Hallux valgus

Introduction 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.

Cause

(1) Causes of the disease

1. The occurrence of genetic hallux valgus deformity is related to congenital factors, and about half of the cases have genetic factors. Lake believes that the first metatarsal varus is the main cause of deformity. Clinically, in many patients, the first wedge bone has a narrow inner wedge shape, causing the metatarsophalangeal joint to incline inward. However, in the author's group of 76 foot valgus, only the first metatarsal of 9 feet was more than 12°. According to Carr's standard, the angle between the 1st and 2nd tibia is 9°, and only a small part of this standard is exceeded. It can be seen that varus is not congenital. 11 of the 76 feet were after McBride, and the angle between the 1st and 2nd tibia was reduced by 2° to 4°. Obviously, after the correction of hallux valgus, the bowstring effect of the extensor digitorum and flexor hallucis muscle was reduced, and the adduction was observed. The effect of the muscles moving to the 1st tibia. At the same time, after the hallux valgus, the bow-like action of the muscles will produce the force of pushing the tibia to inward.

2. Wearing high-heeled pointed shoes is one of the main factors in the formation of hallux valgus. The front part of the pointed shoes is triangular. When the high-heeled shoes are standing, the front part of the foot is inserted into a narrow triangular area, and the hard shoes are The face is forced to eversion and slightly external rotation, the small toe is slightly inverted, the middle toe of the middle toe is flexed, and the joint between the metatarsophalangeal and the distal toe is overstretched.

3. Various inflammations, especially rheumatoid arthritis, often form an outward subluxation due to joint destruction and are hallux valgus deformities.

an 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 included the first toe joint mobility, the degree of swelling, the degree of protrusion of the medial protrusion, and the presence or absence of sputum or painful bun, whether there was localized sesamoid pain in the plantar surface. The evaluation of other toes included whether there was a hammer. The toe, metatarsophalangeal joint is unstable or dislocated and the foot is painful or paralyzed.

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.

Differential diagnosis

The distance between the big toe and the two toes: the limbs of some patients with genetic diseases: small limbs, short limbs, multiple fingers (toes), fingers (toes), short fingers, spider fingers (toes), fingers and toes and second toes Large spacing, rocking chair foot, elbow valgus, hip dislocation, etc.

1. Clinical manifestations occur well in adults. Those with genetic factors can occur in young people. In old age, hallux valgus can often be aggravated due to weakened internal force. 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, and the shape is measured from 15° to 25°, which is called physiological hallux valgus. There is no fixed standard for the degree of tilting to hallux valgus. Clinically, the hallux valgus should be more than 25°, the second toe should be squeezed, and the bunion pain at the first metatarsal head can be diagnosed as hallux valgus. Pain 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 in the second and third metatarsal heads is painful. It is worth noting that the deformity is not directly proportional to the pain. Some deformities are obvious, but not painful. In addition, the second and third toe hammer toes and their pain are also important signs.

2. According to the clinical manifestations, X-ray changes and treatment options, the hallux valgus is divided into 3 stages.

(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 subsided, and the humeral head is paralyzed. Although this technique can be moved, it cannot be consolidated. For women aged 30 to 50 years, the valgus angle of the metatarsophalangeal joint is between 15° and 25°, the interphalangeal angle is <12°, the interphalangeal joint angle is <15°, and the metatarsophalangeal joint has no degenerative changes. 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.

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