What Are the Best Treatments for Toe Pain?

Hallux valgus deformity refers to the lateral displacement of the thumb at the first metatarsophalangeal joint. Hallux valgus is a complex anatomical deformity and is extremely challenging to treat. The thumb capsule refers to the obvious medial protrusion that occurs in the hallux valgus deformity, but in general these two terms are used interchangeably. Hallux valgus is the most common lesion involving the toes. It is more common in middle-aged and older women. It most often occurs in people who have a genetic predisposition and wear inappropriate shoes for a long time. Improper shoes can put abnormal pressure on the toes.

Basic Information

nickname

Hallux synovial cyst

English name

hallux valgus

Visiting department

orthopedics

Common causes

Inappropriate shoes, genetic factors

Common symptoms

The toes deflect laterally at the first metatarsophalangeal joint

Contagious

no

Causes of hallux valgus

The occurrence of hallux valgus may have an important relationship with inappropriate footwear. Hallux valgus deformity is 15 times more common among people who wear shoes than those who don't. Tightened forefoot shoes seem to be the leading cause of hallux valgus deformity. However, not everyone who wears these shoes develops hallux valgus, so there must be other triggers as well.

Heredity is an important factor in the development of hallux valgus, especially in adolescents; many studies have reported a positive family history of patients with hallux valgus. The first metatarsal varus, that is, the first metatarsal varus angled at the zygomatic wedge joint, may also be one of the predisposing factors for the occurrence of hallux valgus, especially in young patients with hallux valgus.

Hallux valgus is also common in patients with systemic arthropathy. For example, synovitis in rheumatoid arthritis causes damage to the metatarsophalangeal joint capsule, resulting in hallux valgus deformity. In addition, for flat feet, the relationship between the first metatarsals is not coordinated. For example, the first metatarsal head is spherical, and the first metatarsal is too long and too short. The posterior tibial tendon stops are mutated, and some fibers extend to the obliques of the adductor hallucis and the peroneus of the abductor hallucis flexor, thereby increasing the contractile force of the combined tendons of the posterior biceps and abnormal bone processes between the 1st and 2nd metatarsal bases. And other factors, play a role in the incidence of hallux valgus. Rheumatoid arthritis and neuromuscular diseases can also be associated with hallux valgus, and adolescent hallux valgus has a familial tendency.

Clinical manifestations of hallux valgus

Stiffness of the thumb is generally manifested by the deflection of the thumb to the outside of the first metatarsophalangeal joint, and obvious osteophytes appear on the inside of the joint. In some patients, the soft tissue at the osteophyte appears to be red and swollen due to friction with the shoes for a long time. Bursitis. Severe hallux valgus patients may have other toe deflections and straddle. Patients with hallux valgus may not all have pain, and deformities are not proportional to pain. The main cause of the pain is the acute bunion inflammation caused by compression and friction after the medial bulge of the thumb bone. The thumb metatarsophalangeal joint is abnormal for a long time, and osteoarthritis causes pain and the condyle under the 2nd to 3rd metatarsal head causes pain.

Hallux valgus check

Check-up

The standing position was used to evaluate the degree of hallux valgus, other toe deformities and arch conditions. The forefoot and hindfoot morphology was evaluated in the sitting position. The evaluation of the toe includes the activity of the first metatarsophalangeal joint, the degree of swelling, the degree of protrusion of the medial protrusion, the presence or absence of the palatal or painful thumb capsule, and the presence of local phalanx pain on the sole of the foot; the evaluation of other toes includes the presence of hammers Toe, metatarsophalangeal joint instability or dislocation and plantar pain or palate

2. Imaging

Perform weight-bearing X-ray flat film and need to measure the following data:

(1) Hallux valgus angle The normal angle between the first metatarsal bone and the midline of the proximal phalangeal shaft is less than 15 °.

(2) The angle between the metatarsal bones The normal angle between the midline of the first and second metatarsal shafts is less than 9 °.

(3) The angle of the patella distal articular surface angle (DMAA) the intersection of the first metatarsal head articular surface and the long axis of the first metatarsal bone: Normally, the metatarsal head joint faces outward less than 10 °.

(4) Joint matching degree Whether the joint surfaces of the first metatarsal head and the proximal phalanges are subluxated. If the sides of the joint are inclined, the joints are not matched.

(5) Angle between phalanges The angle between the midline of the proximal and distal phalanges of the first toe is normally less than 10 °.

3. Classification of hallux valgus according to severity

(1) Mild hallux valgus The hallux valgus angle is less than 30 °, and the angle between the metatarsals is less than 13 °. Joints are often matched, and deformities may be caused by hallux valgus.

(2) Moderate hallux valgus The hallux valgus angle is 30 ° to 40 °, and the angle between the patellas is 13 ° to 20 °. The metatarsophalangeal joint is often mismatched (subluxed), the pronation of the thumb and often the compression of the second toe.

(3) Severe hallux valgus The hallux valgus angle is greater than 40 °, and the angle between the metatarsals is 20 ° or greater. The toe pronation and often overlaps above or below the second toe, and the metatarsophalangeal joints do not match. There is often metastatic pain under the second metatarsal head, and there may be changes in arthritis.

Hallux valgus treatment

Conservative treatment

For patients with only deformities and no symptoms or mild symptoms, conservative treatment can be performed, such as physical therapy and hot compress. Wearing looser or open-toed shoes can reduce the friction on the medial protrusion, and delay the degree of deflection of the toe and the further increase of the other toe deformity by reducing the pressure on the forefoot. Placing cushions in the shoes can reduce stress in the painful areas of the soles of the feet. The use of hallux valgus pads, night splints, and inter-toe pads may temporarily relieve pain and delay the progression of deformities.

2. Surgery

If conservative treatment does not relieve the symptoms of hallux valgus deformity, surgery can be recommended to correct the hallux valgus. The appropriate surgical method should be selected according to the specific circumstances of the patient. For mild and moderate hallux valgus, if the angle between the first and second metatarsal bones is less than 15 °, the medial metatarsal head osteophyte can be used for resection or resection of the thumb adductor tendon. The stump of the thumb adductor tendon is shifted to the outside of the sacrum head and neck or the sacrum head and neck osteotomy is used to move outward. If the angle between the first and second metatarsal bones is greater than 15 °, the first metatarsal shaft or basal osteotomy is generally used. For patients with osteoarthritis of the first metatarsophalangeal joint, younger patients mostly adopt the first metatarsophalangeal joint fusion; older patients can use Keller surgery or artificial joint replacement. Patients should be informed that there may be problems such as limited mobility, decreased strength, residual discomfort, or recurrence after surgery.

Hallux valgus prevention

Avoid shoes and heels that are too narrow. For patients with flat feet, rheumatoid arthritis or neuromuscular diseases, they should adjust their shoes and choose appropriate protective gear to avoid deformities.