hallux valgus
Introduction
Introduction to hallux valgus Hallux valgus deformity refers to the shift of the big toe to the lateral side of the first metatarsophalangeal joint. Hallux valgus is a complex anatomical deformity and is extremely challenging to treat. The bun is the obvious medial protrusion that appears in the hallux valgus deformity, but in general these two terms are used interchangeably. Hallux valgus is the most common lesion involving the big toe. It is more common in middle-aged and older women. It most often occurs in people who have a genetic predisposition and wear unsuitable shoes for a long time. Unsuitable shoes can exert abnormal pressure on the big toe. basic knowledge The proportion of illness: the incidence rate is about 0.005%-0.008% Susceptible people: good for adults Mode of infection: non-infectious Complications: osteoarthritis
Cause
Cause of hallux valgus
Genetic (30%):
The occurrence of hallux valgus deformity is related to congenital factors. About half of the cases have hereditary factors. Lake believes that the first metatarsal varus is the main cause of malformation. In many cases, the first wedge bone has a narrow inner wedge shape, resulting in The toe joint is tilted inward, but in the author's group of 76 foot valgus, only the first metatarsal of the 9 feet is more than 12°. According to Carr's standard, the angle between the 1st and 2nd humerus is 9°. This standard is only a small part, it can be seen that varus is not congenital, 11 of the 76 feet after McBride, the first and second tibia angle decreased by 2 ° ~ 4 °, apparently after correction of hallux valgus The thumb extensor muscle, the bowstring effect of the hallar flexor muscle is reduced, and the effect of the adductor muscle to the first metatarsal bone. At the same time, after the hallux valgus, the bowstring action of the muscle will produce the force of pushing the tibia to varus.
Wear high-heeled pointed shoes (25%):
It is one of the main factors of the formation of hallux valgus. The front part of the pointed shoe is triangular. When the high heel is standing, the front part of the foot is inserted into a narrow triangular area. The hard upper is forcing the hallux to eversion and slightly External rotation, small toe varus slightly internal rotation, middle 3 toe proximal interphalangeal joint flexion, excessive extension of the metatarsophalangeal joint and distal toe joint.
Various inflammations (10%):
Especially rheumatoid, often due to joint damage to the formation of outward subluxation, showing hallux valgus deformity.
Pathogenesis (25%):
Due to the long extensor muscles of the thumb, the flexor hallucis longus and the thumb muscles are tensioned, the hallux is rotated outward along the long axis and the toenail is turned to the midline, and continues to increase, in the medial hallux muscle and the medial head of the flexor hallucis longus. The inner sesamoid is displaced outward, losing the abduction effect, and then the lateral adductor muscle of the thumb and the flexor hallucis longus contracture, the lateral joint capsule is contracted and thickened, the big toe is subluxated, and the lateral sesamoid becomes larger. Moved between the first and second metatarsal bones, the hallux valgus pushes the first metatarsal varus, widens the transverse arch of the foot, and the inside of the humeral head is squeezed and rubbed by the upper, causing bunions, pain, and then the first metatarsal. The head becomes larger and forms an epiphysis that protrudes inward. Due to the strain of the thumb muscle, the transverse arch of the foot is flattened, and the second and third metatarsal heads collapse toward the temporal side, and the weight is increased, and the skin is thickened to form a fistula. The toe is turned outwards, the second toe is squeezed, occupying the position of the 2 toes, lifting the 2 toes and overlapping the big toes, causing the 2 toe metatarsophalangeal joints to stretch, and the proximal interphalangeal joints flexing to become hammer toes, protruding from The hallux and the dorsal side of the third toe, the dorsal side of the proximal interphalangeal joint is rubbed and squeezed by the upper, and pain is also generated.
The thumb and metatarsophalangeal joints are in a subluxation position. Under the action of abnormal stress for a long time, osteoarthritis gradually appears, the joint space is narrowed, the bone becomes hard and more painful.
The pathological changes of hallux valgus were summarized as follows: 1 hallux valgus, subluxation of the metatarsophalangeal joint; 2 first varus, bunion; 3, 2, 3 iliac crest; 4 second toe hammered toe; 5 first metatarsophalangeal osteoarthritis.
Prevention
Hallux valgus prevention
The specific control measures are as follows:
1. Choose a pair of suitable shoes, such as the heel should not be too high, the toe should be loose, so that the toes have a certain space in the inside, so that they can not feel any pressure, especially can not wear sharp and thin high heels.
2. Do barefoot exercise, strengthen the strength of the plantar muscles, and delay the deterioration of hallux valgus.
3. Using your fingers to push the big toe to the inside, it can also effectively prevent the hallux valgus from intensifying.
4. With some orthopedic instruments, such as the hallux valgus orthosis (divided or night orthosis), the hallux valgus orthosis is worn for a long time, which has a certain therapeutic effect on hallux valgus.
5. When the above conservative treatment can not be effectively corrected, surgery should be taken, which is the most effective treatment. Surgical methods to correct the abnormality of the deformity, not only can choose the shoes you want to wear, but also can resume normal work, especially for those with special occupations, like dancers, can resume normal dance career.
Complication
Hallux valgus complications Complications osteoarthritis
Hallux valgus orthosis can occur in any form of surgery.
1. Reason
(1) In the correction of soft tissue surgery, the adductor muscle is not loosened.
(2) In soft tissue surgery, the suture of the medial sac and the abductor tendon of the metatarsophalangeal joint was detached or the thumb was not fixed in the correct position (inversion of 5°).
(3) Keller did not use the Kirschner wire to fix the big toe and tibia or the fixation time was short.
2. Processing method
(1) Recurrence of malformation after soft tissue correction, soft tissue surgery can be performed again, and the hallux toe can be fixed in 5° position for 6 weeks, or the first metatarsophalangeal joint fixation or Keller operation.
(2) Patients with a tendency to recurrence after Keller surgery continue to be fixed with night orthopedic support for 6 to 8 weeks.
Symptom
Hallux valgus symptoms common symptoms joint swelling muscle contracture
1. Clinical manifestations Occurs in adults, with genetic factors, can occur in youth, in old age, due to weakening of the foot, the hallux valgus can often be aggravated, more women than men.
The hallux valgus symptoms are most likely to be bunions and pain. The normal long axis of the big toe forms an angle with the long axis of the first metatarsal. The shape is measured as 15° to 25°, which is called the physiological hallux valgus angle. Only for hallux valgus, there is no fixed standard, clinically should be more than 25 ° hallux valgus, squeeze the second toe, the first metatarsal head with bunions pain, can be diagnosed as hallux valgus, pain It is the main symptom and the main basis for treatment. The pain mainly comes from the inside of the first metatarsal bone. The pain is aggravated when walking. In some patients, the pain of the second and third metatarsal heads is not proportional to the pain. The deformity is obvious, but it is not painful, and the second, third toe hammer toe and its pain are also important signs.
2. Staging According to clinical manifestations, X-ray changes are different from treatment options, and hallux valgus is divided into three phases.
(1) Early (pre-semi-dislocation): mild toe valgus deformity, bunion is mild, pain is not heavy, X-ray film shows the metacarpophalangeal joint to the outer semi-dislocation, does not combine hammer toe, this period can be used Moving positive, non-surgical treatment.
(2) mid-term (semi-dislocation period): obvious hallux valgus deformity, bunion pain is heavier, X-ray film can be seen near the base of the big toe, from the humeral head to the lateral subluxation, due to the outward toe of the big toe 2 toe, the toe can be hammer-toed deformed, so that the humeral head is sunken, and the humeral head is paralyzed. Although this method can be moved, but can not be consolidated, for women aged 30 to 50, the metatarsophalangeal valgus angle is 15 Between ° ° ~ 25 °, interphalangeal angle <12 °, interphalangeal joint angle <15 °, no metastasis of the metatarsophalangeal joint, non-surgical treatment is invalid, suitable for soft tissue surgery such as McBride.
(3) advanced stage (osteoarthritis): In addition to the pain of bunion, the swelling of the metatarsophalangeal joint is painful. The X-ray film shows the osteoarthritis of the metatarsophalangeal joint. The surgical treatment is suitable for combined surgery of bone and soft tissue.
The hallux valgus is larger than the normal angle, and the X-ray film has a subluxation of the metacarpophalangeal joint and the medial bunion of the first metatarsal head. The first metatarsal varus, hammer toe and sputum are not necessary for every case. In the early stage, the big toe can be passively moved to the normal position, and the joint capsule and muscle contracture in the later stage cannot be passively moved back to the normal position. It is advanced in the period of osteoarthritis of the thumb.
Examine
Hallux valgus examination
Check the body
The standing position evaluated the degree of hallux valgus, other toe deformities, and arch of the foot. The morphology of the forefoot and hindfoot was evaluated during sitting. The evaluation of the big toe includes the first metatarsophalangeal joint mobility, the degree of swelling, the degree of protrusion of the medial protrusion, and the presence or absence of sputum or painful bun sac, whether the foot surface has localized sesamoid pain; the evaluation of other toes includes whether there is a hammer Toe or metatarsophalangeal joint instability or dislocation and plantar pain or spasm
2. Imaging
Take the X-ray film with negative weight and measure the following data:
(1) The angle between the first metatarsal of the hallux valgus and the midline of the proximal phalanx, the normal value is less than 15°.
(2) The angle between the first and second metatarsal medial line between the humerus, the normal value is less than 9°.
(3) The angle of the distal radius of the humerus (DMAA) The angle of the first metatarsal joint surface with the long axis of the first metatarsal bone: Normally, the humeral head joint is inclined outward by less than 10°.
(4) Joint matching degree The joint surface of the first metatarsal head and the proximal phalanges has a subluxation. If the joints are inclined on both sides, the joints are not matched.
(5) The angle between the first toe proximal section of the phalanx and the midline of the distal toe bone is normally less than 10°.
3. Classification of hallux valgus according to severity
(1) Mild hallux valgus hallucination angle is less than 30°, and the angle between the humerus is less than 13°. The joints are often matched, and the deformity may be caused by the hallux valgus.
(2) Moderate hallux valgus valgus angle 30 ° ~ 40 °, the angle between the humerus 13 ° ~ 20 °. The metatarsophalangeal joints often do not match (semi-dislocation), and the toe-toe pronation often causes compression on the second toe.
(3) Severe hallux valgus valgus angle is greater than 40°, and the angle between the tibia is 20° or more. The hallux of the toe is often superimposed on or below the second toe, and the metatarsophalangeal joints do not match. There is often metastatic pain under the second metatarsal head, which may have arthritis changes.
Diagnosis
Diagnosis of hallux valgus
The hallux valgus is larger than the normal angle, the X-ray film upper thumb and metatarsophalangeal joint subluxation and the first metatarsal head medial bunion, the first metatarsal varus, hammer toe and sputum, not necessarily in every case, in the early hallux It can be passively moved to the normal position. Later, due to contracture of the joint capsule and muscle, it cannot be passively moved back to the normal position, and the arthritis of the thumb and phalanges is advanced.
