Deformation of the valgus of the first finger (thumb) is an orthopedic pathology, in which the finger is deformed, deviating.Mostly the disease occurs in women after 30 years.At 3%, valgus deformity is detected in people aged 15 to 30 years, at 9% in those from 31 to 60, and 16% in people over 60 years of age.The problem not only causes strong aesthetic discomfort, but also provokes a change in all ligaments, tendons, joints and foot bones.
Pathogenesis
With deformation of the valgus of the first finger, the angle between the first and second bones becomes more plus, the relocation of the first metatarsal bone is observed.The big toe shifts from the outside, and the bone head sticks, forming a bone.This bone does not allow the thumb to match the norm, and gradually deviates from the outside.Tuberculosis (bone) prevents you from wearing shoes, creating inflammation, rubbing and leading to inflammation of the first metatarsophalangeal bag.Gradually, the bone swells and becomes inflamed, painful.The improper position of the union provokes its premature ear, cartilage lesion and an increase in the size of bone growth.This, in turn, provokes foot trauma and further development of pathology.As the disease progresses, the thumb shifts the remaining fingers of the foot, leading to their deformity in the form of a hammer.As the disease develops, it leads to arthritis of plusnoplange joints, inflammation of the articular bags, finger joints, chronic inflammation of the first metatarsofalanga joining bag, the relocation of the first metatarsal bone, flat animals (chronic and transverse), bones and head points.
shape
In normal condition, the metatarsal bones are parallel to one another.Under the influence of some reasons, the first metatarsal bone deviates outside and because of this, a small lump appears in the legs, the ligaments and tendons lose their elasticity, develops their dysfunction.
The disease goes through several stages:
- Early at this stage, the deviation of the thumb is less than 15 degrees.
- The average deviation of the first finger on the side is from 15 to 20 degrees.At the same time, the deformation of the second finger is observed.It rises over the thumb and becomes like a shape in a hammer.
- Severe deviation of the thumb is 30 degrees.All of the toes are already deformed, and at the base of the first phalanx there is a large bone growth.In places where there is a large leg tension, gross corn appears.
Reason
The main provocative factor in the appearance of valgus deformation are irregular shoes.If a person wears tight shoes with a narrow toe or high behavior, 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 leg;
- Rike;
- Cerebral palsy;
- Polneuropathy;
- low leg arch;
- flat feet;
- congenital weakness of the muscular-ligamentous apparatus;
- Chronic common inflammation provoked by psoriasis;
- arthritis;
- multiple sclerosis (accompanied by damage to the shell of the nerve fibers);
- diabetes mellitus;
- gout (deposition of urates in body tissues);
- Hyper of joint mobility observed during marthans and Down syndrome;
- youthful legs (rapid increase in the size of the leg in the adolescent period);
- Charcot-Mari-Tuta disease (hereditary neuropathy, associated with atrophy of distal limb muscles);
- osteoporosis (bone loss);
- Stop overloading about professional activities (waiters, athletes, dancers).
In the presence of provocative factors, the disease progresses rapidly.
Symptoms
Symptoms of pathology depend on the degree of foot damage.In the first stage, redness, tissue swelling in the appearance of bone, pain in the phalaranx fingers, intensifying while walking.At the average stage of development of the disease, pain, swelling, bone growth in the plus bone area, dry corn under the middle phalanx of the finger.In the severe phase in the sole of the leg and thumb, severe and exhausting pain appears.Dry corns form, and skin keratinization appears under the second and third phalanges of the fingers.
Troubleshooting
Diagnostic measures begin with the collection of patient anamnesis.The doctor asks her about worrying symptoms, is interested in provoking their appearance (foot load, walking, shoes), has metabolic, systemic diseases in medical history, lower extremity injuries, hereditary bone disease.Next, an external inspection is carried out, during which a person is required to pass.The doctor looks at the patient's walking while determining the intensity of the pain.The position of the thumb is studied, its location in relation to the other fingers, explore the range of flexion and extension.The presence of other external symptoms (swelling, redness, thickening of the layer under the fingers bones) is checked.Foot Footer is performed in three projections to identify the degree of foot deformation, the displacement of common and related pathologies.An ultrasound of the vessels is performed to exclude the blood circulation disorders.
Treatment
Finger valgus deformation therapy is traditional and operative.In the early stages, when you can do without surgery, doctors advise to choose suitable and accurate shoes.It should not satisfy the load on the foot, friction.Comfortable shoes slow down the progression of the disease.At the same time, the doctor will advise to buy special orthopedic equipment:
- Gaskets for the common finger bag (they eliminate shoe pressure);
- Intodassen rollers, spacers that contribute to the correct distribution of the load on the foot.
All orthopedic devices reduce the pain, but it is impossible to completely get rid of disturbance with their help.To eliminate pain and inflammation, non -steroidal anti -inflammatory drugs are used, corticosteroid injections are used.To facilitate spasms and restore joint mobility, massage and special gymnastics are prescribed to relax the legs.
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, hydrocortisone phonophoresis, paraffin and ozokerity applications.AOne of the most effective methods for eliminating deformity of the big toe valgus is shock wave therapy (UVT).This procedure implies a short -term effect on the painful area with low acoustic pulses -Frequency.With the help of UVT, the symptoms of pain are eliminated, the effects on the factors that contribute to their appearance are obtained.The procedure is performed using a special device that generates shock waves.They only affect pathological areas, without affecting healthy tissues.With the help of ultrasound, metabolic processes improve.UVT is not performed in the presence of neurological, infectious, oncological, heart, somatic diseases, diabetes mellitus, blood clotting disorders.Shock wave therapy is not prescribed for pregnant women, nursing women and children under the age of 18.The effect of the procedure is observed after several procedures.The pain disappears, it becomes easier to walk.But it is impossible to completely remove the elongated bone using a UVT procedure.The doctor may prescribe at least 5-7 sessions.Depending on the stage of the disease, the procedure for performing the procedures is also determined.Some people are prescribed daily sessions, others will be enough for one procedure per week.The result of UVT treatment is held for a long period.
Surgical treatment
With an average and severe degree of deformity of the big toe valgus, surgical treatment is prescribed.To eliminate pathology, many methods have been developed by which they achieve the following goals:
- eliminate the bursitis of the first toe;
- Bending muscles located around the damaged joint to prevent the disease from relapse;
- Perform the bones of the thumb.
If the deformation is not strongly expressed, the increase in growth in the joint bag through a small cut is removed.After surgery, a person needs rehabilitation, with the mandatory dressing of a bandage or shoes with a single wood, using foot, physiotherapy (at least 6 procedures).Currently, with the deformation of the valgus 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 the metatarsal bone and phalaranx of the finger.
- Chevron-Oosteotomy.The operation is performed with a finger deviation not more than 17 degrees.The growth is excited, and the phalanx of the thumb is fixed with a screw and a titanium wire.After a while, the structure is removed.
- Shall-Oosteotomy.The operation is performed if the angle of deviation of the thumb is 18-40 degrees.During intervention, using manual exposure, the position of the metatarsal bone is corrected, and then adjust it with two titanium screws.
The elongated bone of the big toe is not only aesthetically ugly, but it also causes a lot of annoyance when walking.The disease that has not completed treatment leads to complications in the work of the entire muscular system.Therefore, everything should not be allowed in an gear and contact an orthopedic if the first signs of deformation appear