An orthopedic disease of the lower extremities, which is characterized by deviation or abduction of the toe into the foot, caused by deformation of the metatarsal joints, is called hallux valgus. The disease causes damage to all parts of the foot - bones, ligaments, tendons and joints - and leads to serious problems with walking.
Hallux valgus code ICD-10 Q 66, ICD-10 Q 66.5, ICD-10 M 21.0, ICD-10 M 21.4 is one of the most common diseases of the lower extremities of children and adults. Depending on the etiology, the deformation occurs:
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A flat-valgus foot (synonymous with flat feet) can be the cause or consequence of a valgus deformity of the foot in the form of deviation of the big toe with the formation of a lateral bone (bump, growth), which is typical for adults, especially women over 35 years of age.
Depending on the severity of the disease, the big toe can be deviated at different angles - less than 20°, 25-35°, more than 35°. Factors that provoke the development of hallux valgus with abducted finger:
According to code M 21.4 ICD-10, flatfoot deformity is classified into transverse, mixed and longitudinal flatfoot. Quite often children suffer from hallux valgus deformity. The reasons that provoke the development of flat feet in children are:
Congenital hereditary or pathological valgus foot deformity in children with ICD is difficult to diagnose, since by the age of three years the child has all the signs of a flat foot on the lower extremities. In three percent of cases, the diagnosis is disappointing - congenital planovalgus deformity. In the future, adolescents with this disease will require more complex treatment than young children, so at the first sign of the disease you should consult a doctor. The specialist will make a diagnosis and choose the most effective treatment regimen.
It is quite difficult to recognize a congenital or acquired type of pathology in a young child in a timely manner. Generally, the diagnosis of planovalgus deformity is given to children aged 5-7 years. The main signs of the disease are turning of the heel and toes, emphasis when walking on the inner or outer arch of the foot, compaction of the sole, and rapid fatigue. The same symptoms accompany adults, but in addition to them, abduction of the thumb may occur.
Establishing a diagnosis using radiography, podometry and computer plantography allows you to promptly choose a treatment method in order to prevent surgical intervention. Ignoring treatment for flat feet leads to dangerous disorders in the development and functioning of the musculoskeletal system.
The orthopedic disease, popularly known as bunions, is called hallux valgus. Many consider this unpleasant phenomenon to be a cosmetic defect, but in fact, inflammation develops in the joint.
Bursitis of the big toe can be cured without surgery at an early stage of the disease, before the negative changes become irreversible. Delay in visiting a doctor often leads to the need for surgical intervention.
A bunion is an unsightly formation that worsens the appearance of the foot and causes discomfort when walking. A patient suffering from bursitis of the first toe cannot wear nice shoes, and painful sensations occur in the feet while moving.
Hallux valgus is not just a defect, it is a signal of a metabolic disorder and an incorrect lifestyle. The main category of patients are women aged 45–50 years and older, often with excess weight and endocrine pathologies.
It is not difficult to recognize an orthopedic disease: with hallux valgus, the first toe bends, looks inward, and the joint protrudes outward. The stronger the degree of damage, the more the bone “sticks out.” With I degree of pathology, the angle of deviation of the thumb is 15 degrees, with II – 20 degrees, with III – 30 degrees. The displacement of the 1st finger in IV, the most severe degree of valgus deformity, is more than 30 degrees.
Doctors identify two main reasons for the development of joint pathology:
Patients often do not know that their usual activities or lifestyle can cause an orthopedic disease. The sooner it becomes clear what causes hallux valgus, the easier it is to give up some habits and reduce the risk of an unpleasant, painful formation.
The combination of negative factors leads to a change in the angle between the first and second metatarsal bones and displacement of the elements of the foot. The head of the protruding joint is an unsightly “bump” protruding under the skin.
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At the first signs of hallux valgus in the thumb area, most patients self-medicate. Miracle ointments, medicinal baths, patches for bone resorption, and other methods are used.
Sometimes the deformation stops, but, more often than not, the disease progresses against the background of negative factors that worsen the health of cartilage and bone tissue, as before. Only an experienced doctor will study the problem and develop a treatment regimen.
Diagnosis of the disease and treatment of pathology is carried out by a surgeon or orthopedic traumatologist. Bursitis often requires the help of an endocrinologist and therapist.
Conservative therapy is effective for grades 1 and 2 hallux valgus. It will take maximum effort on the part of the patient, discipline, and strict adherence to treatment recommendations. Traditional methods are ineffective; compresses, baths, and homemade ointments slightly reduce inflammation and reduce pain, but they cannot be used as a basis.
The main emphasis is on the following methods:
In case of severe, stage 3 and 4 pathology, displacement of the thumb by 30 degrees or more, conservative therapy does not have a positive effect on the condition of the problem joint. A pronounced valgus curvature is a reason to make an appointment with an orthopedic surgeon.
Operations to excise a painful “bone” have long been deleted from the list of dangerous ones that provoke serious complications. Modern methods return the patient the joy of movement, remove the unsightly tubercle on the side of the foot without serious consequences for the body.
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Common methods of surgical intervention:
After surgical treatment, the patient undergoes rehabilitation to restore foot function. It is recommended to wear special shoes during the day, be sure to apply a special splint at night, and take analgesics and antibiotics to prevent inflammation in the operated area.
If the technique is strictly followed, 3 weeks after the operation the person returns to normal life, forgetting about discomfort when walking and pain.
Congenital foot abnormalities and hereditary predisposition are factors whose effects cannot be prevented. Age-related changes can be corrected if a person leads a correct lifestyle and monitors his health.
After studying the list of causes that cause hallux valgus in the area of the first toe, it is easy to notice: you can mitigate the effect of some factors and prevent the development of orthopedic pathology. Surgeons and orthopedists advise monitoring the condition of the musculoskeletal system and paying attention to the first signs of inflammation in time.
Is it possible to get rid of a bunion on the big toe without surgery? About the features of treatment of hallux valgus in the following video:
Hallux valgus is an orthopedic disease that manifests itself in a pathological change in the shape of the toes, in which they occupy a position at an angle to each other. The most common form of the disease is hallux valgus, which can be easily identified by its external sign - a tubercle protruding to the side in the area of the toe base.
The pathology not only brings discomfort while walking and spoils the aesthetics of appearance, but also leads to the development of arthritis, bursitis, circulatory disorders, and injuries in the ankle area. The causes of hallux valgus (Hallux valgus) are:
There is numerous evidence of the fact that ballerinas, as well as women who prefer to wear high-heeled shoes, are significantly susceptible to the disease. An imbalance of the ligamentous-tendon complex, which develops with excessively high elasticity of the joints, leads to transverse flatfoot, and as a consequence, to Hallux valgus.
The slow progression of the disease does not always allow diagnosis at an early stage, when the deformity can be corrected through the use of conservative therapy and orthopedic devices (orthoses). A soft formation that appears at the base of the first finger is often mistaken for a callus, and traditional methods are used to get rid of the defect. Naturally, such treatment does not produce results - over time, the tubercle hardens, increases in size, and causes pain when walking.
In the next stage, the first toe becomes noticeably curved, deviating toward the outer edge of the foot and displacing the remaining toes. The metatarsophalangeal joint is subjected to excessive loads, which leads to inflammatory and degenerative processes in the bone tissue (Hallux rigidus). When the big toe is deviated by an angle of more than 30 degrees, deformation of all toes occurs (hammer toe, corns, ingrown toenails).
In orthopedics, there are three degrees of Hallux valgus:
The degree of deformation of the osteoarticular complex is the main factor when choosing surgery for hallux valgus.
The main indication for surgery is pain and discomfort when walking, the development of inflammatory and destructive changes in bone tissue. Hallux valgus deformity of the foot (Halus Valgus) can be treated conservatively only in childhood and early adolescence, before the formation of the skeleton is complete.
In an adult, you can only stop the progression of the pathology, partially relieve pain, restore the physiological load on different parts of the foot, and also prevent the development of serious complications. For this purpose, orthopedic devices (insoles, inserts, clamps, bandages) are used. The problem with Hallux Valgus can only be completely solved by surgical methods.
The surgical plan is developed individually for each patient, since this type of pathology is characterized by a wide variety of manifestations and complicating factors, the most common of which are: bursitis of the small toes, arthrosis of the metatarsophalangeal joint, osteomyelitis, arthritis, soft tissue infections.
The choice of surgical technique is determined by the nature of the pathology, the severity of tissue damage, and the presence (absence) of relative contraindications. At the first stage, a gentle technique (mini-invasive) is used, in which soft tissues and tendons are minimally affected.
The purpose of the operation is to restore the aesthetics of the appearance of the foot and eliminate discomfort when walking. This type of surgery allows you to quickly restore your physical shape and endure the rehabilitation period painlessly. At the same time, the possibility of developing a secondary process of hallux valgus in the distant future cannot be ruled out. For grade 3 hallux valgus deformity, minimally invasive techniques are not used.
The first stage is the excision of the bone growth and subcutaneous mucous bursa adjacent to the base of the first metatarsophalangeal joint. The operation is performed under X-ray control (EOC), without open access to the surgical field. To carry out the manipulations, two small punctures are made on both sides of the first finger (3-4 mm).
Using micro-instruments, the joint capsule is opened, a lateral release is carried out (the correct position of the axis of the first finger is restored), part of the bones are filed using micro-mills - to completely eliminate the deformity of the thumb. Minimally invasive surgery does not involve the use of fixations (pins, screws, plates or staples).
The reconstructive surgery technique includes the following steps:
The metatarsal bone is sawed using one of the following methods:
The operation to remove the bunion of the thumb (halux valgus) is as follows:
An important point is that when performing a chevron osteotomy, the surgeon constantly monitors the position of the sesamoid bones using an image intensifier X-ray, given that the area of their displacement is limited.
The type of anesthesia (local anesthesia or general anesthesia) is selected individually, according to medical indications, and with mandatory agreement with the patient.
Absolute contraindications to surgery are:
Arthritis and arthrosis are not contraindications to surgical treatment, but when choosing a surgical technique, possible complications during the surgery itself and during the rehabilitation period are taken into account.
After reconstructive surgery, the same complications that are observed with any abdominal surgery may develop:
The listed complications occur rarely; in general, patients tolerate the operation well, both young and old.
On the first day after surgery, bed rest is indicated. Light development of the foot can be done - the patient moves his toes several times a day. Walking is allowed on the third day, and only in a special orthosis, which removes the load from the operated part of the foot.
Restoration of normal walking mode (without using an orthosis) - no earlier than after 6 weeks. Complete rehabilitation is achieved within 4-6 months (after this period, you can actively engage in sports and wear high-heeled shoes). The length of stay in the clinic under the supervision of a doctor is from 10 days to two weeks. The patient should be aware that swelling in the foot and lower ankle after surgery can persist for quite a long time, up to three months. To reduce swelling, log compresses are used during moments of rest.
To speed up the rehabilitation process, the leg (in a lying position) is kept at a height. If the recommended loads are exceeded, a burning sensation and pain in the foot area may occur, which is sometimes caused by displacement of the fixator. You should take medical indications after surgery responsibly - the speed of recovery depends on the punctuality of compliance with rehabilitation requirements.
To increase the efficiency of tissue healing and restore the functionality of the foot, shock wave therapy sessions, massage (at least 15 procedures) of the leg (from foot to thigh), electrophoresis, and physical therapy are used. Two months after surgery, the recovery program includes swimming and exercise on an exercise bike.
Judging by patient reviews, surgery to correct a deformed thumb allows you to return to your normal lifestyle, wearing high-heeled shoes, without experiencing pain or skin irritation. The aesthetic appearance of the foot is completely restored; relapses do not develop when titanium fixators are used.
The cost of the operation depends on the status of the medical institution where treatment is performed, the degree of destructive changes in the osteoarticular complex, the presence (absence) of complicating factors, and the type of surgical technique chosen. The average price of surgery is 35 thousand rubles, but this amount does not include the cost of the rehabilitation period. “Surgery plus recovery” is the average amount of the order.
A lot of time passes between the birth of a baby and the end of his first year of life. During this period, the baby learns to live in a new world and walks awkwardly. If your baby's gait has not changed for the better (the child continues to step on the inner surface), pay attention to the fact that your baby may have a hallux valgus deformity.
Do not panic! Flat valgus pathology is treatable. Visit your pediatrician immediately; the doctor will carefully examine the baby’s condition and prescribe appropriate treatment. In most cases, the use of orthopedic shoes and special gymnastics are required; only in advanced situations is surgical intervention necessary.
What is hallux valgus in children? The pathology is an inward curvature of the lower leg and foot, accompanied by outward deviation of the heel and toes, a decrease in the arch, and the size of the baby’s foot itself. Some call the disease the “butterfly effect” due to the fact that the back of the foot looks like an insect. The depression between the heel and toes of the child practically disappears. If you put the baby on his feet, the outline of the letter “X” appears.
For what reasons does a defect occur in children? The root of the problem lies in the structural features of children's feet and the impact of negative external factors. Doctors distinguish two types of hallux valgus in children:
Doctors identify several main factors leading to the development of hallux valgus in a child:
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Sometimes hallux valgus in children is accompanied by other diseases of the musculoskeletal tissue. The approach to treatment must be comprehensive; the root cause of the development of the defect must be eliminated; this is the only way to completely return the child’s legs to their previous appearance.
Hallux valgus is normal for children under three months of age; the pathology is caused by hypertonicity in newborns. The defect occurs very often and goes away on its own before the age of six months. The pathology should not be confused with clubfoot, the latter ailment is only of a congenital nature; hallux valgus in children can be an acquired or congenital disease and develops in the first months of life if preventive measures are not followed and negative factors influence the child.
Parents note the occurrence of unpleasant symptoms in the baby during the course of hallux valgus:
The clinical picture is observed in all children who begin to walk; over time, the symptoms disappear, the child moves similarly to adults. If time passes and the symptoms persist, do not panic, contact a specialist to find out the reason for this turn of events, and get treatment if necessary.
Depending on the degree of deviation, doctors distinguish several stages of development of the disease in children:
Often, children with plano-valgus feet develop flat feet. Lack of treatment leads to the development of osteochondrosis, arthrosis, scoliosis, and even various deformities of the lower leg and knee joint in adulthood. Rarely, one leg becomes shortened; clubfoot develops in the other direction due to the progression of hallux valgus. Timely treatment and a serious attitude towards the baby’s health will help to avoid negative consequences.
A small patient requires special attention and specific treatment. Only an experienced specialist can cope with the diagnosis and prescription of the necessary treatment. Special devices (splints, splints, plaster fixing bandages) will help you get rid of the pathology; you can select the necessary thing only after performing the necessary diagnostic procedures:
If there are visible signs of a defect, the use of special fastening devices is prescribed.
You can also independently determine the presence of pathology in your baby. To detect the problem, you will need to perform the following manipulations:
You can take the drawing with you to a doctor’s appointment to speed up the diagnostic process and quickly cope with the defect (if there is one).
After examining a small patient, an orthopedic doctor will prescribe treatment for hallux valgus in children. A child's leg grows up to 12 years of age, the situation can change radically, and sometimes treatment is not required at all.
Turn healing exercises into a game. Buy colored mats and other devices, perform the manipulations regularly, gradually increasing the load and complexity:
Additionally, they resort to help:
It is used in extreme cases when there is progression of the disease and lack of positive results from conservative methods. Modern orthopedic surgery to eliminate flat valgus deformity of the foot is microtraumatic, in contrast to the application of plaster and the use of metal structures (techniques were often used until recently).
The essence of the operation is to change the angle between the bones of the foot, the pulling moment of the ligaments is distributed correctly. After surgery, the baby recovers quickly; the very next day after the operation, the child is able to move independently. The likelihood of relapse after such treatment is reduced to almost zero.
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It is possible to prevent the occurrence of a hallux valgus defect in a child by adhering to the following principles:
The following video shows a therapeutic massage for hallux valgus in children, which should be done every day, preferably in the morning:
With hallux valgus, a comprehensive approach to eliminating the defect is required. In addition to massage and therapeutic exercises, regular wearing of sandals, boots, and boots of a special design is required.
An orthopedic doctor will select the best option for orthopedic shoes for your child. In case of hallux valgus, parents should know which shoes and boots reliably fix the ankle joint and how to wear special shoes correctly. Useful information: how to prevent the appearance of flat valgus foot, when you need to consult a pediatric orthopedist.
Orthopedic disease is diagnosed in children of different ages, more often in the first years of life during the formation of the musculoskeletal system. Weak bones, insufficiently strong muscles, and improperly selected shoes change the appearance of the foot. Often the causes of the disease are calcium deficiency and certain diseases (rickets).
If you complain of pain in the legs or rapid wear of shoes, carefully examine the feet and check whether the child has symptoms of plano valgus deformity. The slightest suspicion of a problem with joints or muscles is a reason to visit an orthopedist. The sooner corrective models replace regular boots and sandals, the easier it is to correct the deformity. Remember: curvature of any part of the lower extremities is not only unsightly, but also harmful to health.
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Special sandals, boots, boots look like traditional models. Fashionable, beautiful shoes have long replaced the nondescript models that children had to wear several decades ago.
Regular wearing of children's orthopedic shoes improves foot condition:
Before purchasing special shoes or boots, be sure to consult with an orthopedist. The range of corrective shoes includes dozens of models. Without a doctor's prescription, parents will not be able to choose the right treatment option.
When choosing, be guided by the following requirements:
Pay attention to the photo of orthopedic shoes for flat valgus feet. All models are similar in many ways, there are slight differences in design and strap width. Even a non-specialist can easily determine: corrective sandals, boots, boots reliably fix a child’s foot.
Many doctors and parents speak positively about the effect of special corrective products with tight fixation, a rigid back, a special heel and an instep support. There are various models from well-known manufacturers on the market. Pay attention to the products of companies that produce quality products in compliance with standards for orthopedic products.
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Think about preventing orthopedic problems before they occur: some diseases and conditions increase the risk of pathologies in children. Unfortunately, the tendency to hallux valgus is inherited.
Parents should closely monitor the condition of the baby’s lower extremities if the expectant mother did not receive enough calcium and phosphorus, spent little time outdoors, rarely took multivitamins and mineral complexes, or had a poor diet. The state of the musculoskeletal system of the newborn baby directly depends on the sufficient intake of vitamins and minerals during pregnancy.
The following measures will help minimize the risk of hallux valgus:
Do not refuse to buy corrective shoes, do not hope that special exercises and massage will completely eliminate the flat valgus foot. The price of orthopedic shoes is quite high - some models cost 3,500–3,900 rubles, but without special products it is impossible to cure an orthopedic disease.
A pediatric orthopedist gives advice on choosing orthopedic shoes in the following video:
The appearance of hallux valgus is due to the presence of shoes: this pathology does not occur among representatives of tribal settlements, since walking barefoot maintains constant tone of the muscles and tendons of the legs. In developed countries, the most significant causes of such deformation are considered to be wearing incorrect shoes and flat feet. More rare factors include:
When the angle between the metatarsal bones does not exceed 5-20? and the finger deviates no more than 40? (i.e., grade I hallux valgus is observed), the symptoms are minor: painful sensations appear in the evening, and disappear completely overnight, especially when using a night bandage. Skin injured due to friction turns red and calluses appear. Hallux valgus is slightly expressed.
After identifying a pathological deviation of the finger, the doctor (usually an orthopedist or traumatologist) prescribes the following examinations:
For a pathology such as hallux valgus, surgical treatment is possible in several ways. In the early stages, it can be corrected with minimally invasive surgical interventions (cutting and suturing the tendons), which are aimed at restoring muscle traction. At the same time, it is possible to remove the bone exostosis (“bump”). In more severe stages, operations are used in which the bones are sawed and then fastened with metal structures to restore the axis. In particularly difficult cases, a false joint is formed or an artificial one is installed.
Treatment of hallux valgus without surgery is quite possible. Its development can be stopped in the early stages by:
A night bandage (or a valgus splint) can be used at any stage of hallux valgus, strictly at night or during rest, because The device is not designed to be worn under shoes. First, the bandage is put on for several hours, and then for the whole night.