Arthrosis of the big toe - hallux-valgus, deformity of the big toe

Foot pathologies are extremely common today, which is largely due to the lifestyle of modern people. One of the common disorders is arthrosis of the metatarsophalangeal joints, especially the 1st toe or hallux rigidus. It can be a complication of other orthopedic pathologies, age-related changes, or be the primary source of the development of other disorders. In any case, the disease can significantly reduce a person’s quality of life and cause him a lot of suffering. Therefore, it is important to promptly consult an orthopedist if signs of damage to the metatarsophalangeal joints appear.

Arthrosis of the metatarsophalangeal joints: what is it?

The metatarsophalangeal joints are ball and socket joints. They are formed by the articular surfaces of the heads of the metatarsal bones and the bases of the proximal phalanges. The ends of the bones that form the joint are covered with thin cartilage tissue. The articular capsules are attached along the edge of the articular cartilages and are thinned on the outside of the foot. On the opposite edge and sides they are strengthened by plantar and collateral ligaments, respectively. In this case, between the heads of the metatarsal bones there is a deep transverse metatarsal ligament.

The structural features of the metatarsophalangeal joints make them susceptible to the development of degenerative-dystrophic changes (arthrosis) and inflammatory processes (arthritis). Moreover, arthrosis is often complicated over time by the development of arthritis. This significantly worsens the well-being of patients.

Arthrosis is called damage to the cartilage tissue covering the heads of the metatarsal bones and the bases of the proximal phalanges of varying degrees of severity. Initially, the cartilage becomes dehydrated and thins, becoming covered with microscopic cracks. But gradually, under the influence of loads or other factors, they increase in size and take on the appearance of large cracks and depressions. This leads to a decrease in the size of the joint space, which causes difficulties in movement and prevents the free sliding of the heads of the bones.

As a result, there is an increase in load and increased friction between bone surfaces. This is accompanied by the formation of osteophytes on them, i.e. bone growths. They may have sharp edges that will injure surrounding tissues and the joint capsule. As a result, over time, arthrosis of the metatarsophalangeal joints can be complicated by arthritis, that is, the addition of an inflammatory process.

Most often, arthrosis affects the metatarsophalangeal joint of the 1st toe or big toe. In this case, hallux rigidus is diagnosed. It is somewhat less common to diagnose arthrosis of the joint of the 2nd finger and extremely rarely of the others. This is due to the fact that the first finger bears the main load when walking, standing and physical activity.

The main danger of the disease is the occurrence of severe deformities of the joints, which will lead to a significant decrease or even complete loss of their functionality. As a result, patients may experience difficulty moving, even to the point of losing the supporting ability of the foot. The risk of local circulatory disorders also increases sharply. This increases the likelihood of developing varicose veins of the lower extremities.

Causes

Arthrosis of the metatarsophalangeal joints is a polyetiological disease. It can occur in people of any age. But if for representatives of the older generation the development of degenerative-dystrophic processes in all joints of the body is an inevitable process, then for young people they are most often the result of injuries, active sports, and the wrong choice of shoes.

People of all ages and genders are susceptible to the development of arthrosis of the metatarsophalangeal joints, although they are more common in people over 45 years of age.

In general, the development of arthrosis of the metatarsophalangeal joints can be provoked by:

• metabolic disorders, including gout;
• circulatory disorders in the feet;
• systemic connective tissue diseases, in particular rheumatoid arthritis and lupus erythematosus;
• endocrine pathologies accompanied by hormonal imbalance, including diabetes mellitus, hyperthyroidism, hypothyroidism, etc.;
• foot injuries;
• flat feet;
• clubfoot;
• shortening of one of the legs due to the presence of hip dysplasia or other factors;
• excess body weight, which leads to a sharp increase in the load on the foot;
• prolonged, constant wearing of uncomfortable, tight shoes, especially high heels;
• the need to stand or walk for a long time, carry heavy loads;
• excessively active sports;
• prolonged hypothermia or even frostbite of the toes.

Hereditary predisposition plays an important role in the development of arthrosis of the metatarsophalangeal joints.

Thus, most often, arthrosis of the metatarsophalangeal joints most often affects people with obesity of 2-3 degrees, athletes, as well as elderly people who are forced to stand for a long time.

Symptoms of arthrosis of the metatarsophalangeal joints

The disease is characterized by smooth progression. Therefore, it can develop completely unnoticed over several years, and at this time a person does not even suspect the presence of deviations from the norm in the condition of these small joints of the foot. Only in isolated cases, usually after injuries, does the disease begin acutely.

But gradually the intensity of the symptoms of arthrosis of the metatarsophalangeal joints increases. The disease is characterized by:

• the occurrence of pain that increases over time in the area of ​​the bases of the phalanges of the fingers;
• the formation of subcutaneous dense protrusions that can be felt independently (this may be accompanied by painful sensations);
• swelling;
• gait disturbances in the form of instability, lameness, clubfoot;
• a sharp increase in pain in the foot when standing and walking;
• increased leg fatigue;
• limited mobility of affected joints;
• formation of calluses in the joint area.

Most often, arthrosis of the 1st metatarsophalangeal joint or big toe is observed. This is accompanied by the formation of a bone growth or exostosis in the projection of the affected joint (on the lateral surface of the foot). This kind of thing is usually called a bump or a bone.

In this case, the thumb gradually deviates towards the neighboring ones, and the callus increases in size. This is accompanied by severe pain, and swelling and redness of the soft tissues may also occur. The formation causes discomfort when wearing tight shoes, and over time, patients may notice that previously comfortable shoes or boots have become too tight. In the future, exostosis causes difficulties in choosing shoes, and a big toe that deviates from the normal axis provokes deformation of neighboring ones. Thus, arthrosis of the 1st metatarsophalangeal joint can lead to the development of hallux valgus.

Video

Symptoms and treatment of arthrosis of the toes. Published by the “Treatment of Joints” channel.

Arthrosis interferes with a person’s life, regardless of which area is affected and how much it is affected. Destruction that occurs in the lower extremities is especially difficult to bear. Osteoarthritis of the toes occurs in a minority, so very few people know what to do. The likelihood of developing disability over time is very high, therefore, it is extremely important to seek help immediately after the first minor symptoms appear. To do this, you need to familiarize yourself with the clinical picture of the disease. You don't have to be an expert to do this.

Inside view

Stages of the disease

In general, the following stages are distinguished during arthrosis of the metatarsophalangeal joints:

• Stage 1 - symptoms of degenerative-dystrophic changes in the metatarsophalangeal joints occur no more often than once every few weeks or even months. At this time, patients may notice slight discomfort, tingling and a feeling of stiffness in the joints when resting on the toes or when rolling on them from the heel. All unpleasant sensations pass quickly and are therefore not perceived by patients as a serious disorder.
• Stage 2 - the progression of pathological changes in the metatarsophalangeal joints leads to the periodic appearance of pain, as well as a crunching sound during movements. At this stage, you can already notice a slight deformation of the affected joints, as well as signs of arthritis (redness, swelling, pain in the area of ​​the affected metatarsophalangeal joint).
• Stage 3 – pain is constantly present, including at rest. At this stage of development of the disease, curvature of the finger is observed, the metatarsophalangeal joint of which is affected. Typically this is the big toe. As a result of its deviation towards neighboring fingers, a callus or lump begins to form in the area of ​​​​its metatarsophalangeal joint. It may periodically become red, swollen and painful. But besides this, the curvature of the big toe and the formation of the so-called bunion on the foot leads to significant difficulties when choosing shoes.
• Stage 4 – the affected joint is severely deformed, and corresponding changes occur in the adjacent fingers. This is accompanied by severe pain and difficulty moving. At this stage, the only way to save the situation and return the patient to the ability to walk normally is through surgery.

Treatment of a bunion on the big toe in Vladivostok

Baths won't help! No matter what adherents of traditional medicine write on the Internet, lotions, baths, compresses and iodine nets will not get rid of a bunion on the foot. All these measures can only temporarily alleviate suffering by relieving pain and heaviness in the legs. If the deformity is minor, it can be corrected using various orthopedic means.

For example, special orthopedic insoles are very effective - which can be individually made for each patient by a traumatologist-orthopedist at the Komarov Clinic.

At the initial stage of the disease, wearing a night abduction bandage, which fixes the big toe in the correct position, can alleviate the situation. The design does not allow you to walk with it, but it does not interfere with sleep. It turns out to be a kind of therapeutic sleep.

For daily wear, there are special corrective pads that protect the bones from pressure from shoes and form the correct position of the big toe, as well as various interdigital partitions.

Diagnostics

If signs of arthrosis of the metatarsophalangeal joints occur, patients should consult an orthopedist. The doctor will conduct a survey, during which he will find out the nature of the patient’s complaints and lifestyle, and then proceed to the examination. At the same time, he always pays attention not only to the condition of the joints themselves, especially the big toe, but also to the condition of the skin. Already on the basis of these data, an orthopedist can diagnose the presence of arthrosis of the metatarsophalangeal joints.

But to accurately determine the degree of degenerative-dystrophic changes, the presence of an inflammatory process and other changes, the following must be prescribed:

• UAC and OAM;
• x-ray of feet in two projections;
• Ultrasound of the metatarsophalangeal joints;
• CT and MRI (prescribed in complex cases when other methods cannot determine the specific course of pathological changes).

Treatment of arthrosis of the metatarsophalangeal joints

For each patient diagnosed with arthrosis of the metatarsophalangeal joints, treatment is selected individually in accordance with the degree of pathological changes. Initially, all patients, with the exception of advanced cases of degenerative-dystrophic changes in the joints, are prescribed conservative treatment. But the disease can be completely cured only if it is detected at the initial stages of development. In the future, conservative methods can only stop the further progression of pathological changes in the joints, but not reverse them.

For arthrosis of the metatarsophalangeal joints of grade 3 and 4, surgical intervention is indicated. This is the only way to get rid of pain and other symptoms of the disease that reduce the patient’s physical capabilities.

Conservative treatment for arthrosis of the metatarsophalangeal joints is always complex. It includes:

• drug therapy;
• physiotherapy;
• exercise therapy;
• massotherapy.

In addition, the orthopedist can give individual recommendations for patients. Thus, he will recommend that people who are overweight take measures to reduce it. To achieve this goal, you will need to make adjustments to your diet and increase your level of physical activity. But any single-component and other unbalanced diets are contraindicated. It is extremely important that the body receives all the substances necessary for the proper functioning of the joints. Therefore, the daily diet should contain the required amount of proteins, fats, carbohydrates, vitamins, etc.

If you have flat feet, hallux valgus or other foot deformities, your orthopedist will prescribe the use of orthopedic insoles. But they must be made individually. It may also be recommended to use special fixing bands and splints.

If arthrosis of the metatarsophalangeal joints is detected at an early stage of development and promptly begins to use orthopedic devices (custom insoles, bandages), it will be possible to avoid valgus deformity of the toe and maintain an aesthetically attractive appearance of the foot.

It is also important to avoid wearing tight, uncomfortable shoes and high heels. Patients with this diagnosis are only suitable for comfortable shoes with wide toes and wide heels of low height.

Drug therapy

For arthrosis of the metatarsophalangeal joints, a complex of medications is prescribed that are aimed at relieving pain and stopping the progression of degenerative processes in cartilage tissue. For each patient, a set of drugs is selected individually, taking into account the severity of arthrosis, existing concomitant diseases and a number of other factors. As a rule, they are prescribed:

• NSAIDs are non-steroidal anti-inflammatory drugs that help not only eliminate inflammatory processes, but also help reduce pain. Depending on the characteristics of the disease, the doctor may prescribe ointments, creams, tablets and drugs in other dosage forms.
• Chondroprotectors are a group of drugs that include glucosamine and chondroitin as active ingredients. These compounds are natural to the body and are used by it to regenerate cartilage tissue. The course of treatment with drugs of this group is long (3-6 months). Chondroprotectors can be prescribed in the form of capsules and powders, but injectable forms are most effective.
• Corticosteroids are hormonal drugs that have a pronounced anti-inflammatory effect. They are indicated for severe inflammatory processes and severe pain that cannot be eliminated by taking NSAIDs. Corticosteroids are often prescribed by injection because this route of administration causes fewer side effects.
• Vitamin complexes are prescribed to improve the course of metabolic processes, normalize the functioning of the immune system and provide the body with the substances it needs for proper functioning.

Sometimes patients are given intra-articular injections of synovial fluid substitutes. They help reduce friction between joint components and activate regeneration processes, which will lead to a reduction in pain.

When arthritis occurs, patients are additionally prescribed drug treatment aimed at eliminating the inflammatory process. Antibiotics and other medications can be used for this purpose.

Physiotherapy

Physiotherapeutic procedures are indicated outside of the acute inflammatory process. They are most effective when used for arthrosis of the metatarsophalangeal joints of degrees 1 and 2. In most cases, patients are shown courses consisting of 10-15 procedures:

• UHF;
• magnetic therapy;
• laser therapy;
• electrophoresis;
• phonophoresis.

Thanks to physiotherapy, it is possible to reduce the severity of pain and eliminate swelling. In addition, it helps to improve metabolic processes and activate blood circulation in the foot, which has a positive effect on the condition of the joints. Also, certain physiotherapeutic effects can increase the tone of the muscles and ligaments of the foot, which is very important in the presence of flat feet and other orthopedic disorders.

Exercise therapy

One of the mandatory components of conservative treatment of arthrosis of the metatarsophalangeal joints is exercise therapy or physical therapy. It helps improve muscle tone, strengthen the natural arches of the foot and improve joint mobility. For each patient, the training program and exercises are selected individually, taking into account not only the nature of pathological changes in the metatarsophalangeal joints, but also the level of physical development, the presence of foot deformities, etc.

Initially, it is recommended to engage in special exercise therapy groups under the guidance of a physical therapy instructor. This will allow you to master the technique of performing each exercise as accurately as possible, which will ensure that you get the best effect. Gradually, the exercises can become more complicated, the number of repetitions increased, etc. But all this is carried out only as prescribed by the attending physician or exercise therapy instructor. In the future, you can do therapeutic exercises at home.

The main condition for the effectiveness of exercise therapy is a systematic approach. Therefore, it is necessary to perform the set of exercises recommended by your doctor every day.

Massotherapy

Massage therapy sessions help increase the effectiveness of drug therapy and other measures taken. With their help, it is possible to increase blood circulation in the affected joints and muscle tone. They also help increase joint mobility and restore normal foot anatomy.

Surgery for arthrosis of the metatarsophalangeal joints

In case of arthrosis of the metatarsophalangeal joints of the 3rd and especially 4th degree, as well as in the case of rapid progression of the pathology, severe pain and limitations of mobility against the background of ineffectiveness of conservative treatment, surgical intervention is indicated. Modern surgery can offer the following options for operations for arthrosis of the metatarsophalangeal joints:

• Cheilectomy – removal of osteophytes, i.e. bone growths on the articular surfaces of bones. This allows you to improve the function of flexion and extension of the metatarsophalangeal joints and, accordingly, the toes.
• Arthrodesis is an operation, the essence of which is the fusion of articular surfaces with each other and, therefore, complete immobilization of the joint. Therefore, it is performed mainly in the most difficult cases, when other methods cannot solve the problem of arthrosis. But arthrodesis provides reliable pain relief. Thus, during the operation, the surgeon places the metatarsal bone and proximal phalanx of the finger in the correct position and fixes them with special correctors.
• Endoprosthesis replacement is a high-tech operation performed for arthrosis of the 1st metatarsophalangeal joint of 3-4 degrees. It consists of replacing a worn-out joint with an artificial prosthesis, which completely preserves the functionality of the joint and eliminates the symptoms of the disease. Endoprosthesis replacement involves resection of a fragment of the base of the main phalanx of the big toe and the head of the first metatarsal bone. The legs of the endoprosthesis are mounted inside the bones, after which the artificial joint is repositioned and the wound is sutured layer-by-layer.

When choosing the first two methods, provided that valgus deformity of the finger develops and a protruding bone is formed, Schede's operation is additionally performed. Its essence is to remove the callus formed at the base of the joint affected by arthrosis. Therefore, it is aimed at removing the consequences of the disease, but does not directly affect it. But Shede's operation ensures a good cosmetic defect.

Thus, arthrosis of the metatarsophalangeal joints is an extremely unpleasant disease, which, if left untreated, can provoke a number of undesirable changes in the condition of the feet. But today it can be cured at any stage of development.

Preventing the appearance of a bunion on the big toe

However, no matter what innovative technologies and methods are, the best treatment is prevention. In this case, the right shoes, wide in diameter, with a round toe, made of soft materials and with a heel no higher than 4 cm. If you cannot refuse stilettos, then be sure to insert a special insole for high heels with a transverse corrector to support the foot.

By the way, running or jumping sports can also provoke the formation of a bunion on the big toe, since the front arch of the foot is overloaded during training. The solution to the problem is to wear special sports shoes for a specific type of physical activity.

And one more tip - there is nothing better for preventing “bumps” on your feet than walking barefoot on sand or small pebbles. This massage perfectly strengthens the ligaments of the foot and helps to avoid the development of flat feet and other joint diseases.

You can make an appointment with the clinic’s traumatologists-orthopedists for a consultation on the diagnosis, treatment and prevention of foot deformities by calling the outpatient department or 240 27 27.