Botulinum toxin in the treatment of hallux valgus
Hallux valgus is not only a medical problem, which is a serious orthopedic disease, but also an aesthetic one, since a pronounced “bone” on the first toe spoils the appearance of the foot, causes debilitating pain, and deforms beautiful shoes.
Wikipedia defines aesthetic medicine (EM) as a branch of the beauty and health industry, combining all theoretical information and practical possibilities for correcting a person’s external data using medical techniques. That is, in other words, EM is a branch of medicine aimed at correcting, treating or eliminating congenital or acquired defects.
Currently, we are witnessing the emergence of a new direction in aesthetic medicine - aesthetic traumatology and orthopedics. Treatment of hallux valgus has long consisted of minimally invasive procedures or surgery, after which patients in most cases do not drop out of social life or lose their ability to work.
Anatomical changes
Hallux valgus is a condition in which the first toe is deformed at the level of the medial metatarsophalangeal joint with a valgus, that is, outwardly directed deviation. With such a deformation of the foot, the angle between the first and second metatarsal bones increases: the first metatarsal bone moves inward, and the first toe is held outward by the adductor muscle. As a result of this process, a tubercle appears, which is called a “bone”.
On the one hand, this condition of the foot is caused by a long-term violation of the biomechanics of the first metatarsophalangeal joint, which is often associated with transverse flatfoot, weakness of the ligamentous apparatus, some neurological disorders, congenital deformities, genetic factors and a number of other reasons. According to statistics, this orthopedic disease occurs more often in women than in men, and one of the most common factors in its occurrence is considered to be wearing narrow high-heeled shoes.
Joint deformation is accompanied by progressive arthrosis.
The main symptoms of hallux valgus are a visible deviation of the first toe outward, a gradual increase in exostosis, “hammer-shaped” and “claw-shaped” deformation of the remaining toes, and pain. Painful sensations when walking, wearing shoes, burning in the joint after a long walk or a long vertical load, difficulties in choosing shoes. With further development of the disease, the degree of deformation increases and pain occurs at rest. This leads not only to constant physical discomfort, but also to a deterioration in the quality of life, associated both with limitation of physical and social activity, and with dissatisfaction with one’s appearance.
Why does pain occur in the area of the first metatarsophalangeal joint? We mentioned that one of the factors in the development of hallux valgus is transverse flatfoot. In this case, there is a constant spasm of the muscles that adduct and extend the first toe, which causes pain, fatigue and increased deformity. Then inflammation of the joint capsule is added to this process.
Classification
The descriptive classification of valgus deviation of the first toe by MJ Coughlin and RA Mann best meets modern requirements. The authors distinguish moderate, medium and significant deformations of the first finger depending on the angle of its deviation.
With moderate deformity, the angle of valgus deviation of the first finger is radiographically no more than 20°, and the deformity is often aggravated due to valgus deformation of the first finger itself.
With an average deformity, the angle of valgus deviation of the first finger is from 20 to 40°, while the first finger puts pressure on the second, displacing it.
Significant valgus deformity exceeds 40° of lateral deviation, which causes displacement of the second toe above or below the first (Fig. 1).
Treatment
Treatment of this disease can be either conservative or surgical.
The most modern surgical method for treating hallux valgus is minimally invasive percutaneous surgery. Conservative treatment includes wearing interdigital partitions and orthopedic insoles, therapeutic exercises of the toes, physiotherapeutic treatment, injection of hormonal drugs into the cavity of the first metatarsophalangeal joint, plasma therapy, taking non-steroidal anti-inflammatory drugs, kinesio taping, botulinum therapy.