgus should mainly be aimed at eliminating the pathological load. Doctors advise avoiding wearing tight shoes, high heels, avoiding long walking and standing, and losing excess weight. All conservative methods are very effective in the early stages of the disease. In case of severe deformities, 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 take baths with warm water and essential oils (for example, lavender oil). This will also be effective in combating corns and calluses. During the day, therapeutic exercises are indicated to strengthen muscles: moving small objects (sticks, pencils) with the foot, walking on uneven surfaces (sand, pebbles), rolling a ball, exercising on wall bars, gathering a piece of fabric into folds and others.

To tone the muscular-ligamentous apparatus and reduce inflammation, treatment with ultrasound (ultraphonophoresis of medicinal substances), electrical (UHF therapy) and magnetic fields(inductothermy, magnetic laser therapy, local magnetic therapy), heat therapy (paraffin therapy, ozokerite therapy), electrophoresis, as well as professional massage and self-massage of the feet. Special orthopedic devices that should be purchased for Hallux valgus are liners, insoles, interdigital cushions, ties, correctors, bandages, orthopedic shoes. They help to consolidate the physiological position of 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.

In case of 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 serve as a reason for prescribing local funds with antiseptics/antibiotics. Nerve pathology should be treated together with a neurologist.

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

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

When treating Hallux valgus, reviews indicate that the rigid design of the splint provides better tissue fixation and does not interfere at all during sleep. The only contraindication for the use of any type of orthopedic correctors is damage or infectious lesions skin of the foot.

Take care of your feet and don’t end up with surgery. Rather, buy a hallux valgus splint and use it every night. The results will not take long to arrive. Be healthy!

A huge number of women are faced with such a problem as changing the direction of growth of the thumb. This area of the leg deviates inward, causing a portion of the bone to protrude. As a result, a special bone is formed in the area of the lower part of the finger - a bump, which brings an uncomfortable sensation and requires appropriate treatment. In international terminology, this disease is called hallux valgus. It can be corrected using conservative techniques or surgical intervention. Let's try to understand how hallux valgus is corrected, and consider its treatment in more detail.

How to correct hallux valgus without surgery? Conservative treatment

Non-operative correction of hallux valgus makes sense only in the initial stages of the development of the disease, when the lump reaches a small size and only the first finger is deviated.

Traditional conservative therapy helps to slow down the growth of a pathological bone in the leg, or completely stop it. It is worth considering that it is completely ineffective if the disease has reached a moderate or severe stage of development.

In conservative treatment, it is customary to use various orthopedic correction devices. These include various insoles and instep supports, as well as interdigital ridges. Such products quite effectively optimize the distribution of loads across the forefoot, and also help to visually level it a little.

Good results can also be achieved by using finger correctors; they are usually worn at night to physically hold the finger in its natural position. They simply do not allow him to deviate in the wrong direction.

Conservative treatment may also involve the use of special ties; they look like an elastic band with a tubercle insert. This design provides excellent support for the transverse arch of the foot. It is worth considering that this design is completely unsuitable for constant wear.

In addition, the doctor may recommend the use of special orthopedic splints that tightly fix the thumb and prevent its deflection. Certain versions of such devices are great for wearing under shoes.

Among other things, conservative correction may include foot massages, various baths, as well as the use of physiotherapeutic techniques. Such treatment methods help optimize muscle-ligamentous tone in the foot, and also optimize blood circulation processes. If the patient suffers from severe pain, he is advised to take non-steroidal anti-inflammatory compounds.

How is hallux valgus surgically treated? Operation

Surgical treatment of bunions can be carried out at various stages of development of the disease. So modern medicine knows more than 150 methods of carrying out such correction. Not so long ago, the patient simply sawed off the protruding area, or completely removed the head on the metatarsal bone. But such surgical intervention completely disrupted the functions of the finger; it could not serve as a support. Other previously used treatment methods involved staying in a cast for a long time, but this technique is very uncomfortable for the patient.

Modern surgical treatment of hallux valgus is characterized by insignificant trauma. The angle between the bones of the phalanges in the big toe is changed for the patient, the location of the tendons is changed and the formation of the correct forefoot arch is carried out. In this case, the bones do not suffer at all, so there is no point in wearing a cast and using crutches.

If the disease is in a particularly advanced state, an operation to cut the bones is performed. Next, they are moved to the desired position and secured with screws. In this case, special metal structures are used that do not need to be removed when performing repeated surgery.

What to do after hallux valgus? After operation

Modern techniques for performing surgical interventions to correct hallux valgus can enable the patient to short time completely restore normal activity of the foot. In this case, the patient does not face the problem of pain and various complications. The optimal result of rehabilitation after surgery is achieved if the patient does not step on the entire surface of the foot for three weeks. At this time, it is better to rely solely on the heel. Orthopedists advise not to operate on both legs at once, but one at a time - with an interval of approximately three to six months. In case if surgical interventions carried out simultaneously, it is necessary to resort to the use wheelchair for moving.

After surgery, the patient will have to wear special shoes for at least one month. Next, you should completely abandon heels for some period. In addition, recovery after surgical treatment of hallux valgus may include physiotherapeutic procedures, massage sessions, baths and physical therapy.

If treatment for hallux valgus is started in a timely manner, you may well be able to cope with the disease using conservative treatment methods. But it is worth recognizing that the maximum effective method Correction of this pathology is surgical intervention.