General informationHallux valgus or valgus deformation of the foot is a disease which implies curvation of the metatarsophalangeal joint of the great toe and deformity of other toes. Having this disease it is almost impossible to wear usual footwear because of a bunion at the head of the great toe which is accompanied by nagging pain. This problem has been known to the humanity since ancient times. But the first one to describe valgus deformity of the great toe was Ruselo in 1769. In 1871 Hutter introduced the term ”Hallux Valgus” describing it as an abductive contraction with the great toe laterally deviating from the middle plane of the body. The first one to suggest the connection between valgus deformity and uncomfortable footwear was Paul Broca in 1852. Albrecht was the first one to describe foot deformity in Russia in 1911.
Splaying of the forefoot and toe deformities are accompanied by strong pain in joints which affects the support function of extremities, makes wearing usual footwear uncomfortable and in serious cases leads to lower productivity. Valgus deformity of the great toe affects from 17 to 65 per cent of the adult population. More often this disease affects the working-age population and it is highly progressive.
- transverse flat-footeness
- endocrine disorders
How deformity of lower extremities forms
In a normal condition the forefoot support is provided by distal heads of the first and fifth metatarsal bones, distal heads of the fourth, third and second metatarsal bones form an arch whose peak is the head of the third metatarsal bone. According to the research, the maximum load in the vertical position is on the head of the first metatarsal bone (44%), 15% of the load is on the head of the second bone, 11% on the third, 14% on the fourth and 16% on the fifth.If the support surface is even, splaying takes place – adaptation to the horizontal surface. The forefoot widens like a fan and supinates due to heel pronation. And the inner edge of the arch becomes more compressed due to the raise of the first metatarsal head.
Then lowering of the lateral arch and valgus deviation of the great toe take place, if the first metatarsal bone is deviating inwards. This makes the lateral and longitudinal arches more compressed.
DiagnosticsValgus deformity of the great toe is diagnosed based on instrumental examination and clinical data. X-ray research (roentgenography in three projections) and plantography (foot prints indicating lateral deformity of the foot) are conducted. It can indicate inflammation of the periosteum and arthritis (joint inflammation) in this region.
Preventive measures include:
- examination conducted by an orthopedist for immediate detection of flat feet;
- wearing special orthotics;
- wearing comfortable footwear (made of natural materials; no pointed toe and high-heeled shoes;the heel must not be longer that 7 cm);
- if your occupation implies spending a lot of time on foot, you should keep a proper work-rest regime.
Treatment depends on the stage of the disease and pain sensations. It is better to start treatment at an early stage of the disease. This will allow preventing articular deformity. Wearing special orthopedic footwear can also reduce deformation.
Conservative treatment of foot deformities most commonly just reduce pain and inflammation in the region of bunions on great toes. But it’s just a temporary relief which is commonly used as a preoperative procedure. Such procedures include the use of anti-inflammatory medications and physiotherapy. One should mention that steroids such as hydrocortisone, diprospan and kenalog have a good anti-inflammatory effect.
If there are complaints about intense pain during X-ray examination and palpation, surgical treatment is necessary. It implies incision of exostosis and/or restorative surgeries with dissection of metatarsal bones and, if necessary, fixation of bones in accord with the individual presurgical plan. Naturally, it is really important to choose the right type of surgery, to plan step-by-step treatment before and after surgery and to make the patient follow all the recommendations.
We use an individual and complex approach to each patient taking into account all examination results in order to guarantee fast rehabilitation.Just in three days after surgery our patients can walk in special footwear – Barouk shoes which provide a load relief for the forefoot without any additional support or gypsum. And in just 4-6 weeks patients can walk without special orthopedic footwear.