Hallux valgus ICD-10: description of the disease

Classification and stages of development

In modern orthopedic practice, the following types of hallux valgus are distinguished:

• 
  Congenital (ICD-10: Q6). Pathology is formed during development inside the mother's womb. As a rule, its first signs are detected by the time the child begins to move independently.

• Paralytic. An acquired form of the disease, the pathogenesis of which is caused by dysfunction of the foot muscles. Occurs as complications after suffering from polio and polyneuropathy.
• Rachitic. The pathology occurs at an early age against the background of rickets caused by a lack of vitamin D in the child’s body.
• Traumatic (ICD-10: M 21.0). The occurrence of this form of pathology is caused, as its name suggests, by injuries (sprains, bruises, fractures).
• Static (ICD-10: M 21.0). The most common type of hallux valgus, associated with impaired trophism and dystrophy of the connective tissue of the foot.

To determine the stage of the disease, indicators of deviation from the norm of two parameters used by orthopedists during x-ray examination of the foot are used:

• HVA. This abbreviation refers to the angle at which the big toe deviates relative to the first metatarsal bone. Normally, the HVA should not be more than 15 degrees.
• IMTA. In this case we are talking about the angle formed by the two axes of the metatarsus. Normally, IMTA should not exceed 9 degrees.

Based on the deviations of these parameters from normal, the stage of the pathological process is determined:

• I Art. Light form. IMTA 9 to 11 degrees, HVA 15 to 20 degrees. The joint is proportional, no pain is noted.
• II Art. Medium severity. IMTA is from 11 to 18 degrees, and HVA is from 20 to 40 degrees. The appearance of a visually clearly visible lump or “bone”, as well as slight pain.
• III Art. Severe form. IMTA – more than 18 degrees, HVA – at least 40 degrees. Severe deformation of the foot and ankle. High risk of complications. There is pronounced pain when walking.

At the third stage, hallux valgus deformity without proper and timely treatment can lead to loss of ability to work.

Causes

Congenital flat feet are caused by genetic factors, as well as a violation of the correct formation of the foot ligaments in the prenatal period.

The following reasons influence the change in the shape of the foot and the progressive development of deformity:

• wearing poor quality or old shoes,
• standing on your feet for a long time,
• obesity, leading to significant stress on the entire musculoskeletal system, especially on the foot,
• traumatic injuries causing deformation of the bone elements of the foot,
• a disorder of vitamin D metabolism that causes rickets,
• complete or partial paralysis of the muscles of the foot (develops as a result of poliomyelitis, cerebrovascular accident or polyneuropathy of an infectious or toxic nature).

The cause of flat feet is determined only after a diagnostic examination by a specialized specialist. Parents should seek help from an orthopedist if they suspect improper development of the foot: early treatment increases the baby’s chances of restoring the shape of the foot.

Symptoms

With hallux valgus, the patient notices the following symptoms:

• 
  the appearance of a “bone” (small flattened bump) on the thumb;

• inflammation of the joint, accompanied by pain and swelling;
• formation of growths at the head of the metatarsal bone;
• difficulty moving;
• In the early stages of the disease, symptoms may be blurred or not appear at all.

At the first symptoms, you should immediately consult a doctor.

Diagnostics

If you suspect hallux valgus, you should consult an orthopedist. During the initial appointment, the specialist will pay attention to the appearance of the foot and ankle and collect the necessary medical history. To confirm the diagnosis and determine the severity of the disease, the patient will be referred for additional examination, which consists of using the following instrumental methods:

• 
  X-rays. An X-ray image visualizes pathological processes in various parts of the foot. Using it, a specialist can calculate the angles of deviation from the norm and determine the degree of deformation.

• Computer podometry. A method that allows you to assess the degree of load on the foot in general and on its individual parts in particular.

In addition, depending on the cause that led to hallux valgus, the patient may require consultation with other specialists, such as a neurologist, endocrinologist, or surgeon.

As part of the differential diagnosis, the doctor should distinguish this pathology from flat feet and varus deformity of the foot, which have similar visual signs.

With varus deformity of the foot, the foot is directed inward, and accordingly, the entire load falls on its outer part. Flat feet are characterized by the fact that a patient suffering from this disease uses the inner parts of the foot when walking, leaning on them. In fact, this pathology often causes hallux valgus.

Diagnosis of flat feet

Flat feet in children: how to determine without a doctor? Impatient parents often ask themselves. You can do a simple test at home. Wet your child's foot and pat it slightly dry with a towel. Place your foot on a flat surface, maybe on paper. Now you need to evaluate the mark: if it has acquired a normal shape with a side notch, then there is no pathology. In clinics, a foot print is made in a similar way to determine flat feet in children.

The test is not 100% indicative. You shouldn't self-diagnose. Modern X-ray equipment and a doctor’s examination accurately determine the presence of pathology. X-rays are taken for both feet in frontal and lateral projections with a load. In some cases, an MRI is prescribed.

In Ladisten you can get a detailed consultation with an orthopedist and conduct high-quality hardware diagnostics.

Treatment

The treatment tactics for the pathology in question depend on factors such as the causes of its occurrence and the severity of the disease. Thus, at stage 3, hallux valgus can be cured only through surgery. With the first two, conservative therapy methods can be successfully used.

Drug treatment

The use of pharmacological drugs involves getting rid of unpleasant pain symptoms, inflammation and swelling. This is symptomatic therapy that will not get rid of the disease, but will alleviate its course.

Thus, pain-relieving ointments (Voltaren, Ketoprofen, Diclofenac) are widely used, which also have anti-inflammatory properties. To quickly relieve pain, tablet medications from the NSAID group (Nise, Nimesulide) can be used, but long-term use is not recommended, since these drugs have a negative effect on the gastric mucosa.

Physiotherapy

Physiotherapeutic methods proposed for the treatment of hallux valgus have a beneficial effect on the metabolism and trophism of tissues and joints, and also relieve swelling, inflammation and pain. These include, among others:

• laser therapy;
• ultrasound;
• shock wave impact.

Physiotherapeutic treatment methods must be agreed with the attending physician.

Exercise therapy

Physical exercises, including elements of exercise therapy, are selected individually, depending on the degree of deformation. The most universal and effective of them are:

• 
  walking barefoot (on toes, on heels, on the edges of the foot);

• squats;
• rolling from heel to toe and back;
• "bike";
• rolling a block or bottle with your foot;
• walking on a pebble surface or its imitation.

Light exercise should be performed daily.

Massage

Massage is an auxiliary method of treating hallux valgus. It effectively helps eliminate pain and reduces swelling. It is highly desirable that the procedures are carried out by a specialist with a medical education and appropriate qualifications, familiar with various techniques of therapeutic massage for orthopedic diseases.

Types and degrees of flat feet, code according to ICD-10

Taking into account the features of the deforming process, the following forms of flat feet are distinguished:

1. Transverse: The metatarsals fan out, causing the anterior region to widen and the big toe to deviate outward.
2. Longitudinal: the length of the foot increases, the longitudinal arch flattens, the leg turns outward.
3. Combined violation.

Based on the severity of pathological symptoms, foot deformities of a planovalgus nature are distinguished: mild, moderate and severe.

The International Classification of Diseases defines the encryption of flat feet according to ICD-10 as follows:

• acquired changes – M21.4,
• congenital flatfoot – Q.66.

Severe pathology can only be corrected through surgery. Restoring motor function using conservative methods is possible only with timely diagnosis and immediate treatment.

Prevention

Treatment of hallux valgus is an extremely labor-intensive and lengthy process, so issues related to the prevention of this pathology are of fundamental importance. The main measures to prevent this disease include:

• 
  Wearing comfortable shoes. It must be selected according to the size and shape of the foot, taking into account weather and climatic conditions.

  Read also:  Hip dysplasia in children: diagnosis
• Physical exercise. Gymnastics and physical exercises keep the muscles and ligaments of the legs in good shape.
• Proper nutrition. A rational and balanced diet will help you avoid problems associated with excess body weight, including orthopedic problems.

There are no specific methods for preventing congenital hallux valgus, but adherence to the principles of a healthy lifestyle and following medical recommendations during pregnancy planning and during pregnancy will significantly reduce the likelihood of having a child with intrauterine developmental anomalies.

Hallux valgus is a common disease of the musculoskeletal system that occurs in both children and adults. This pathology can become a catalyst for the development of more serious problems, which is why its therapy should be started as soon as possible. Only in this case is a favorable prognosis and complete recovery possible.

Flat feet in children

According to code M 21.4 ICD-10, flatfoot deformity is classified into transverse, mixed and longitudinal flatfoot. Quite often children suffer from hallux valgus deformity. The reasons that provoke the development of flat feet in children are:

• Prematurity and intrauterine pathologies.
• Cerebral palsy, rickets.
• Diseases and weakness of connective tissues.
• Previous infectious poliomyelitis.
• Foot injuries, obesity in childhood.

Congenital hereditary or pathological valgus foot deformity in children with ICD is difficult to diagnose, since by the age of three years the child has all the signs of a flat foot on the lower extremities. In three percent of cases, the diagnosis is disappointing - congenital planovalgus deformity. In the future, adolescents with this disease will require more complex treatment than young children, so at the first sign of the disease you should consult a doctor. The specialist will make a diagnosis and choose the most effective treatment regimen.

Signs of flat feet in children

It is quite difficult to recognize a congenital or acquired type of pathology in a young child in a timely manner. Generally, the diagnosis of planovalgus deformity is given to children aged 5-7 years. The main signs of the disease are turning of the heel and toes, emphasis when walking on the inner or outer arch of the foot, compaction of the sole, and rapid fatigue. The same symptoms accompany adults, but in addition to them, abduction of the thumb may occur.

Establishing a diagnosis using radiography, podometry and computer plantography allows you to promptly choose a treatment method in order to prevent surgical intervention. Ignoring treatment for flat feet leads to dangerous disorders in the development and functioning of the musculoskeletal system.