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Saturday, January 30, 2021

Hallux valgus – foot thumb deformity

Hallux valgus is a most common deformity in the foot, more specifically in its front part. There are 4 types of Hallux valgus: static, congenital, inflammatory, and posttraumatic.

Most common is static hallux valgus, which is connected to existence of other static deformities of the foot like pes transversoplanus and pes planovalgus.

Almost 25 % of civilized society has this deformity. Hallux valgus is more common in the fourth decade of life, especially in women. 

THERE IS NO CAUSE OF HALLUX VALGUS, ONLY PREDISPOSITIONS, WHICH CAN BE DIVIDED INTO TWO GROUPS:

  • endogenous – connected with foot anatomical variations, as well as genetics (anatomical variations of thumb abductor and adductor, shorter first metatarsal bone, weakness of muscle-ligament system etc.)
  • exogenous – wearing non physiological shoes, long standing, walking on flat and hard surfaces etc.

HALLUX VALGUS CHARACTERISTICS:

  • valgus thumb
  • greater first intermetatarsal angle
  • pseudoexostosis – bursitis in the medial area of the metatarsal bone
  • internal thumb rotation in more advanced cases

HOW DOES HALLUX VALGUS OCCUR?

Deformity is usually expressed already in adolescent age and advances gradually. In order for the foot to retain its normal function, the correct shape and position of bones is important, as well as strong and hard muscles and ligaments. If there is an imbalance between foot strength and the pressure, foot instep begins to weaken. The divergence of first and fifth metatarsal bone occurs so that the front part of the foot is expanded like a fan. First metatarsal bone is adducted, and since the thumb cannot follow into adduction due to tense tendons, it goes into abduction. Also, tight and non physiological shoes the adduction of first metatarsal bone is maximized through the thumb. This way, subluxation in metatarsophalangeal joint occurs. The head of first metatarsal bone pronates medially into pseudo exostosis. Present bursa often gets inflamed due to tight shoes, especially in the winter.

In later phases, secondary issues can occur in this area, like osteophytic arthrosis, painful bursitis, and even metatarsalgia, so moving and shoes wearing is difficult. 

DIAGNOSIS OF HALLUX VALGUS

Diagnosis can be reached through clinical exam, and real changes of bone structures are diagnosed after RTG exam. This deformity often leads to flat foot, so we can find more than one diagnosis in the foot. 

TREATING HALLUX VALGUS

There are two basic approaches to treating this deformity – conservative and operative. 

Physical therapy includes medical gymnastics – strengthening the muscles and other foot structures, especially flexor and extensor of the thumb. It’s very important to educate the patient to wear more suitable shoes along with metatarsal pillow and silicone inputs which is set between the thumb and second finger and physically stopping the progression of the deformity.

When inflammation occurs, we use procedures to diminish it, like magnetic therapy, ultrasound, and electrotherapy. Lately, we use taping as well, which can stimulate moving the thumb outwards. This method is in its beginning phase and it is combined with medicinal gymnastics. 

Surgery corrects the deformity in the metatarsophalangeal joint and the thumb is returned to normal position. After surgery, physical therapy is very important in order to retain normal range of movement and muscle strength. Surgery does not guarantee that the problem will not occur again, but with great deformities it can ease the condition and help in a long term way.

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