Bunion (hallux valgus)

Bunion (hallux valgus) causes

Most often valgus foot is hereditary. Short and tight shoes can serve as a precipitating factor for the occurrence of deformation (especially women). The degree of foot deformation may range from a slight deflection of the finger to a significant displacement of all the first metatarsophalangeal joint.

The emergence and development of hallux valgus is due to the deformation of the forefoot that is associated with changes in the middle and rearfoot.

When deletion of the lowering of the longitudinal arch and heel inward (pronation) is shifted inwards midfoot, especially talus and the navicular bone, as well as its extension due to hyperextension of the ligamentous apparatus. There is an increase of pressure on the part of these bones in the cuneiform bones, which in turn acts in the Lisfranc joint (joint located between the bones of the tarsus - three cuneiform and cuboid one - and metatarsals) based on the I-IV metatarsals. Shifting the bases and pushing I-IV metatarsal bones outwards, pronation them where the pivot point is the head of the bone. There is a reduction of I-IV metatarsal bones in the distal deviation outwards in proksamalnoy parts and pronation.

The fifth metatarsal is experiencing less pressure on the part of the midfoot, as participates in the formation of the outer arch itself carries the load. Its base is articulated with reference cuboid bone, which is located medial to the base V metatarsal bone. V metatarsal cuboid bone to hold strong instep-cuboid ligament. The fifth metatarsal bone throughout tends to move laterally relative to the average department. Thus there is a tension of the muscle abductor thumb sesamoid bone and first finger are displaced outwards, and there is a dependency subluxation sesamoid bones of the degree of displacement of the fifth metatarsal bone outwards. Abductor muscle tension first finger sposobstvut supination of the fifth metatarsal bone.

The deviation of the big toe outward tension of the muscles contribute to tapping the thumb and the muscles razgebatelya length of the thumb, which is shifted with respect to the above first metatarsal bone.

Offset bases I-IV metatarsal bones and bringing them due to the fact that the angle between them when expressed strains varies less than the angle between the metatarsal bones IV.

Thus, there is a displacement inwards substantially only the forefoot in relation to the average. Thus the angle between I and II metatarsal bones will change little. In this situation, extensor digitorum longus tendon, leaving the displaced and the grounds metatarsal bones, promote a shift finger outwards, but because of the flattening of the transverse arch II-IV fingers move up and more. The tendon of the long razgebatelya fifth finger, moving inwards relative to the entire calcaneus metatarsal bone, helps bring and subluxation of the fifth finger inwards relative to the head of the metatarsal bone.

Patients with hollow soles occurs isolated load on the forefoot. They have been isolated from the flat cross-hallux valgus deformity of the first finger.

Hollow foot is formed due to deformation of the foot when the height and the curvature of the longitudinal arch increases.

 

Bunion (hallux valgus) clinical manifestations and symptoms

Characteristic features are- subcutaneous "bump" on the inner surface of the head of the first metatarsal bone, the outer offset of the first finger, often with hallux valgus rotation of the latter. Irritation tissue medial first metatarsophalangeal sustva can cause medial bursitis, accompanied by inflammation underlying tissues, or neuritis of the medial cutaneous nerve of the rear. Patients noted a progressive increase in the width of the foot, which causes difficulty in selecting and wearing shoes.

The deviation of the first metatarsal bone (Metatarsus varus) deformtsiyu increases, which in turn, causes a restriction of movements in the first metatarsophalangeal joint as a result of osteochondral exostosis (growths). Changes in the articular surfaces is the cause of Hallus rigidus.

 

Disorders associated with bunion (hallux valgus)

Valgus deviation of the I toe (Bunion (hallux valgus)) is accompanied by numerous violations:

• hammertoes deformation of the second finger - lateral deviation of the thumb can deform the second, third and sometimes a fourth fingers, the second finger moves above or below the first finger or fingers in close contact with each other
• callosity (plantar hyperkeratosis) formed under the heads 2, 3, 4 metatarsal bones; formation callosity due to the excessive pressure on the metatarsal heads of the soft tissue when standing or walking
• central metatarsalgia (pain in the midfoot) develops as a result of failure of the first beam; carrying loads on the head of the second, third and fourth metatarsal bones causes local capsulitis and synovitis of metatarsophalangeal joints relevant
• pronated foot - pronation is a consequence of the weakness of the ligamentous apparatus of the foot
• equinus foot - is due to the enhanced traction of the gastrocnemius and soleus muscles; equinus foot evident limitation of flexion of the foot, followed by developing its pronation
• ingrown toenails - one of the causes of ingrown nails on the foot is a valgus deviation of the first toe

 

Bunion (hallux valgus) treatment options

When symptoms of hallux valgus foot begin to affect quality of life, the beginning of the treatment involves wearing a wide, soft, low-heeled shoes, the corresponding shape of the foot, as well as the use of individual orthopedic insoles, inserts, soft pads under the "bump" analgesics.

 

Displaced toe and foot deformation evaluation

To assess the foot deformation is consulted an orthopedic specialist. Clinical examination feet held to the presence of radiological images in dorsoplantarnoy and lateral views under load on the forefoot, better standing. Then, using X-rays measured degree of deformation.

Grade I of deformation:

• I toe outward deflection (angle M1-P1) < 25°
• deviation I metatarsal bone medially (angle M1-M2) < 12°
• angle PASA - normal or negative

II degree of deformation:

• I toe outward deflection (angle M1-P1) > 25°
• deviation I metatarsal bone medially (angle M1-M2) < 18°
• angle PASA - normal or negative

III degree of deformation:

• I toe outward deflection (angle M1-P1) > 35 °
• deviation I metatarsal bone medially (angle M1-M2) > 18°
• angle PASA - negative

 

Bunion (hallux valgus) conservative treatment

Bunion (hallux valgus) conservative treatment is performed in the disease beginning and is used as a preventive antiprogressiruyuschee event will offload the forefoot, reduce pain (metetarzalgiya) slow deformation of the toes. For konsrevativnogo treatment it is necessary to wear orthopedic insoles, InterDigital partitions and other offsets that can be purchased in orthopedic showrooms.

Bunion (hallux valgus) conservative treatment cases show failure patient from surgical correction. For this mspolzuetsya free shoes with a wide toe, soft insole. Changes may be needed shoes - tensile relief in pressure points or her individual production.

Other ways to relieve pain during metatarsalgia:

• pad on the "bump"
• bandaging the feet overnight
• bandages
• foot massage
• foot baths

 

Bunion (hallux valgus) surgical treatment

The indications for surgical treatment of hallux valgus foot are:

• congruent or not congruent joint with Bunion (hallux valgus) angle of 30 ° and intertarsal angle up to 13 °
• mild, moderate and severe foot deformity
• rheumatoid arthritis
• post-traumatic arthritis
• revision of failed previous surgery

Bunion (hallux valgus) surgical treatment patient involves three stages - preoperative preparation of the patient, the stage of surgical treatment and rehabilitation period the patient after it conducted a planned operation.

Preoperative preparation of the patient:

• Operations planned, ie carried out when it is convenient to the patient (as the rehabilitation after the surgery takes 3-6 weeks)
• Before the operation, it is necessary to make a stop in the X-ray projections 2 (straight, lateral)
• With executed radiographs must visit podiatrist for foot clinical examination, diagnosis, surgical treatment of choice, obtain comprehensive information for the operation and rehabilitation
• Complete standard preoperative examination (blood, urine, chest X-ray, ultrasound of lower limb veins, medical consultation, the anesthesiologist)

Surgical treatment:

• The operation is performed on the day of admission
• For small operations may conduct conductor (local) anesthesia, but in most cases, spinal (epidural) anesthesia
• The duration of operation of 30 minutes to 2 hours (two foot)
• If the "bumps" on both legs, it is better to operate right foot 2
• Titanium screws after surgery to remove unnecessary. Titanium - inert material for bone. No complications screws do not give, do not "link" the passage of the magnetic frame (at the airport)
• Hospital stay - no more than 1-2 days
• Minor pain after surgery, and then only in the first day (held adequate analgesia)
• Walking is allowed from the first day after surgery, but you can only go in a special post-operative orthopedic shoes, which relieves forefoot (shoes Baruk)
• Wearing a special postoperative orthopedic shoes for 4-6 weeks after surgery
• No crutches and plaster is not required
• Always after the operation carried out antibacterial, anti-inflammatory, anticoagulant therapy
• Ligation after the surgery done 1-2 times a week; self-ligation forbidden to do, dressing only carries the operating doctor as bandages perform important functions fixing
• Removal of sutures - 12-14 days after surgery
• Fixation bandage - 3 weeks after surgery

The rehabilitation period after surgery:

• After 3 weeks after surgery to begin the development of the movements of the fingers
• Feet edema after any operations in the hallux valgus is held for a long time (sometimes up to 3-4 months after surgery). Therefore, in the first weeks after surgery required Kholodov applications on the foot, a minimum distance, and elevation of legs
• Walking in the shoes without a heel - 4-6 weeks after surgery
• Car driving advisable 4 weeks after surgery
• 2 months after the operation needs be sure to wear insoles insoles (optimally produce customized insoles - directly in your footsteps)
• Wearing shoes with heels - no earlier than 4 months after surgery, the heel height is recommended - no more than 3-4 cm
• Sporting load allowed 5 months after surgery