Hallux valgus is a pathological deformation of the big toes, as a result of which a lump appears on the side of the foot. It causes a lot of inconvenience and unbearable pain. The disease hallux valgus is classified as a number of age-related diseases. It does not appear suddenly; it takes several years to develop. The main category of patients is female. Women's ligaments are weaker than men's. This is also due to the curvature of the foot, due to walking in high heels and using uncomfortable shoes. This disease is hereditary, but more and more medical research is establishing a number of other causes of manifestation.
The disease reaches its peak in patients over the age of 50. As a result of walking, the bone tissue damages the joint in which the fluid is located, thereby forming a growth. The friction created moves the phalanx of the thumb to the side. As statistics show, untimely contact with an orthopedic doctor leads to immediate surgical intervention.
Degrees of the disease
There are three degrees of deviation and curvature of the thumb. The degree depends on the angle of deviation of the phalanx of the finger from the metatarsal bone.
1. The first is referred to as the minimum stage of growth development. The angle is about 12 degrees, and the thumb deflection is up to 25 degrees. There may be no visual or tangible symptoms.
2. The second degree is due to an increase in the angle to 18, and the slope is more than 25 degrees. If this degree is present, discomfort and pain are felt when walking in ordinary shoes. The lump is constantly filled with blood, which provokes the appearance of a callus. This swelling indicates the beginning of the inflammatory process.
3. The last degree is the most painful. Deviations from the metatarsal bone exceed 18 degrees, and the toe rests on the adjacent toe, forming a cross. The top is bright red and very painful when touched. Wearing shoes becomes a painful and unrealistic process. Lameness and severe pain appear.
Species diversity
Basically classifies two main areas of the disease. The first is a typical clubfoot. It manifests itself in connection with dysfunctions of the musculoskeletal system. Most often associated with improper development or recovery after injury to muscles and tendons. But there is also an atypical form. It depends on the same injuries or diseases, but associated with the tibia, which also initiates the pathology.
It is also customary to distinguish between congenital and idiopathic forms. And let us clarify that in the vast majority of cases this is exactly the situation with which babies are born. This is how equinovarus foot deformity usually manifests itself in children. But for exceptions, let us explain how the idiopathic form manifests itself.
It can be diagnosed by the following signs:
- The talus bone is critically reduced. There is also an incorrect position, which is especially clearly manifested in the part of the neck of the bone.
- Shortening of the calf muscle. This is visually assessed as a factor in reducing the length of the leg as a whole.
- The front of the mating surface is not positioned correctly.
Causes
Let's consider the main causes of this pathology:
§ Flat feet. It is caused by a curvature of the foot, in which the transverse arch becomes flat.
§ Congenital leg defect. For example: clubfoot.
§ Shoes. Wearing narrow, small and uncomfortable shoes. The material of manufacture also affects.
§ Excessive load. Standing for long periods of time, frequent walking or standing work.
§ Obesity. Increased stress on bones and joints.
§ Diabetes. The disease leads to poor circulation, physiological or pathological atrophy of tendons, tissues and muscles.
§ Pregnancy period in women. Due to hormonal imbalances, weight gain increases rapidly, and a growing belly increases the load on the forefoot.
§ Trauma. Severe bruises or fractures of the limb provoke the development of the disease.
The main symptoms of hallux valgus are pain in the legs when walking, namely in the metatarsophalangeal region. At rest the pain does not bother me. After prolonged exercise, during sleep, the feeling of foot fatigue intensifies. The pain can be either moderate or sharp, burning. There are changes in the visualization of the legs. The loss of the usual shape is due to an increase in the usual size of the leg and the presence of constant chafing. Palpation is painless or not pronounced.
Often the movement of the thumb is limited, the limbs swell, especially the affected area. Osteochondral growth prevents the phalanx from bending or straightening. If these symptoms are present, you should immediately seek medical help.
What is Hallux Valgus
This is a disease in which the big toe moves to the side and a bone appears in the area of the metatarsophalangeal joint. The pathology code for hallux valgus according to ICD 10 is M20.1.
The main cause of the disease Hallus Valgus is considered to be hereditary weakness of connective tissue . Provoking factors are:
- wearing tight shoes;
- constant walking in heels;
- excessive loads.
Less commonly, hallux valgus deformity occurs due to developmental defects, injuries, or other diseases.
Diagnosis process
The diagnosis is made after examination by a therapist, orthopedist, surgeon and mandatory general urine and blood tests. If no inflammatory process is observed in the blood, then the diagnosis continues. An x-ray of the foot is taken. The position for the image is selected at a special angle to view the space between the 1st and 2nd metatarsal bones.
After studying the x-ray photograph, the degree of arthrosis changes is determined. The subchondral bone plate is deformed, the joint space is narrowed. For a more detailed examination, an MRI is additionally prescribed to study muscle tissue and subcutaneous tissue. CT scan – to assess the condition of the bones. If there is a disturbance in the supply of nerve impulses to the muscles, you definitely need to consult a neurologist. The usual list of studies can be supplemented by an analysis of hormone levels to rule out the appearance of a malignant tumor or oncology.
Program and types of treatment
The purpose of surgical treatment of hallux valgus depends on the degree of the disease. In the first and second stages, you can get by with medications, splints and braces. The third requires immediate hospitalization to prevent complications.
First, you should normalize your lifestyle and nutrition plan. Exclude the pathological factor - completeness. A diet, special nutritional supplements and missing vitamins are prescribed. Movement and load on the joint bump are limited. Treatment with splints, insoles, bandages and braces is confrontational. They allow you to ensure immobility and secure the joint in the desired healthy state.
Bandage. It is a locking mechanism that is attached to the inside of the big toe and foot. Tightening the rubber bands directs the finger in the desired direction, like a lever. Thereby ensuring the correction of hallux.
Tires and clamps. Used on an ongoing basis, even while sleeping. During application, joint movement is limited. Silicone retainers are worn on one or all fingers. The soft structure allows you to wear it even in shoes.
Insoles. The special surface allows you to avoid the development of flat feet. Relieves tension from the metatarsophalangeal joint, evenly distributing the load on the sole.
Shoes. Orthopedic shoes ensure correct foot placement and prevent foot sway. Arch supports reduce pressure on the ligaments. The dense, close-fitting and flexible base makes it easier to move around. The breathable structure and high-quality material will protect you from friction.
Prevention of hallux valgus
Prevention of Hallux valgus should begin early. Particular attention should be paid to the health of the feet of children whose family has relatives suffering from hallux valgus on the big toes. A bunion is formed when there is transverse flatfoot, so children and adults with this pathology need to regularly perform exercises to strengthen the ligamentous-muscular system.
It is important to choose the right shoes - loose, with stable soles, made from natural materials. You should give up heels. It is useful to wear arch supports. If indicated, it is recommended to use orthopedic insoles. Regular, but not excessive, physical activity is beneficial.
You should get rid of excess weight to reduce static load.
Preparation and progress of the operation
Orthopedists advise treating hallux valgus only with surgery. The main flow of patients seek help when therapy is no longer effective.
Indications for surgery:
- long-term continuation of symptoms.
- increased pain syndrome.
- severe visual distortion.
- ulcers, suppuration, deterioration of the skin.
- severe lameness.
- restriction of movements.
- ineffectiveness of conservative methods.
There are a huge number of surgical methods for removing hallux valgus. About three hundred types of surgery can be classified into three subtypes: surgery on bone, soft and bone-soft tissue. Soft tissue surgery is performed in the first case of development of a deviation. Treatment of second and third degree hallux, mainly with scarf and chevron surgical bone fracture methods.
During chevron surgery, a V-shaped incision is made and the desired portion of the metatarsal bone is removed. Using a saw or chisel, the callus is removed. The phalanx is secured with titanium screws and wire. It is removed three months after the intervention, but the screws are not removed.
Scarf osteotomy consists of a zigzag cut. The fragments are shifted to eliminate the degree of angle. Having reached the acceptable standard position of the finger, the broken parts are connected to each other with screws. This universal technique has a number of advantages:
- when the joint is tilted, the bone elements can be moved;
- the result is achieved due to rotation of the head of the metatarsal bone during surgery;
- the length of the bone can be adjusted;
- the doctor has the opportunity to remove the unnecessary area;
- adjustment of the load balance on the foot occurs by moving the bone down and to the side.
Performed under spinal anesthesia. Installed screws are not removed unless they cause discomfort. A splint is worn throughout the recovery and weight bearing is limited, with gradual walking over 3 to 6 weeks.
Surgery to correct Hallux valgus
Surgical treatment is indicated for moderate to severe hallux valgus. At the request of the patient, mild surgery is sometimes performed to eliminate a cosmetic defect. There are many methods for removing a lump:
- resection of exostosis;
- osteotomy;
- tendon movement according to McBride and others.
We talked more about bunion surgery in a separate article.
The intervention is carried out using the usual method or through percutaneous correction (using small punctures). It is possible to excise the growth with a laser. One or more incisions are made on the side or back of the foot. The cone is cut off, sometimes artificial fractures of the main phalanx or 1st metatarsal bone are created, and the fragments are fixed with screws.
How much does it cost to remove a bunion on your foot?
In the initial stage of Hallux Valgus, the operation lasts 30-40 minutes , in case of severe deformity – up to one and a half hours . The cost of traditional interventions is 15-30 thousand rubles , with a large volume and the use of modern technologies it reaches 70 thousand rubles .
Operation techniques
Seri. Surgeon Foldini discovered this technique in the late 90s. One of the world's most popular techniques. Effective at the initial stage of disease development. It takes place under local anesthesia. A special chisel or hammer is used to penetrate the joint part through the incision and artificially remove the interfering parts. The knitting needle is inserted and the desired angle is manually set from the first finger. The period of wearing the plaster is two weeks. The pin is removed as healing progresses.
McBride. The aesthetic appearance of the foot is achieved by making an incision in the area of the first metatarsal bone and tendon. The tendon is sutured with absorbable synthetic threads. Next, through an incision in the foot, the doctor gets to the sesamoid bone. The nerve is branched off from it and taken to the side. The joint capsule is crushed. Remove excess growths so that in the future they do not cause pain and discomfort while walking. The wound is tightened and sutured. The method was invented 80 years ago, but is still widely used in orthopedic centers today.
Laser. A gentle surgical method that is useful in the first stages. Treatment is administered through a small incision in the center of the lump, and once healed, the scar remains virtually invisible. The use of a laser greatly limits the surgical process. Laser removal of hallux valgus is carried out in specially equipped clinics. The recovery process is fast, patients return to their normal lives after a couple of weeks. The position of the bone and phalanx of the finger does not change, only the protruding joint is ground, so relapses may occur.
Treatment methods
This is a whole complex of procedures that have a cumulative effect. Treatment is a long process that can take years. And no modern methods can qualitatively speed up the result.
Therefore, we clarified that it is so important to diagnose the pathology as early as possible. After all, considering how much time you will have to spend on treatment, it is better to start in advance. And every day, while the child does not use his musculoskeletal system correctly, the situation worsens. The diagnosis must be made by an orthopedic surgeon. And for subsequent procedures and appointments, it is important to choose the most professional specialist. People make mistakes, and the cost of making mistakes in this industry is too high. Therefore, this is exactly the case when it is better to spend resources on choosing the best performer.
Focus on the immediate results only by five years. Previously, qualitative changes will not be noticeable. After all, the musculoskeletal system itself fully develops just in time for this period. And it is then that we can draw conclusions about whether the treatment is successful.
Remember that traditional medicine methods are strictly excluded. In principle, they cannot be considered effective. In some areas, doctors look at the use of traditional medicine carelessly. Like, what’s wrong if you use grandma’s broth to treat a runny nose? But from this perspective, traditional medicine can bring the most unfavorable consequences.
If clubfoot equinovarus is treated with traditional methods, they may well completely block the symptoms for some period of time. And also reduce the possible pain effect. As a result, the patient will not complain, the problem will begin to be ignored. But incorrect load, abnormal position of the foot, deformation of bone tissue, decreased muscle tone - all this will remain. And the problem will grow and worsen day by day. And the moment will come when it will no longer be possible to ignore it, but then modern classical medicine will hardly be able to demonstrate impressive results. The case will be too neglected.
After diagnosis, the first thing you will have to deal with is the referral for tests and examinations. This:
- Radiography.
- General blood and urine analysis.
- In some cases, magnetic resonance imaging is prescribed.
Next, a set of medical procedures is prescribed, which show effectiveness only when used together. Therefore, you should not exclude any of the procedures because of inconvenience or because the child does not like them. Think about his future health. So, the assignments could be as follows:
- Physiotherapy. Various techniques have been successfully used in this area. Laser therapies, thermal, and magnetic are reflected. But in this case, they are still of an auxiliary nature rather than being the main one for treatment.
- Exercise therapy. That is, physical therapy. It is worth noting that the complex is selected strictly according to the direction of the treating orthopedist. Classes are held in special centers. Further, after a little training, you can continue training at home. But parents must strictly go through the learning process and understand all the features of the baby’s physiology. Carefully study which exercises contribute to development, and which, on the contrary, can only aggravate the situation. Often, many parents continue to attend classes so that the process proceeds under the watchful supervision of the instructor.
- Massage. This is already one of the basic elements. And it is used at almost all stages. High-quality services of a massage therapist with specialized education are often paid. Moreover, a specialist is usually called to your home. Several times a week he visits the baby, massages him, kneads the ankle, and helps increase mobility and proper fixation.
The last method, which is considered the most successful, is the selection of specialized orthopedic shoes. It helps to fix the position of the foot, which ensures the reverse deviation process. Constantly wearing shoes and insoles is a painless method to correct the situation. But here a lot depends on the selling company.
Our project is pleased to offer you orthopedic shoes and insoles. If your child has equinovarus feet ICD 10 Q66, then we will easily select a suitable product for you. The Ortopanda online store works with various prescriptions from the attending physician and has a wide range of products that will satisfy the requirements for any stage and form of pathology. Even if we are talking about rare deviations, we will always be able to select specific shoes that solve exactly this problem.
Advantages of the clinic
Surgical interventions are performed in the departments of orthopedics or surgery. A staff of experienced specialists in their field will provide high-quality diagnostics and accurate diagnosis. Thanks to a serious approach to therapy and the combination of various methods of world medicine, careful work is carried out for results. A quick recovery and patient safety is the main goal of the medical center team.
Contacting the clinic guarantees an individual and effective treatment program. All external factors and characteristics of the human body are taken into account. Compliance with medical orders will help you achieve success with minimal financial investment.
The clinic is provided with all necessary and modern equipment. The entire range of medical practice from classical treatment to unique technologies little known on the Russian market. Cooperation has been established with distinguished professors. The center also creates prosthetics and orthopedic insoles. How much the hallux valgus operation costs can be found on the official website of the clinic or by phone number.
Surgical intervention
There are two types of surgical treatment. First of all, a support bandage is prescribed using the Ponseti method. In fact, it is not too different from the orthopedic shoes already indicated above. The meaning is the same, but the impact is more intense. A plaster cast is applied, which fixes the foot in the abducted position. After which the child wears it constantly. Naturally, the bandage will need to be changed every couple of weeks. To do this, you need to visit the hospital, where the doctor will perform all the procedures.
If the stage is already advanced and conventional methods do not bring any effect, then the second type of surgical intervention is used. This is a surgical intervention. That is, the patient ends up on the surgeon’s operating table. But this procedure can only be prescribed if the child is over two years old. Otherwise the risk is too great.
And in principle, surgery is considered an undesirable choice. And orthopedists refer patients to it only when other methods simply do not work. Therefore, in order to avoid surgery, it is advisable to start solving the problem as early as possible.
Having seen what equinovarus foot deformity is, photos of which are presented in the article, many parents sound an urgent alarm and panic. Of course, it is necessary to resolve the issue urgently, but there is clearly no need to panic. Modern medicine has long been able to cope with such problems with almost 100% probability.
Rehabilitation and recovery period
Thumb deformity, unless it is hereditary, has developed over time. Also, its complete cure requires comprehensive care and therapy. Rehabilitation involves slowing down the process of relapse.
Full completion takes place after six months. Active walking, sports and normal shoes are allowed. The process is always accompanied by x-rays and tests for metal rejection and complications.
During the early stages of healing, the leg is kept in a horizontal position, lying on the bed. You are allowed to move the limb slightly if it does not cause pain. With the help of a clamp, the leg is kept elevated.
A massage is prescribed for 4-6 weeks. Dynamic movements are contraindicated. To tone the muscles and stretch the tendons, circular movements of the feet are made. Walking is accompanied by lameness. Arch supports are required at this stage.
After 7 weeks, physical therapy is allowed. If the pain due to implanted implants has completely disappeared, cycling or short jogging is allowed. Wearing only orthopedic shoes. Using a tennis ball, you can do exercises to wrap your foot around the ball and pass it from foot to foot. Self-massage will restore blood circulation and sensitivity to the first finger. Exercise on an exercise bike and visiting the pool will speed up the healing process.
Rehabilitation after removal of valgus
Recovery after lump removal lasts about 2 months. The key to a complete recovery is strict adherence to the orthopedist’s recommendations. If the rules of rehabilitation are ignored, complications may develop in the long-term period after surgery - re-formation of hallux valgus or restriction of movements in the joints throughout life.
What shoes to wear after surgery
Orthopedic shoes for recovery after removal of valgus.
From the second day you are allowed to walk in Baruk's shoes. Until the swelling decreases, you should move as little as possible ; most of the time the patient lies with his leg elevated. After 2 weeks, walking restrictions are lifted. The use of a Baruk boot remains mandatory for 1-1.5 months after excision of the bone . Then you can wear loose sneakers or boots with wide toes.
You need to give up heels for six months.
Is it possible to have a massage after surgery?
Massage can be done after the wound has completely healed. To improve blood circulation and lymph drainage, massage the entire lower part of the limb. The procedure begins with stroking. Then knead the plantar and dorsal surfaces of the foot in a circular motion. Grasp the ankle joint with your hands and move towards the knee. At the final stage, strokes are performed again.
Exercise therapy for feet with screws
Physical therapy is a mandatory part of the rehabilitation period for Hallux Valgus and begins in the third week after surgery. First, the finger is bent and extended 3 times, held in each position for 10 seconds. Exercises are repeated 3-4 times a day. All movements are done carefully, avoiding discomfort.
From the second month after removal of the valgus, the number of repetitions is increased to 7-8, the number of approaches - to 6-8 per day. Discomfort is acceptable. Active movements are complemented by passive ones (using hands). After a month and a half, you need to stand on your toes 5-6 times a day, 7-8 times, and maintain this position for about 10 seconds.
It is useful to walk on an inclined surface and climb stairs.
Corrective bandages
Corrective corset.
Corrective dressings are used after stopping the use of the Baruk shoe. The products consist of two bandages connected by a hinge and fix the thumb in the abduction position. After 1-1.5 months, the bandage is replaced with silicone inserts. The leg should not be squeezed - this interferes with blood circulation and can cause soft tissue injuries.