Valgus deformity is a condition which characterized by big toe is twisted outward and bunion with foot deformation.
Valgus deformity is the most common foot pathology. Hallux valgus – in latin, mostly observed in women.
Valgus deformity is caused by flat feet, when metatarsal bones separated because of weak tendons. Varus deformity develops with longitudinal flat foot, which reduces feet amortization. Due to stress redistribution, tendon, which located along the first toe changes the pressure and pull the toe inwards. It deforms foot muscles and tendons even more and develops the disease.
The primary feature that causes flat feet and further valgus deformity is the pathology, which changes biochemical structure of the foot. First of all – it’s inherited weakness of muscular and tendon system of lower limbs, which can be inherited through the female line.
Traumas (fractures and joint dislocation of lower limbs) and professional harm (prolonged standing, physical inactivity) also can cause flat feet development.
Quite rare cause of foot deformity is cured in childhood hypovitaminosis D leading to rickets, which caused X-form deformity of legs and as a result valgus deformity. Varus deformity develops after lower limb deviation of O-form.
One more condition that leads to valgus deformity of feet is acute neurological disorder, which is followed by numbness of tibial and foot arch muscles.
Valgus deformity of foot develops slowly as well as varus. The disease can be divided into 4 stages, according to deformation of the first toe and disease progression.
No evident pain and signs. Careful examination may show dislocation of big toe less than angle of 20 degrees.
Toe and foot pain occurs during prolonged walking, and disappears after rest. Metatarsal bone starts to swell out. Footwear provides discomfort.
Pain and discomfort around front point of metatarsal bone, which have swollen dramatically. Pain occurs in shin region after prolonged walking. Footwear provides serious discomfort.
Pain in foot joint becomes permanent. A large deformity of joint occurs, usually red due to inflammation, caused by frequent traumatizing.
The second toe raises and overhang other toes, twisting into a hammer-like form. A patient can’t extend the toe individually; it requires removal of bone, in order to reset the second toe into its original location. At the 4th stage of the disease only removal of the bone can reveal discomfort.
Severe valgus deformity causes local circulation failure and innervation disorder, and frequent joint traumatizing of metatarsal bone develops inflammation of tissue and the joint itself. These factors cause arthrosis and chronic bursitis, sometimes septic.
As a rule, it’s enough to consult a traumatologist to diagnose valgus deformity. The doctor makes a conclusion based on complications, medical history, and examination.
Valgus deformity must be differed from gout, arthritis, and deformative arthrosis of first metatarsal bone of joint and other possible diseases. Pain and inflammation are gone after joint treatment.
X-ray and plantography (foot imaging) are used to confirm diagnosis. MRI or computed tomographies are used less often.
Treatment methods of valgus deformity are divided into conservative and surgical (bone removal).
Conservative treatment is first of all directed on right selection of footwear. Narrow pointed shoe are not recommended, choose comfortable protective leather footwear. Inner soles are necessary to correct valgus deformity. It’s important to not to confuse types of soles, since varus deformity also requires correction by special footwear.
Remedial gymnastics includes exercises that improve muscular and tendon system of the foot. Doctors administer various exercises which involve toes: barefoot walking on tiptoes, picking up small objects and drawing with toes.
Next therapy includes shin and foot massage, which provides muscles relaxation and improves blood flow.
Physiotherapeutic procedures like electrophoresis, ultrasound and mud baths improve tissue nutrition and remove edema.
NSAIDs are used for local inflammation and pain-relieving in metatarsal joint. Products which cause inflammation are also excluded (sweets, fat, roasted or smoked meat, fish). Antibiotics used in rare cases.
Valgus splints are widely used; they improve foot form if worn for a long time. Valgus deformity is treatable only up to the third stage. Varus deformity can be also corrected by special splints.
In case of ineffective conservative treatment or the disease developed the 4th stage, valgus deformity is treated with surgery, which includes bone spur removal.
These operations have different functions. Some of them provide bone spur removal, other foot bones replacement, or improve tendon strength. However, all the operations intended to improve the angle between metatarsal bones. Removal operation is provided under anesthesia.
Valgus deformity can be treated with laser. This method recently came into use. A good cosmetic effect can be reached with laser resurfacing of bone.
Laser therapy has its advantages: removal is performed under anesthesia and quickly, patient may go home after the procedure. But, laser therapy directed only to bone spur removal, thus patients must be provided with prevention measures.
Rehabilitation lasts for 3 months. And after 2 more weeks, patients allowed to go back to normal life.
Rehabilitation excludes footwear with heels for a year; heel height must be lower than 6cm.
Postoperative treatment also includes massage, remedial gymnastics, physiotherapeutic procedures, and broad-spectrum antibiotics if necessary.
Folk treatment of valgus deformity is directed to remove inflammation, swelling and pain.
Chamomile, celandine and pine baths are common methods. Iodine grid performed after bath.
Compress of red mud, turpentine and sea salt effectively removes swelling and inflammation of the joint, and reduces the size of outgrow.
Joint bone spurs, pain and inflammation also reduced after 2 week salt bath therapy.