Hallux Valgus (valgus deformity of the 1st or big toe) is a common pathology that is more common in middle-aged and older women. Nevertheless, it can also occur in children, leaving an imprint on their mobility and taking away some of the joyful emotions due to an external defect or the inability to spend time in active movement as much as their peers. Therefore, when what is popularly called a “bump on the foot” forms, you should immediately contact an orthopedist and begin treatment before the deformation reaches impressive proportions and leads to undesirable consequences.
What is Hallux valgus
Hallux valgus or hallux valgus deformity of the 1st toe is an orthopedic disorder in which, as a result of existing disturbances in the structure of the foot or under the influence of external factors, the big toe deviates from the rest. As a result, deformation of the metatarsophalangeal joint occurs, which causes the formation of a protrusion in its projection. This leads to the inclusion of a compensatory mechanism - the formation of a protective bone growth in the lateral part of the affected joint.
Thus, a lump gradually forms on the inner surface of the foot. In medicine it is called exostosis. Over time, it tends to increase in size. Gradually, the first finger deviates even more from its normal position, deforming the neighboring ones. After all, the muscle imbalance that occurs due to deviation from the normal position of the big toe provokes the creation of an increased load on the small bones of the foot when walking. As a result, corns and calluses begin to form, and the heads of the 2nd and 3rd metatarsal bones suffer due to overload. Later, degenerative-dystrophic changes, i.e. arthrosis, may occur in their joints. As the pathology develops, the big toe deviates more and more to the side and goes under the neighboring toes, which together gives the foot a very unattractive appearance.
But the danger of the disease lies not only in the occurrence of difficulties when walking, pain and aesthetic defects. It has a negative effect on the remaining joints of the lower extremities and creates the preconditions for the development of arthritis and arthrosis. In the future, it is possible that changes in the condition of the spine may occur, including the development of scoliosis and osteochondrosis.
As for the foot itself, Hallux valgus is often accompanied by the occurrence of bursitis of the metatarsophalangeal joint of the 1st toe. In this case, it is possible that pus accumulates in the joint capsule, which causes severe pain, redness and swelling of the skin. The risk of ingrown toenails also increases.
Reasons for development
In children, the main reasons for the development of hallux valgus of the 1st toe are weakness of the ligamentous apparatus of the feet and transverse flatfoot. But the following can also contribute to the development of deformation:
- metabolic disorders;
- shoes that are too tight and squeeze your toes;
- wearing shoes with heels higher than 3 cm;
- being overweight;
- rickets;
- foot injuries;
- endocrine disorders.
Heredity plays an important role in the development of Hallux valgus.
Transverse flatfoot
Types of disease
There are two types of hallux valgus: it can be congenital or acquired.
The congenital form develops in the womb due to the incorrect location of the bone structure of the foot. The diagnosis in this case is made to the child in the first months after birth.
Acquired deformity is formed against the background of weakness of ligaments and tendons, disturbances in the development of the musculoskeletal system. It appears by a year or a little earlier. Sometimes the reasons are injuries, a long stay in a cast, getting on your feet too early, dysplasia, etc.
Preventive measures:
- orthopedic shoes;
- prevention of rickets;
- minimizing the load on weak legs for up to 7-8 months;
- regular examinations of the child by an orthopedist.
Symptoms of Hallux valgus
Valgus deformity of the 1st toe progresses quite slowly. At first, it practically does not appear, and there are no pronounced external changes. But over time, children may notice that previously comfortable shoes become tight. If the leg remains the same size, it begins to press, rub and wear out more actively.
Over time, you can notice the first signs of the formation of a protrusion on the lateral surface of the foot. During this period, characteristic discomfort in the feet usually occurs after prolonged walking or physical activity. If you look closely, you can see the beginning of a deviation of the thumb. In the future, while maintaining the same lifestyle, the deformation progresses and becomes clearly visible.
Hallux valgus is often combined with a flat-valgus deformity of the foot, i.e., it rolls inward. As a result, when walking, the child places emphasis on the inner surface of the foot, which leads to displacement of the ankle joint. This is accompanied by curvature of the articular axis and can subsequently provoke an X-shaped deformity of the legs.
In general, the development of Hallux valgus causes significant discomfort for children. Moreover, it is often greater than in adults due to the peculiarities of perception of the world and oneself. Physically, deformation of the 1st toe leads to:
- discomfort while walking;
- increased fatigue during physical activity;
- pain in the area of the lump that occurs or intensifies after prolonged walking, physical activity, or wearing tight shoes;
- discomfort while putting on shoes;
- swelling of the legs;
- gait instability due to decreased support function of the foot.
With severe deformation, the 2nd and 3rd toes acquire a flexion position, which leads to an increase in the size of their joints. This is called hammertoe deformity. Also, in the later stages of development, painful corns and calluses form on the plantar part of the foot under the heads of 2-4 toes.
As a result, children are not able to participate in outdoor games on an equal basis with their peers, go on long hikes and fully engage in those sports that involve heavy loads on the legs (dancing, football, basketball, etc.).
But, in addition, it is difficult for children with such a pathology to choose suitable shoes that would not compress the protrusion and at the same time correspond to the child’s taste. Girls, especially teenagers, can develop complexes due to the unaesthetic appearance of their feet and the inability to wear beautiful open shoes. This can cause isolation, depression and other psychological difficulties.
Treatment of planovalgus deformity of the feet in children
Treatment is carried out with the aim of restoring the correct shape of the foot, strengthening ligaments and muscles. With the congenital form of the disease, in some cases, immobilization of the limbs is required, provided by plaster casts - they are selected and modeled by an orthopedist, taking into account individual factors. The next stage of therapy (in the acquired form it is the first) are foot baths, massage, electrophoresis, exercise therapy, gymnastics, etc. Source: O.V. Kozhevnikov, I.S. Kosov, A.V. Ivanov, A.V. Bolotov Hernias of the anterior abdominal wall // Questions of science and education, 2021, pp. 62-66
Let us dwell on the main methods of treating hallux valgus.
Gymnastics
Exercise therapy consists of a set of simple exercises that need to be performed several times a day. From the list of recommended exercises, 2-3 are selected one by one and performed with the required number of repetitions.
Massage
Massage of the lumbosacral region allows you to stimulate the nerve endings that transmit impulses to the legs. All manipulations are carried out only by a specialist and using special medical techniques.
What should the shoes be like?
For children suffering from this condition, quality foot support is extremely important. It is provided with rigid sidewalls and a back, high and dense instep support. Such shoes compensate for muscle strain and prevent the condition from worsening.
When will the result appear?
This set of measures provides a lasting result, which can become noticeable no earlier than six months later. This indicator is individual, as it is influenced by the rate of growth, correction of bones, strengthening of muscles and ligaments.
Degrees of hallux valgus
In general, according to the angle of deviation of the phalanges of the thumb and formed by the 1st and 2nd metatarsal bones, 3 stages are distinguished during the disease:
- Hallux valgus 1st degree – the angle of deviation of the big toe does not exceed 25°, and the intermetatarsal one is 12°. This is the asymptomatic stage of the pathology, although sometimes you can pay attention to the child’s increased fatigue, especially if he has flat feet.
- Hallux valgus 2nd degree - the angle of deviation of the big toe is 25-35°, and the intermetatarsal one is 12-18°. At this stage of development of the deformity, symptoms characteristic of hallux valgus are already present. Also, attention is drawn to the fact that previously comfortable shoes become tight.
- Grade 3 – the angle of deviation of the big toe is more than 35°, and the intermetatarsal toe is more than 18°. In such a situation, pronounced changes in the condition of the foot are already visible, large exostosis is present, and corns appear. In this case, pain in the feet can become very severe, and also occur in the back. Such situations in children occur quite rarely, although in the absence of treatment they are not excluded.
Prices
Price (rub.)In installments* (rub.)Consultation with a surgeon on surgery (SPECIAL)0—Online doctor’s opinion on surgery (SPECIAL)0—Surgery on the feet, category II. complexity from 20,000—Foot surgery Cat. III. complexityfrom 30000—* You can read more about the conditions here - Treatment on credit or in installments
The cost is preliminary. The exact cost of the operation can only be determined by a surgeon during a free consultation.
Diagnostics
If you have the slightest suspicion of the development of Hallux valgus in a child, you should consult an orthopedist. Initially, the doctor will conduct a survey and find out what worries the patient most. Then, both feet of the child must be examined. In this case, the orthopedist pays attention not only to the deformation of the thumb, but also to:
- flattened forefoot;
- the presence of redness and swelling in the projection area of the metatarsophalangeal joint;
- condition of 2 and 3 fingers;
- condition of the skin of the plantar part of the foot.
After the examination is completed and there are signs of hallux valgus, instrumental studies are performed:
- radiography of the feet in 2 projections - the resulting images allow you to accurately determine the angle of deviation of the big toe and the size of the intermetatarsal angle;
- computer plantography is a method that involves obtaining prints of the plantar parts of the foot while standing;
- CT and MRI are auxiliary diagnostic methods prescribed when there is a suspicion of the development of complications and the need to detail the nature of changes in the condition of the bones of the foot and soft tissues.
Thus, examination and diagnosis of Hallux valgus does not cause any discomfort to the child and can, in most cases, be carried out within one day. Based on the results obtained, the orthopedist makes a diagnosis indicating the degree of deformation and prescribes treatment appropriate to the situation.
Treatment of Hallux Valgus
In the early stages of the development of Hallux valgus, treatment is carried out using conservative methods. But the only way to eliminate an already pronounced bump and improve the condition of the foot is surgery. After all, in essence, exostosis is a bone callus. Therefore, no medications, ointments, and especially folk methods can lead to reverse bone resorption (resorption).
But even if there are indications for children, the operation cannot be performed, since the feet still continue to grow and develop. Interfering with this process can lead to even more unpleasant consequences. Therefore, until the bone growth zones are closed in such situations, treatment is also carried out only by conservative methods. The objectives of the prescribed therapy are to prevent the worsening of hallux valgus and to improve the child’s well-being.
Growth zones are areas in the bones that form cartilage tissue, resulting in an increase in bone length. Gradually, the newly formed cartilaginous zones harden and transform into bone tissue.
As part of the conservative treatment of Hallux valgus, children are prescribed:
- custom insoles and orthopedic shoes;
- physiotherapy;
- massotherapy.
If pain occurs, occasional use of NSAIDs is allowed to relieve it. But if a child is diagnosed with gastritis, you should consult a doctor to choose a specific pain reliever.
In general, if they follow all the recommendations received from the orthopedist, children can lead a full life and not deny themselves anything, including sports. But if a child is overweight, it is important to take measures to reduce it. Extra pounds have an extremely negative impact on the condition of the entire musculoskeletal system and can cause the ineffectiveness of conservative therapy or even the development of complications in the form of spinal pathologies.
Radical correction of both the deformity itself and the protrusion formed on the lateral side of the foot is possible only after the final closure of the growth zones. This can be determined by x-rays. At the same time, surgical treatment should not be scary, because today there are minimally invasive, highly safe techniques. In addition, discharge after surgical treatment of Hallux valgus occurs on days 2-7, and rehabilitation is quite easy.
Custom insoles and orthopedic shoes
First of all, children are shown the constant use of individually made orthopedic insoles. They not only prevent further deformation, but also help the foot form in an anatomically correct position. Their use allows:
- create the correct supporting surface of the foot;
- relax overly tense muscles and engage weakened ones;
- restore correct biomechanics of movements;
- reduce the load on other joints of the lower extremities and spine, reducing the risk of complications;
- significantly reduce pain or even completely eliminate it;
- prevent the formation of corns and calluses or reduce them;
- activate blood circulation in the foot and avoid the appearance of swelling;
- increase stability and endurance.
They should be placed in regular shoes, but only with wide toes, or in orthopedic ones. The latter is called shoes made exclusively from natural materials, which have:
- high hard back and thick sidewall;
- widened toe that prevents pinching of the fingers, which is very important for Hallux valgus in children;
- Thomas's heel, whose width on the inside is 1.5 times greater than the outside;
- at least 3 fasteners to securely secure the leg;
- dense, elastic sole.
Special inserts may also be prescribed to form the correct position of the first toe.
Individual insoles are made strictly according to the parameters obtained as a result of computer plantography and the recommendations of the orthopedist. However, they may differ for the right and left legs, which depends on the degree of deformation of each of them. These insoles are made from hypoallergenic, wear-resistant materials and are suitable for any shoe.
Initially, they are worn for 2-3 hours a day, but gradually you need to increase the time to the maximum. Insoles can be transferred from shoe to shoe, but they must be used constantly.
If your foot size increases, you should immediately contact an orthopedist and order new insoles.
Physiotherapy
Exercise therapy is a mandatory component of the treatment of Hallux valgus in children. But classes must be held daily. Otherwise, you cannot count on a positive result. For hallux valgus deformity of 1 toe, physical therapy is designed to:
- eliminate pain, discomfort and fatigue of the legs;
- strengthen the muscles and ligaments of the foot;
- activate blood circulation.
For Hallux valgus, a set of exercises is developed individually, taking into account the degree of deformation, the presence of concomitant diseases, and the age of the child. Initially, it is worth attending special exercise classes, led by a physical therapy instructor. He will help each child learn how to correctly perform the exercises he needs so that they give the most pronounced results. After the child and parents have fully mastered the technique of performing each exercise, they can conduct classes at home in a comfortable environment.
In most cases, the following exercises are indicated:
- Lying on your back, slide the outer edge of the foot along the shin of the other leg, and then change legs.
- Lying on your back, imitate riding a bicycle with your feet, carefully pulling your toe forward when moving forward and pulling it towards you when moving your leg back.
- Sitting on a chair, perform flexion-extension movements with your toes to move the foot, first forward and then back.
- A special rubber exercise machine is put on the big toes, stretching it in different directions. It is important that your heels do not leave the floor.
- After a warm bath or foot bath, place your foot on the knee of the other leg and gently pull your big toe towards you with your hand. In this case, you can lightly press on the joint area, i.e., the place where the lump forms. You need to fixate in this position for 3-5 seconds, and then repeat with the second leg.
- Place a ball or rolling pin on the floor and roll it back and forth with your foot.
- Sit on the floor, put your legs together and actively fan out your toes. This exercise can be combined with preliminary clenching of the fingers into a “fist”.
If a child has flat feet, it is recommended to walk barefoot on the street, if circumstances allow it. Walking on uneven surfaces, bumps, stones, etc. has a very good effect on the condition and process of formation of the feet. An alternative to this can be a special massage mat that imitates various natural uneven soil conditions. You should walk on it daily barefoot, shift from foot to foot, perform sliding movements, etc.
Massotherapy
With Hallux valgus, children are advised to undergo therapeutic massage sessions. They contribute to the proper formation of the feet and strengthening of muscles and ligaments. Initially, the massage is performed by a specialist in the field of manual therapy. But if parents cannot afford to pay for quite expensive massage sessions, they can ask the doctor to train them and carefully observe his movements. After several such sessions, they will be able to independently perform therapeutic massage for the child at home. But still, if you have the financial opportunity, it is better to entrust this task to a professional.
Therapeutic foot massage is carried out taking into account the nature of the existing changes. It always begins with stroking and light kneading, designed to activate blood flow in the foot and prepare the soft tissues for more active action. Subsequently, the doctor can use vibration techniques, massage the fingers, ankle joint, etc. Be sure to actively work on the arches of the foot and the area of the metatarsophalangeal joints. Additionally, massage is performed on the legs, thighs and buttocks, and sometimes the lower back. This allows you to improve the nutrition of other joints of the lower extremities and reduce the risk of them being affected by arthrosis.
Thus, hallux valgus in children can have a significant impact on the course of their lives. But don't despair. The main thing is to pay attention to deviations from the norm in the condition of the feet as early as possible and consult a podiatrist. Pathology of this kind can always be dealt with, and with early diagnosis - only by conservative methods. But even if time is lost and the lump has already formed, it is still possible to cope with the problem. This will require surgery. It has a high level of safety and not only provides an excellent cosmetic effect, but also allows you to completely restore the normal supporting function of the foot.
Diagnosis and treatment
Often, congenital pathologies are diagnosed from the first months of a baby’s life at an appointment with a pediatrician. Symptoms become especially noticeable when the child begins to walk. A preliminary diagnosis is made by a pediatrician, then the child is referred to a specialized specialist - an orthopedist.
The pathology treatment program is selected individually depending on the type and severity of the deformity, the individual characteristics of the body, and the patient’s age. In medicine, a variety of surgical correction methods are used: tendon transplantation, installation of a device for external fixation of the foot, reconstructive operations, etc. The clinic’s specialists pay attention to each patient, selecting the most suitable treatment methods for congenital or acquired deformities.
Make an appointment at the SM-Clinic to learn more about conservative and surgical methods of treating congenital or acquired foot deformities in a child.
Return to the pediatric orthopedics section.
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