Valgus deformation of foot - symptoms and treatment

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.

 valgus deformity of the big toe feet

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:

  • flat feet: cross, longitudinal, combined; congenital and acquired;
  • osteoporosis: low calcium content in the bones, which leads to a loss of stiffness and change of shape. The cause may be hormonal failure and hereditary predisposition;
  • overweight: at your feet is the limiting potential is the pressure that can withstand, is not deformed. When you reduce the resistance or increase the weight of the ligaments and muscles do not and strongly stretch;
  • genetic predisposition: hyperelasticity of the foot can be congenital. When this muscular-ligamentous apparatus is weak, and the likelihood of developing flat feet increases;
  • walking in the incorrect footwear. Side wear narrow shoes and high heels, because the load on the foot is divided wrong - almost the whole weight falls on the front of the department, and the metatarsophalangeal joint of the first finger;
  • endocrine disorders: the sharp changes in hormonal levels during pregnancy, during menopause and even just his monthly fluctuations caused by the menstrual cycle, can cause weakening of ligaments;
  • leg injury: a blow or the fall of a heavy object on the foot may cause fracture or bruised, which evoke the beginning of the deformation.

Symptoms of valgus deformity of the feet

symptoms of valgus deformation of the

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.

The pathological valgus deformity of the feet

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.

the pathological valgus deformity of the feet

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.

Classification and stage of development of a valgus deformity of the feet

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:

  1. In the first instance a person, as a rule, does not feel discomfort or pain. However, the legs will get tired, long load transfer is no longer so easy. Rentgenograficheski the angle of the arch of 130-140 degrees, and the height of 25 mm.
  2. The second stage is diagnosed by the increase of the angle of the 141-155 degrees and omissions of the vaults from 17 to 25 mm. Appear pain, increasing in load. The first shoes becomes narrow.
  3. The third degree stops completely flattens, the angle of the arch increases more than 155 degrees, and the height of the drop below 17 mm. Constant muscle pain in legs, joints, back. Develop various complications, ordinary shoes can not wear, and to travel long distances impossible.

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 first phase: the divergence of no more than 10-12 degrees;
  • in the second stage, this angle increases up to about 15 degrees;
  • the third stage is characterized by a divergence of up to 19 degrees.

Complication of a valgus deformity of the feet

complications when a valgus deformity of the feet

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.

Diagnosis of valgus deformity of the feet

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:

  • intramural consulting orthopedic surgeon-trauma surgeon;
  • radiography of the feet in 3 planes in order to determine the stage of the disease, as well as the identification of related diseases, which include osteoarthritis, subluxation and dislocation of the joints. The study should be done under load, so as a result of the curvature of the corners may vary about 20%. On the x-ray image performed all the calculations necessary for the determination of tactics of treatment.

Radiography of the foot (direct projection)

rentgenografija feet
  • plantography for the determination of flat feet (footprints);
  • podoscopy examination of the plantar part of the foot in a standing position;
  • if it is necessary to exclude other diseases may be associated with CT or MRI;
  • ULTRASOUND is necessary for storage vessels for suspected violation of blood circulation.

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.

Treatment of valgus deformity of the feet

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;

the scheme of operation McBride

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.

12.08.2018