Paluchy valgus (halluxes) is, contrary to appearances, not only an aesthetic defect. Foot deformation adversely affects the entire motor system and worsens the quality of life. Often times, an operation is the only way to fix a problem.
Onvalgus , which is the popularhalluks , suffers from approx. 23% of people aged 18-65 and over 35% of people over 65; as many as 90% of patients are women. We talk to Dr. Cezary Michalak, a specialist in orthopedics and traumatology, about the disease and how to deal with it.
- What are halluxes?
Cezary Michalak, MD, PhD: The full name of the disease is hallux valgus - that is, hallux valgus. This is a deformation of the forefoot, which is where the first toe of the foot at the metatarsophalangeal bends towards the other toe. A painful bulge gradually develops in the metatarsophalangeal joint, which over time begins to protrude beyond the foot. Irritation in this area causes inflammation - pain, redness, swelling, and sometimes infections associated with skin damage. Degenerative changes develop and the joint is significantly damaged over time.
- What are the causes of this problem?
C.M .: Hereditary factors must be mentioned first. It is estimated that 83% of people with hallux valgus have this problem in a family. This is due to the inborn weaker structure of the joints, resulting from looser ligaments, which promotes deformation. Also, some types of structure
of the foot make it more susceptible to deformation. An obvious risk factor is wearing the wrong footwear: high heels and shoes that are too tight or too narrow in the forefoot. An interesting fact is that in barefoot populations, the hallux valgus is rarely observed, while it is common in Japan or China, where small and narrow shoes are considered pretty. Workload and standing position at work are also important. The link between hallux valgus and obesity seems obvious, although this has not been fully confirmed. Rheumatic diseases, especially rheumatoid arthritis, are an important risk factor.
- Can deformation be prevented?
C.M .: It is important to care for the comfort of walking and wearing the correct footwear. Walking barefoot and exercising, e.g.rolling the towel on the floor with your toes, carrying small items caught with your fingers.
- Can I slow down the deterioration of the deformity or alleviate the discomfort?
C.M .: Conservative methods that can be used in the early stages bring temporary relief. The progression of the disease will be slowed down by the change of shoes with a large toe and flat heels, as well as inserts preventing transverse flatfoot, lifting the transverse arch of the foot upwards. In some cases, a good temporary effect can be achieved by using separators, i.e. interdigital wedges. Corrective braces and splints worn during the day or only at night bring some relief. Attached to the foot, they restore the correct position of the big toe, however, they cannot result in permanent improvement of the position of the big toe. Recently, the so-called kinesiotaping - correction and holding of the big toe in the desired position with the use of tape. It brings relief from ailments while waiting for surgery and is a useful element of preparation for surgery, but of course it cannot bring about a permanent correction. Let's be straightforward: if the deformation is already evident, the effectiveness of non-operative methods is low. It is not possible, for example, to permanently correct an existing advanced distortion with the use of splints or correction devices.
C.M .: One has to make a sad statement here that an attempt to use long-term conservative treatment out of fear of surgery is a risk of the progression of changes and irreversible damage to the joint. The ligaments stretch and the muscles that keep the bones in the correct position become weak. The biomechanical disturbance occurs, the gait pattern changes, and there are further overloads in other parts of the musculoskeletal system, because the body weight is distributed in a disturbed manner. Due to the incorrect course of the tendons, the muscles of the foot begin to deepen the deformation, there is further deformation: the deepening of the usually already existing transverse flatfoot and deformation of the remaining toes, the so-called hammer fingers. The overloaded metatarsal bones begin to cause severe discomfort, there are thickenings of the foot skin - corns or calluses. Over time, even wearing regular shoes may become impossible. But foot deformity is not just a local problem. It affects the entire motor system, pain or degenerative changes in the knees, hips, spine, and more: the general he alth and mental state of the patient.It limits the activity and ability to work and worsens the quality of life.
C.M .: Surgery is necessary when deformation is evident. One of the decisive factors is that the pains become persistent, both at rest and when walking, the patient has gait disturbances and has serious problems with choosing shoes. The aim of the procedure is, above all, to relieve pain and improve gait efficiency, as well as to enable the wearing of ordinary shoes. An important issue for the patient is to improve the appearance of the foot. Remember that the operation performed with low intensity changes is much less extensive than when the changes become very severe, and the recovery period is also shorter.
Worth knowingNot only bad shoes to blame
Most people with hallux valgus have a hereditary problem: deformities are prone to inborn weaker joints, resulting from looser ligaments. Also, certain types of foot structure make it more susceptible to deformation. The risk factor is the wearing of incorrect footwear: high heels and shoes that are too tight, with narrow toes. Occupational workloads are important, e.g. standing at work, punch dancing. The link between halluxes and obesity seems obvious, although it has not been fully confirmed. Rheumatic diseases, especially RA, are an important risk factor.
According to an expertCezary Michalak, MD, PhD, specialist in orthopedics and traumatology, CM Enel Med Hospital, Warsawmonthly "Zdrowie"