Stiffness of the big (first) toe refers to pathologies in the joint, which is located at the base thumb. This condition creates pain and joint rigidity. With aggravation pathological process Over time, it is more difficult for the patient to perform motor actions in this joint. This pathology belongs to one of the forms of degenerative. Many patients mistakenly consider this disease to be bursitis of this joint formation, however, these are completely different pathologies in the therapeutic issue.
Most common causal factors This pathological condition in the joint of the first phalanx is perverted work and abnormal changes in the structure of the foot, contributing to the development in some cases.
This type of arthritic lesion as a result of wear and tear of the joint often occurs in individuals who have defective changes that lead to the development of dysfunction of the foot and big toe. For example, individuals diagnosed with flat feet are predisposed to developing rigidity. In some versions this pathological change has a hereditary nature, that is, the type of foot is inherited, which is especially susceptible to the described pathology. Work based on heavy load on the feet can also cause this pathological process. Traumatic injuries thumb, inflammatory diseases (rheumatoid arthritis, etc.) also belong to the list of possible etiologies of this dysfunction.
Early signs of rigidity are:
As the pathology develops, additional signs appear:
Success in therapy depends on timely diagnosis. Therefore, when initial signs You should immediately consult a doctor for advice. When diagnosing, the doctor conducts a physical examination of the foot, performs passive motor actions of the first phalanx in order to determine their range. X-ray examination helps to determine signs of inflammation of the joint formation (arthritis), growths from bone tissue and other possible anomalous processes.
In most cases, timely treatment can prevent or delay surgery. In the lungs and moderate severity In cases of rigidity of the first finger, the following methods can be used:
IN special cases operative method acts as the only way to reduce pain. When choosing the type of operation, the doctor takes into account the degree of deformation in the pathologically changed joint and adjacent tissues, the age factor, the degree of activity of the patient, etc. The duration of the rehabilitation period also depends on all of the above.
tsa feet, others (Matzen) fix it with a plaster splint. The author uses only a redressing bandage, encouraging the patient to move the operated big toe after a few days. After the wound has healed, he can begin walking in shoes with a hard sole, and after 4-6 weeks he can wear normal shoes with an insole. Wearing high heels after surgery is not recommended. Active movements of the operated joint have a beneficial effect.
If mobility in the main joint of the big toe is limited and painful, it causes severe impairment in walking. Depending on the cause of painful stiffness during surgery Brandes And Keller form a movable joint, or the painful joint becomes immobile. Arthrodesis is also suitable for reducing complaints arising after surgery Mauo. The painful joint is operated on through a medial longitudinal incision. After resection of the cartilaginous surfaces, the thumb is brought into a state of extension by 20 -25°. Two roof-shaped bone surfaces placed next to each other are well fixed (rice. 8-192). After surgery, external fixation is rarely required. After the wound has healed, the patient can get up and 3 weeks after the intervention can begin to walk in shoes with a hard sole.
If the V toe turns to back side, almost lies on the IV finger and is turned steeply upward, then it causes significant complaints. Incorrect finger position can be corrected by surgery. At the dorsolateral edge of the finger, a skin incision is made in the lateral stretched extensor tendon, which bends into a transverse fold at the level of the proximal joint. The extensor tendon is cut in a Z-shape, then dorsally, with a capsulotomy, the proximal joint is relaxed. If necessary, the base of the main phalanx is also resected for this purpose. If the V finger can then be brought to its normal position, then a diamond-shaped flap is cut out from the plantar fold of skin located under the finger, and the skin of the tip of the finger is stitched to the skin of the sole. Thanks to this skin grafting, the plantar crease under the V toe disappears, resulting in an improved toe position. IN
Rice. 8-193. Operation on the fifth toe, arched inward, A) Skin incision on the dorsum of the foot, b) extensor tendon lengthening, V) plantar skin excision, G) suturing the skin of the fingertip with the plantar skin
The rapé on the back of the foot connects the offset ends of the extensor tendon with a knotted suture. After the wound has healed, the patient can walk and wear regular shoes for a few weeks after surgery. The operating principle is shown in rice.8-193.
One of pathological conditions toes is the so-called. claw-shaped or hammer-shaped
Rice. 8-194. Operation by Hohmann with hammertoe. A) Skin incision b) And V) resection of the head of the main phalanx
Rice. 8-195. Lengthening the flexor tendon of the big toe for hammertoe, A) Pathological position of the finger, b) skin incision, V) flexor tendon lengthening
their figurative change and painful callus. The hammer finger that causes complaints is operated on. A longitudinal incision is made over the proximal interphalangeal joint of the finger. After longitudinal splitting of the extensor tendon, the head of the main phalanx
lifted from the joint and using scissors Liston separated and removed (rice. 8-194). This is followed by suturing of the capsule, extensor tendon and skin. After the wound has healed, the operated finger is kept in a dressing bandage for several weeks, and the thickening of the skin disappears on its own. If the major phalanx at the proximal joint cannot be brought out of extension, the incision is extended proximally and joint capsule is cut on the dorsal surface of the proximal joint. In exceptional cases, the entire main phalanx can be removed.
Hammertoe is rare disease, which is a flexion contracture at the end joint. To eliminate the deformity, the flexor tendon is lengthened in a Z-shape. This operation can restore the function of the thumb. The tendon lengthens at the level of the main phalanx. The skin incision is made at the medial edge of the main phalanx and continues in the plantar fold, i.e. gets L-shape (rice. 8-195).
Stiff big toe (Hallux valgus) is a term that refers to a disorder associated with the joint located at the base of the big toe, a form of degenerative arthrosis. It leads to painful immobility of the big toe. Arthrosis of the big toe can be diagnosed using x-rays. In any case, in order to avoid the development of the disease, it is necessary to start therapy as early as possible.
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Stiff big toe is a disease of the big toe joint that can have many causes. Uncomfortable shoes, injuries, improper load distribution on the foot and overexertion are just a few of them. Hereditary factors can also play a big role. Find out more about typical symptoms Stiffness of the big toe.
Typical complaints when arthrosis of the big toe:
Depending on the stage of the disease, the desired result is achieved various types therapy. On initial stage Disease pain can be mitigated with the help of special insoles and orthopedic shoes. In addition to this, it is recommended to undergo a course of physiotherapy. Progressive thumb stiffness is treated with medications and injections that suppress inflammation. At surgical intervention The bone may be removed or the joint may be replaced with a prosthesis. In any case, the patient will eventually be pain-free and able to move freely.
Make an appointment with Professor Lille in Munich. A renowned orthopedist will take all necessary measures to prevent further development Hallux rigidus.
The articular surfaces of the first metatarsophalangeal joint, as in all joints, are covered with smooth articular cartilage. With arthrosis, gradual damage to the cartilage occurs, it becomes thinner, and eventually the bone base of the articular surfaces begin to rub against each other when walking. As a result of natural processes, bone growths are formed - exostoses, which reduce mobility in the joint. Gradually, the big toe becomes rigid and almost motionless.
Treatment is due to the relief of symptoms of the disease without eliminating its pathogenetic causes:
· Custom orthopedic insoles
· Orthoses – abduction splints
· Individual orthopedic shoes
· Physiotherapeutic treatment aimed at relieving pain.
Cheilotomy
– deletion bone growth, preventing movement in the joint.
This surgery is usually recommended for mild to moderate mobility limitations. It involves the removal of bony exostoses, allowing the finger to have a greater range of movement.
Shortening the first metatarsal bone.
This operation allows you to reduce the load on the first metatarsophalangeal joint, thereby reducing pain and stopping progression degenerative changes in the joint. Typically, these mini operations are performed on the foot at a time, multi-stage operations.
If damage articular surface are significant and there is no way to preserve the joint and restore mobility, an operation is performed, which consists of complete removal cartilage for the purpose of fusion of the main phalanx of the thumb and the first metacarpal bone. Metal screws and plates are used to fix the joint in the desired position. Moreover, after healing, the thumb cannot move - because the joint is no longer there. And the interphalangeal joint of the first toe takes on the partial function of rolling the foot.
Taylor's deformity or "tailor's foot" is a disease characterized by outward deviation of the fifth metatarsal bone, varus deformation of the 5th toe with the formation of a painful lump on the outside of the spot.
Also main reason development of this pathology in modern conditions is heredity, longitudinal - transverse flatfoot. In this case, the resulting exostosis in the projection of the 5th metatarsophalangeal joint begins to cause inconvenience and pain when wearing everyday shoes. As a result, the growth becomes covered with hyperkeratosis.
Surgical treatment consists of removing exostosis from the head of the fifth metatarsal bone, followed by its Z-shaped or L-shaped ostotomy, lateral displacement of the metatarsal fragment and fixation titanium screw Herbert.
The recovery process usually takes three to six weeks. Immediately after the operation, weight bearing on the legs is allowed in special postoperative Baruk shoes. The load is removed from the front part of the foot, and the moment of rolling the foot is eliminated. Wearing post-operative shoes lasts for 6 weeks after surgery.
In the early postoperative period, in mandatory Antibacterial anti-inflammatory therapy is carried out. Anticoagulation therapy is carried out for up to 30 days from the date of surgery. IN outpatient setting After the patient is discharged, special fixing bandages are applied for up to 3 weeks. Withdrawal after surgical sutures performed 14–16 days after the operation. After 6 weeks, patients are advised to wear normal everyday shoes with limited rolling of the foot for up to 2 weeks. 2 months after the operation, it is necessary to make individual instep supports for heelless shoes.
In order to prevent rigidity of the first metatarsophalangeal joint (MTP1), daily development of the range of motion in the joint is necessary. Developing range of motion is important to achieve better postoperative results and allows you to:
The recovery process directly depends on your desire and attention. If you experience difficulty performing an exercise during your rehabilitation, consult your doctor.
Rest and elevation lower limbs. There are no exercises necessary during this period.
Start with moderate intensity exercise. Grab your thumb at the base, close to the metatarsophalangeal joint. Do not confuse the interphalangeal joint (IPJ) with the metatarsophalangeal joint. Interphalangeal joint located in the middle of the finger, closer to its nail plate. Gently straighten your finger in an upward motion until you feel resistance and mild discomfort. Then hold your finger in this position for ten seconds. Repeat this exercise three times, then bend your finger, moving downward, until you feel the same sensation, repeat the exercise three times, ten seconds each. This series of exercises should be performed three times a day for the second week.
During this period, manual development movements should be increased to approximately six times per day with a gradual increase in strength and intensity.
Start a set of exercises under weight load. This exercise is performed in a standing position, by lifting the heel up without lifting the toes from the surface; this exercise allows, under the influence of body weight, to gradually increase the amount of extension in the toes. Stand on your toes for about ten seconds (after week six!!). Start walking uphill to increase finger extension. Walking with long strides is also effective - this is an excellent exercise for increasing flexibility in the first metatarsophalangeal joint.
With one hand, grab anterior section foot, to the base of the big toe. With your other hand, grab the base of your thumb, close to the metatarsophalangeal joint. The first step is to stretch the big toe, as shown in figure A. Then stabilize the forefoot by holding it with your hand, as shown in figure B, with the other hand, pull the big toe up, without twisting, the direction of the forces is indicated by the arrows in the figure, while keeping the foot bend (keep your finger straight). Hold your finger in this position for 10 seconds and repeat the exercise three times. Perform a similar exercise, but with the big toe shifted downwards, keeping the foot straight, as shown in Figure B, the direction of the forces is indicated in the picture. Hold your finger in this position for about ten seconds and repeat the exercise three times. These exercises should be performed six times a day.
