Valgus deformation of the first (thumb) finger is an orthopedic pathology, in which the finger is deformed, deviating out.Mostly the disease occurs in women after 30 years.In 3%, Valgus deformation is detected in people aged 15 to 30 years, in 9% in those who are from 31 to 60, and 16% in people over 60 years old.The problem causes not only strong aesthetic discomfort, but also provokes a change in all ligaments, tendons, joints, and bones of the foot.
Pathogenesis
With the valgus deformation of the first finger, the angle between the first and second bones becomes more plus, the shift of the first metatarsal bone is observed.The thumb of the foot shifts outward, and the bone head sticks out, forming a bone.This bone does not allow the thumb to match the norm, and it gradually deviates outward.The tubercle (bone) prevents you to wear shoes, creates inflammation, friction and leads to inflammation of the bag of the first metatarsophalangeal joint.Gradually, the bone swells and becomes inflamed, painful.The improper position of the joint provokes its premature wear, lesion of the cartilage and an increase in the size of the bone growth.This, in turn, provokes the trauma of the foot and the further development of pathology.As the disease progresses, the thumb shifts the remaining fingers of the foot, leading to their deformation in the form of a hammer.As the disease develops, it leads to arthrosis of the plusnoplange joints, inflammation of the articular bags, the joints of the fingers, chronic inflammation of the bag of the first metatarsophalangeal joint, the displacement of the first metatarsal bone, Flat pedes (chronic and transverse), bone and Cartilage augmentum headMetatarsal bones.
Forms
In normal condition, the metatarsal bones are parallel to each other.Under the influence of certain reasons, the first Metatarsal bone deviates out and because of this, a small bump appears on the foot, the ligaments and tendons lose their elasticity, their dysfunction develops.
The disease passes several stages:
- Early.At this stage, the deviation of the thumb of the foot is less than 15 degrees.
- Average.The deviation of the first finger to the side is from 15 to 20 degrees.At the same time, deformation of the second finger is observed.It rises above the thumb and becomes like a form to a hammer.
- Heavy.The deviation of the thumb is 30 degrees.All the fingers of the foot have already been deformed, and at the base of the first phalanx there is a large bone growth.In places where there is a large voltage of the foot, gross corns appear.
Reasons
The main provoking factor in the appearance of valgus deformation is irregular shoes.If a person wears tight shoes with a narrow toe or high -heeled, then the fingers are constantly in the wrong (compressed) position, which contributes to the development of valgus deformation.But not only this becomes the cause of the development of the disease.The following reasons affect the appearance of pathology:
- traumatic damage to the lower leg and foot;
- rickets;
- Cerebral palsy;
- polyneuropathy;
- low arch of the foot;
- flat feet;
- congenital weakness of the muscle-ligamentous apparatus;
- chronic joint inflammation provoked by psoriasis;
- arthritis;
- multiple sclerosis (accompanied by damage to the shell of nerve fibers);
- diabetes mellitus;
- gout (deposition of urates in the tissues of the body);
- Hyper of the joint mobility observed during Marthans and Down syndrome;
- youthful foot (rapid increase in the size of the foot in the teenage period);
- Charcot-Mari-Tuta disease (hereditary neuropathy, accompanied by atrophy of the muscles of the distal limbs);
- osteoporosis (bone loss);
- Stop overstrain in connection with professional activities (waiters, athletes, ballerinas).
In the presence of provoking factors, the disease progresses rapidly.
Symptoms
The symptoms of pathology depends on the degree of damage to the foot.At the first stage, redness, swelling of the tissues in the appearance of the bone, pain in the phalanx of the fingers, intensifying during walking are observed.At the average stage of development of the disease, pain, swelling, bone growths in the area of the plus bone, dry corn under the middle phalanx of the finger appear.In the heavy stage in the sole of the foot and in the thumb, severe, exhausting pains appear.Dry corns are formed, and keratinization of the skin appears under the second and third phalanges of the fingers.
Diagnostics
Diagnostic measures begin with the collecting of the patient's anamnesis.The doctor asks him about disturbing symptoms, is interested in what provokes their appearance (leg load, walking, cramped shoes), there are metabolic, systemic diseases in the medical history, injuries of the lower extremities, hereditary diseases of the bones.Next, an external inspection is carried out, during which a person is asked to go through.The doctor watches the patient’s gait, while determining the intensity of pain.The position of the thumb of the foot is studied, its location relative to other fingers, explore the range of its flexion and extension.The presence of other external symptoms (swelling, redness, thickening of the stratum layer under the bones of the fingers) is checked.The footenography of the foot is performed in three projections in order to identify the degree of deformation of the foot, dislocation of the joint and related pathologies.An ultrasound of the vessels is carried out to exclude circulatory disorders in the legs.
Treatment
Therapy of valgus deformation of the thumb of the foot is traditional and operational.In the early stages, when you can do without surgery, doctors advise choosing convenient and correct shoes.She should not please the load on the foot, friction.Comfortable shoes slows down the progression of the disease.At the same time, the doctor will advise to purchase special orthopedic devices:
- gaskets for the joint bag of the thumb (they eliminate the pressure of the shoes);
- Intodassen rollers, spacers that contribute to the correct distribution of the load on the foot.
All orthopedic devices reduce pain, but it is impossible to completely get rid of discomfort with their help.To eliminate pain and inflammation, non -steroidal anti -inflammatory drugs, corticosteroid injections are used.To relieve spasms and restore joint mobility, massage and special gymnastics are prescribed to relax the feet.
The effectiveness of physiotherapy
An important role in the treatment of valgus deformation is played by physiotherapy.To eliminate the disease, doctors prescribe electrophoresis with calcium, phonophoresis of hydrocortisone, paraffin and ozokeritic applications.One of the most effectiveMethods for eliminating the valgus deformation of the thumb of the foot is shock wave therapy (UVT).This procedure implies a short -term effect on the painful zone with acoustic low -frequency pulses.With the help of UVT, pain symptoms are eliminated, the effects on the factors that contribute to their appearance are obtained.The procedure is carried out using a special device generating shock waves.They affect only pathological areas, without affecting healthy tissues.With the help of ultrasound, metabolic processes improve.UVT is not carried out in the presence of neurological, infectious, oncological, heart, somatic diseases, diabetes mellitus, blood coagulation disorders.Shock-wave therapy is not prescribed for pregnant women, nursing women and children under 18 years of age.The effect of the procedure is observed after several procedures.Pain disappears, it becomes easier to walk.But it is impossible to completely remove the protruding bone using one UVT procedure.The doctor can prescribe at least 5-7 sessions.Depending on the stage of the disease, the procedure for conducting procedures is also prescribed.Some people are prescribed daily sessions, others will be enough for one procedure per week.The result of the treatment of UVT is held for a long period.
Surgical treatment
With an average and severe degree of valgus deformation of the thumb of the foot, surgical treatment is prescribed.To eliminate the pathology, many methods have been developed by which they achieve the following goals:
- eliminate Bursitis of the first finger of the foot;
- Bowing muscles located around the damaged joint to prevent relapse of the disease;
- Carry out the reconstruction of the bones of the thumb.
If the deformation is not strongly expressed, the growth of the growth on the joint bag through a small incision is removed.After the operation, a person needs rehabilitation, with the obligatory wearing of a bandage or shoes with a wooden sole, using the proofreaders of the foot, physiotherapy (at least 6 procedures).Currently, with the valgus deformation of the thumb, the following operations are performed:
- Small deformation correction.Small cuts are made on both sides of the thumb, through which, with the help of miniature mills, the position of Metatarsal bones and phalanx of the finger.
- Chevron-oosteotomy.The operation is performed with a finger deviation of no more than 17 degrees.The growth is excised, and the phalanx of the thumb is fixed with a screw and a titanium wire.After a while, the structure is removed.
- Scarf-oosteotomy.The operation is carried out if the angle of deviation of the thumb is 18-40 degrees.During the intervention, using manual exposure, the position of the Metatarsal bones is corrected, and then fix it with two titanium screws.
The protruding bone of the thumb of the foot is not only aesthetically ugly, but also causes many inconvenience when walking.The disease that has not finished treating leads to complications in the work of the entire musculoskeletal system.Therefore, everything should not be allowed on a gear and contact an orthopedic if the first signs of deformation appear