Hammer toes are caused by excessive flexion at the interphalangeal joint and extension at the metatarsophalangeal joint. Visually, the pathology is represented by bent toes, and the deformity of the second toe is always more pronounced.
The pathological process brings not only aesthetic discomfort. The curvature prevents you from wearing comfortable shoes, as calluses constantly form on the protruding areas. In addition, when two or three fingers are affected, the gait changes; the person tries to reduce the load on the affected parts of the feet. As a result, the load on the joints of the legs and lower back increases, and back pain appears.
Therefore, treatment of hammertoes in Germany is aimed not just at smoothing out the protruding area, but at restoring the anatomically correct shape of the foot.
Diagnostics
The cause of the disease most often lies in a change in the architecture of the foot under the influence of flat feet. In order to effectively treat hammertoe deformity, the factor provoking the pathology must be eliminated, that is, the normal axis of the foot must be restored.
In order to confirm flat feet, X-rays of the affected foot are taken in frontal and lateral projections. This diagnostic method allows not only to identify the cause of the disorder, but also to obtain all the necessary data directly on the nature of changes in bones and joints at the site of deformation.
Clinical picture
- The characteristic appearance of a crooked finger.
- Pain.
- Movement restrictions.
- Corns on the back of the finger, on the sole of the foot.
- “Bump” at the base of the first finger, valgus deformation of the latter.
- Dropping of the arches of the feet.
- Subluxation and dislocation of the metatarsophalangeal joints.
Surgical intervention
Surgery can be used to treat hammertoe deformity of the second toe, as the area most affected by the process, or all toes, depending on the lesion. More often, of course, surgical intervention is practiced in the most altered areas, and eliminating the cause of the deformation allows other minor curvatures to be eliminated.
Toe deformities are corrected in two ways: through open or minimally invasive surgery. It is important that during surgical treatment, conduction anesthesia is used, which turns off the sensitivity of only the operated leg, and the patient remains conscious. This allows you to reduce the toxic effect of the anesthetic on the body and improve the patient’s condition after surgery.
During traditional open surgery, the doctor aligns the fingers and secures them in the interphalangeal joint with special screws or knitting needles, which ensure the fusion of the structures in a given direction. During open surgery, the second finger can be shortened in cases where it is its length that has led to the deformity. After 2-3 months, the implanted metal structures are removed during a second operation.
In their practice, foreign specialists often use biodegradable structures, which dissolve in the body after 1.5-2 years. This innovation allows patients to avoid a second trip to the clinic for surgery.
During a minimally invasive operation, a specialist inserts microscopic surgical instruments through miniature incisions on both sides of the affected phalanx, which excise bone growths, remove pathological tissues inside the joint and realign the finger. In this type of intervention, no metal structures are implanted into the body. To consolidate the result, the fingers are fixed in the correct position with a special bandage after the operation.
In addition to the surgical interventions described, the surgeon can perform laser removal of calluses that have formed on the skin. The laser beam gently removes pathological tissue, leaving behind space for the formation of new skin. After healing, a good aesthetic result is formed.
Conservative treatment
It begins with the selection of comfortable shoes, the manufacture of individual orthopedic insoles, physical therapy, massage, and physiotherapy.
An advanced trend in physiotherapy treatment is:
SHOCK WAVE THERAPY - especially for severe pain associated with metatarsalgia.
But it should be understood that with significant deformation, conservative measures will only have a temporary effect, or will partially alleviate pain and discomfort. Therefore, in such situations, surgical treatment is indicated!
Rehabilitation and return to physical activity
After the operation, patients do not have to stay in the clinic, but a mandatory examination by a specialist is planned the next day, so you can fly home only one day after the operation. After treatment, be sure to limit physical activity and wear comfortable shoes. Return to usual physical activity is observed after 3-6 weeks, depending on the degree of deformity.
Treatment of hammertoe deformity in German clinics is carried out strictly individually. A preliminary diagnostic and treatment plan is selected during an in-person consultation between our specialists and the doctors of the clinic where the patient will undergo treatment.
The coordinator of the Deutsche Medizinische Union will provide you with a preliminary treatment plan, calculation of the cost and duration of stay in the state. Of course, treatment options may change after the doctor examines the patient. In any case, you can be sure that we will refer you to competent specialists who are responsible for the quality of their work.
Treatment of hallux valgus
Table of contents
- What are hallux valgus deformities?
- Main types of deformations
- Causes and symptoms
- Diagnostics
- How is therapy carried out?
- Diagnostics
Hallux valgus deformities occur in both children and adults.
Such a pathological change in the big toe leads not only to severe discomfort, but also to aesthetic problems. The patient not only experiences discomfort, but often cannot wear open shoes. Today such deformation can be eliminated. To treat hallux valgus, you must contact qualified doctors. They will select the optimal method of therapy. When choosing, both the degree of deformation and the presence of certain contraindications in patients and general health will be taken into account.
What are hallux valgus deformities?
This pathology of the big toe is one of the most common orthopedic diseases. Its main symptom is the curvature of the joint. In the early stages, hallux valgus deformity (Hallux Valgus) manifests itself as a small growth. At the same time, the pathology develops quite slowly, so diagnosing it in the initial stages is not easy. If the situation worsens, the patient already faces serious problems. These include both severe discomfort when walking and a number of dangerous complications, including:
- disruption of tissue blood supply
- arthritis and arthrosis
- acute inflammatory process (bursitis)
Main types of deformations
There are several degrees of pathology:
- First degree.
It is characterized by a curvature of the finger of no more than 20 degrees and no pain. - Second.
At this degree, the joint has already shifted by 21–30 degrees. The mobility of the finger is not impaired, and the discomfort is mild. - Third.
This degree of deformation is characterized by a curvature angle of more than 30 degrees. Patients often complain of constant pain that disrupts their usual lifestyle, does not allow them to play sports, wear normal shoes, or even just move around fully. - Fourth.
At this degree, the joint has moved more than 50 degrees. Patients suffer from constant formation of calluses, severe pain and severe difficulties in choosing even special shoes
Causes and symptoms
Several factors can contribute to finger curvature.
The main ones are:
- flat feet
- congenital pathologies
- leg injuries
- destruction of cartilage tissue due to processes such as arthritis and arthrosis
- muscle weakness, which leads to abnormal bone mobility
Important! Wearing uncomfortable shoes is not a direct cause of the disease, but can significantly accelerate its development. For this reason, the defect is often diagnosed in women.
Osteoporosis can also lead to changes in the joint. Another cause of the defect is endocrine disorders. They reduce the strength of the ligaments. This causes the ligaments to lose their ability to hold the joint in the correct position. Increased loads also aggravate the situation. The risk of developing the disease increases as the body ages.
Flat valgus foot in children and adults requires serious treatment, as it causes severe discomfort.
Patients complain about:
- inability to wear normal shoes
- pain after prolonged standing
- fatigue
- pain associated with inflammation
Often a soft lump forms at the thumb, the skin in the area of which swells and turns red. Over time, the shape of the limb changes significantly, and a callus forms, which leads to irritation of the soft tissues. The pain intensifies, and joint mobility is limited. In advanced cases, the pathological process can spread to all fingers and lead to serious limitations in movement.
Diagnostics
Treatment of hallux valgus in children and adults is carried out after a comprehensive examination. To make a preliminary diagnosis, a foot examination and medical history are taken. The doctor evaluates the presence of calluses and bone lumps, the severity of changes in gait and the degree of curvature of the joint.
Depending on the external manifestations of the pathology, the specialist prescribes the following examination methods:
- X-ray
- Ultrasound of joints and ligaments
- CT scan
- Magnetic resonance imaging
As part of the diagnosis, it is possible to identify not only obvious changes, but also hidden ones. The true causes of the development of Hallux Valgus are also often discovered.
How is therapy carried out?
Treatment of flat valgus foot depends on the stage of the pathological process.
- stop the development of the disease in the early stages
with the help of special orthopedic shoes or insoles. Physiotherapeutic procedures and massages are also provided - At the second stage of deformation development,
special silicone inserts are added to the insoles or shoes, which are placed between the thumb and second toe. Patients may also be prescribed a special splint. Additionally, procedures are carried out aimed at relieving the inflammatory process. It should be understood that conservative treatment of hallux valgus often only delays surgery, but does not eliminate the need for it. It is impossible to remove changes using physical therapy and other procedures. And wearing orthopedic shoes only relieves discomfort and allows you to move freely - At a severe stage of deformation,
conservative methods become completely ineffective and do not alleviate the patient’s condition. Surgery required
Operations to treat hallux valgus
To eliminate Hallux Valgus (bumps on the finger), the following types of interventions are performed:
- Percutaneous surgery.
This operation is minimally invasive and allows you to remove a small bone through small incisions. - Laser resurfacing.
The intervention is also minimally invasive and suitable for removing bone in the early stages of formation - Reconstruction of the forefoot.
This intervention is carried out when the deformity is advanced. The operation is performed in an open manner and involves dissection of soft tissues, realignment of the axis of the finger and removal of growths
The minimally invasive interventions performed take little time. They last only 30–40 minutes and do not require long-term rehabilitation. Modern foot surgery makes it possible to restore full functionality of the joint and the aesthetic appearance of the limbs. The patient does not have to wear a cast or face problems with movement. He can go home right away.
Important! The optimal treatment method for hallux valgus in children or adults is selected exclusively by the surgeon. Only a doctor has accurate information about the condition of all internal tissues. Only he objectively evaluates all health indicators and can identify contraindications to certain interventions.
Advantages of treating hallux valgus at MEDSI
- Experienced qualified surgeons.
Our doctors have all the necessary skills and knowledge. They successfully select techniques that allow maintaining foot mobility and ensuring a short rehabilitation period for the patient. - Fast diagnostics.
Preparation for surgical treatment of hallux valgus is possible within 24 hours. During this time, the patient undergoes tests and undergoes all necessary examinations (radiography, ultrasound, computed tomography and magnetic resonance imaging) - Fast rehabilitation.
Most patients stay in the hospital for no more than a day. During the recovery period, wearing a cast and using crutches is not required, which significantly increases the comfort of those operated on - No age restrictions.
Treatment in our clinics is available for both adults and children - Possibility for rehabilitation.
We have everything necessary for the rapid recovery of patients after any interventions
If you are planning treatment for hallux valgus in a child or adult, and would like to clarify the cost and other features, call +7 (495) 7-800-500. A specialist will answer all questions and select a convenient time for consultation with a doctor.
Postoperative period
In the postoperative period, plaster immobilization is not used
After 1-2 days of elevated position of the foot, the patient begins to walk with a load on the limb, using Baruk shoes - specially made orthopedic shoes, with unloading of the forefoot.
The duration of use of special shoes depends on individual characteristics, usually 4 - 6 weeks.
Particular importance is attached to constant independent (or with the help of relatives) physical therapy exercises and constant passive movements in the operated fingers to prevent possible stiffness.
According to medical statistics, 80 - 85% of those operated on using the described technology are satisfied with the result.
Surgical treatment
Unfortunately, until recently, in the opinion of many orthopedists, the mutilating operation “Schede-Brandes”, better known in European literature as the Silver operation (1932), was constantly replicated in the opinion of many orthopedists.
At the moment, preference is given to the so-called. distal osteotomy of the first metatarsal bone, Scarf, Chevron. This clear and harmonious technology was developed and introduced into surgical practice by a French orthopedist from Bordeaux, S. Barouk. After a graceful longitudinal cut of the first metatarsal bone, the plantar fragment is displaced and fixed with submersible mini-screws bearing the name of the author of the operation. In cases where this is not enough, a mini-cut of the phalanx of the first finger is also carried out to eliminate its curvature, as shown in the figure.
Hallux rigidus (arthrosis of the first metatarsophalangeal joint)
This pathology of the first metatarsophalangeal joint, which occurs for various reasons, often brings significant discomfort, especially to patients leading an active lifestyle.
A characteristic feature is a significant limitation in the range of motion in this joint. Pain occurs when walking, when the ability to do the necessary amount of dorsal flexion of the first finger is significantly limited. The reason for this limitation is severe deformation of the cartilaginous surfaces of the joint, marginal bone growths, ossification (salt deposition) of the periarticular tissues.
In the initial manifestations of this pathology, we successfully use shock wave therapy . But, often, surgical care becomes the only effective solution.
In principle, 4 surgical directions can be distinguished.
- Marginal resections are a temporary measure that, for minor deformities, provides a good result for several years.
- Arthrodesis (fusion) of the first metatarsophalangeal joint. To date, this is the most effective operation, which completely eliminates pain. But perhaps the only drawback is the lack of movement in this joint in the future.
- Polymer "inserts". Unfortunately, the products (particles) of degradation and abrasion of polymers have a detrimental effect on the surrounding bone tissue, which ultimately leads to arthrodesis after a few years, only in more severe anatomical conditions.
- Endoprosthesis replacement of the first metatarsal-phalangeal joint. Most of the leading podiatrists in foot surgery in various countries are reluctant to this method. Instability and loosening of this implant very often causes major surgical problems caused by re-operation.
Our clinical experience with arthrodesis in the treatment of Hallux Rigidus allows us to confidently expect good results.