A Valgus deformity of the foot is a complex disease that manifests itself in the cross and longitudinal flat feet, curvature of the first finger, the formation of bone wounds and the violation of its own muscle-ligamentous balance.
The disease is accompanied by flattening of the feet and their slope to the inner part.
According to statistics, among the many orthopedic diseases of the feet a leading place occupies the cross-spread deformities of his front department, which accompanies the reaction of hallux valgus (outward) deviation of Ukraine to your finger. For the first time pathology was described more than 200 years ago and to this day is about 80% of all the possibilities of deformation of the feet. To a greater extent, this pathology affects women around 98%.
In everyday life people call it a disease differently gallux, hallux, pine cones on your finger, the curvature of the first finger and so on and so Like not the name, but the essence remains the same: the first finger is deviating to the side of the other, and takes place the deformation of the metatarsophalangeal joint (the bump). In addition to the aesthetic component, the disease causes a person discomfort and discomfort when walking.
Issued to many reasons, which lead to the curvature of the legs, but they rarely occur isolated:
In the initial stages appears fatigue during walking, corns on the stop, and availability of peeves from the inner side of the first metatarsophalangeal joint. There is pain in the joints, the thumb is deviated to the side, appears a bump on the inner side. Together with the first finger is deformed and the other, they become like a hammer.
The pain gets stronger, the first shoes become narrow, and pick up comfortable shoes is practically impossible. 'With your fingers on the legs and thickened soft tissue becomes painful and inflamed. It is formed by bunions, which may become chronic.
The back of the front legs too crooked, that it looks like an unusual clubfoot deformity was. The pain intensifies and begins to appear in the quassae and ankle joint. If left untreated, the overloaded knee, hip joints and spine. Sometimes, ingrown nail of the first finger, which creates discomfort when walking.
Initially, the sick usually troubled just a cosmetic defect deviation of the first finger and the bone of the game result on the inner side of the joint. This is especially noticeable when wearing open-toed shoes, a visit to the beach or the pool. This is what many women come to a specialist a podiatrist.
Due to the weakening of the muscular-ligamentous apparatus of the legs and irregular load is to change the points of support and the flattening of the transverse and longitudinal arch.
The load and the dependence of the passes at all the metatarsophalangeal joints, which leads to a fanlike divergence of the bones of the front separation on the legs. Occurs imbalance of muscle strength that holds the first finger exactly, consequently, deviates, and the curvature progresses.
A significant shift of the bones of the first finger outwards is considered a shift by more than 10 degrees. Parallel changes occur in the capsule-ligamentous apparatus of the sprain outdoor flag, offset sesamoid hammocks.
Even the cross-contradiction contributes to the development of metatarsalgias pain in the area of II-IV metatarsal bones due to excessive load, as is normal in the front department, the main pillar falls on the head I and In.
In addition to the metatarsalgias are formed in the form of a hammer the second, third and even fourth fingers due to the increased tension of the tendons of the leg flexors and natahovačů. This leads to sprains and contractures in the respective joints.
The deformation of the (receding) middle department of the foot occurs when the weakening of the ligamentous apparatus Shaparova joint. This pathology occurs rarely and is usually the result of injury.
The back department is also subjected to change: it is distorted in the area of the heel bone occurs her pronation (internal rotation), while increasing the which it is diagnosed subluxation in quassae joint.
According to the department of the deformation of the legs, front or rear, to distinguish individual stages of the disease. For the determination of the phase is necessary to radiograph in two planes and examination of the trauma surgeon-orthopedist.
In the deformation of the first finger there are three stages on the basis of the angles of deviation:
I degree, II. degree and III degree;
Interstitial angle of 12°, 18°, 18°, respectively;
The angle of the valgus deviation of the first toe: 25°, 25° and 35°, respectively.
There is another classification of the extent of the deformity of the hallux, where it is evaluated only interstitial angle. It is less precise and is used for the primary diagnosis:
Even articles about 15 degrees;
II century 20 degrees;
III century 30 degrees;
IV of the century of more than 30 degrees.
For the characterization of the deformation of the rear department for the AD to stop there is its classification, and one of the indicators included the installation of the heel to the axis of the shins:
The stage stop is set to tag all, but the deviation small: 10 to 15°;
Stage II is the angle is 15-20°;
III degree of curvature of 20-30°, and it still can be eliminated;
IV grade heavy grade, the dog completely divorced, and deviations from standards is equal to 30° and more.
Of course, it is necessary to distinguish the degree of actually flat foot (transverse and longitudinal) the culprit of all the tension, as they are in direct connection with him.
In the process of flattening of the longitudinal arch of the foot touching the floor the whole flat of the foot. Little increasing the length of the foot, as the state will disappear. In this process there are three phases:
When the cross state becomes more flat the process of adoption of flat feet is characterized by the divergence of the fingers and increasing the width of the legs. So the definition of the severity of the flat feet on the basis of the measurement of the angle between 1 and 2 metatarsal bones:
The most common complication is inflammation of the synovial bags (bourse).Manifested by hyperemia, swelling, pain that gets worse during agitation.
Another common complication is the development of arthrosis of the first metatarsophalangeal joint destruction of cartilage, formation of bone of exostosis (growth), decreased mobility and the beginning of the pain.
Osteoarthritis of the first metatarsophalangeal joint
If to summarize the rest of the violations, then it is the defeat of the joints of the foot, and generally a violation of the courses. In advanced cases suffering from knee, hip joints and spine, which affects the articular arthrosis sufferers and their deformation.
A common complication is a heel spur, which arises due to the stretching of the plantar fascia. Patients suffer when this sharp pain when walking in the heel area. Sometimes it arises Achilles bursitis - inflammation in the Achilles tendon. So, early treatment leads complex complications that require further treatment.
To determine the adequate treatment and to prevent progression of the disease is necessary to conduct a full examination of the patient, to determine the causes of deformation and to determine the stage of the process.
The main methods of diagnosis:
Radiography of the foot (direct projection)
After the examination is required differential diagnosis to rule out diseases with similar symptoms (arthritis, gout, deformed osteoarthritis). For this, it's called laboratory tests: the factors of inflammation, specific markers and the clinical warehouse.
In the last hundred years surgery legs not only has not lost its relevance, but also makes continuous steps forward, with the advent of better tools and fixers. This place has developed more than 400 types of operations and their modifications with the aim of correction of the deformation of the different divisions of the foot.
When the initial changes can not do surgery McBride, method, Silver, method Rv Rv Vreden. When this bone is not cut, and changing the place of insertion of the tendon of the head of the muscles of the thumb. Renewal time is minimal and amounts to 2-3 weeks.
The scheme of operation McBride
If it is diagnosed II and III level, then performs the more traumatic the operation of the osteotomy (cut bone) with the exhibit the right angle also with screws or spokes. There are many methods for the correction of the first finger:
The distal (applies if the angle is between 1 and 2, the metatarsal bones no more than 14°): operations qui Effusus est removal of exostosis (bumps), caput continentiam wedge osteotomy on the J. Reverdin, operation T. R. Allen, the operation D. Served Austin (Symbol osteotomy);
Diaphyseal (applies if the angle is between 1 and 2 metatarsal bones from 15° to 22° Z-shaped osteotomy M. Meyer (scarf), operation Kb. Ludloff, osteotomy C. L. Mitchell;
The proximal (the angle between the I and II metatarsal bones of more than 22°): a double osteotomy on Logroscino, wedge osteotomy M. Well, He, E. Juvara, osteotomy on Serving Patton and J. E. Zelichowski;
Sometimes in the presence of deformation of the main phalanx of the first finger is the need for additional osteotomy Of the. F. Akin (Moberg).
Selection is a traumatologist-the orthopedist, due to the localization of the major changes, the coincidence of the first metatarsophalangeal joint (the articular surfaces) and the severity of the pathology.