Hallux valgus is the lateral deviation of the [toe at the first metatarsophalangeal joint. Exostosis is a complex anatomic deformity and can be extremely challenging to treat. A capsule is a distinct medial protrusion that occurs in [valgus deformity, but the two terms are generally used interchangeably. [Ectropion is the most common lesion involving the [toe and is most often seen in middle-aged and older women, most often in those with a genetic predisposition combined with prolonged wear of ill-fitting shoes that exert abnormal pressure on the [toe. The toe is externally rotated along its long axis as the long extensor, long flexor, and retractor muscles are strained and pulled, and the toe continues to be exacerbated toward the midline. The medial head of the medial extensor and short flexor muscles and their internal seed bones are displaced outward and lose their abduction effect, and then the lateral head of the extensor and short flexor muscles contract, the lateral joint capsule contracts and thickens, the toe is semi-dislocated outward, the lateral seed bone becomes larger and moves between the 1st and 2nd metatarsal heads, toe valgus pushes the 1st metatarsal inward, widens the transverse arch of the foot, to the point that the medial metatarsal head is squeezed and rubbed by the shoe upper, capsulitis occurs, painful, and then the 1st The head of the metatarsal bone becomes larger and forms a medially protruding bone. As a result of strain on the retractor muscle, the transverse arch of the foot flattens and the 2nd and 3rd metatarsal heads collapse toward the lateral end of the metatarsal, which causes thickening of the skin and formation of callus due to weight bearing and friction. The toe turns outward, squeezes the 2nd toe, occupies the position of the 2nd toe, lifts the 2nd toe and overlaps the toe, causing the 2nd toe metatarsophalangeal joint to overstretch and the proximal interphalangeal joint to flex, becoming a hammer toe, protruding on the dorsal side of the toe and 3rd toe, and the dorsal side of the proximal interphalangeal joint is rubbed and squeezed by the shoe surface, also producing painful calluses.
Pathogenic factors.
1, genetic The occurrence of ectropion deformity is related to congenital factors, about half of the cases have genetic factors.
2, wearing high-heeled pointed shoes is [one of the main factors in the formation of ectropion, pointed shoes for the front of the triangle, high-heeled standing, the front of the foot is stuffed into a narrow triangular area, the hard surface of the shoe forced the toe turned out and slightly externally rotated, the little toe turned in slightly internally rotated, the middle 3 toes proximal interphalangeal joint strength flexion, metatarsophalangeal joint and distal interphalangeal joint hyperextension.
3, various inflammatory diseases Especially rheumatoid, often due to joint destruction to form outward semi-dislocation, in a valgus deformity.
Pathological manifestations.
The pathological changes of ectropion are summarized as follows.
(1) Ectropion, metatarsophalangeal joint subluxation;
(2) 1st metatarsal inversion and capsulitis;
(3) Callus at the 2nd and 3rd metatarsal heads;
(4) Hammer toe of the 2nd toe;
⑤ Osteoarthritis of the 1st metatarsophalangeal joint.
Treatment.
1, non-surgical therapy early lesions, less painful, non-surgical therapy can be used, including wearing shoes with a wide front heel height of no more than 62.5px, massage, moving the toe to the inside of the foot, walking barefoot on sand, exercising the foot muscle, hot compresses, rest, etc. Gymnastics to correct valgus also has certain efficacy, that is, on both sides of the first toe set rubber band to do left and right opposite direction traction action, 2 times / d, each time 5 ~ 10 min. trying to reduce the pressure and friction on the bone protrusion, is also a proven method, such as putting a soft washer around the bone protrusion, if the pain is limited to the capsulitis or metatarsophalangeal joint, can assist a variety of brace treatment.
2.Surgical treatment The purpose of surgical treatment is to reduce pain and correct deformity, which is suitable for patients in the middle and late stages. Some ectropion deformities are very serious but not painful, so surgical treatment is not needed. There are more than 200 surgical methods reported, which can be summarized into 5 categories.
(i) Soft tissue surgery: mainly the retractor muscle is cut at the stop of the proximal phalanx and relocated to the fibular side of the 1st metatarsal head, as represented by the McBride procedure.
② osteotomy: removal of part of the bone to relax the contracted soft tissue and relieve the symptoms commonly used are Mayo surgery and Keller surgery.
(iii) correction of the 1st metatarsal phalangeal osteotomy, or simultaneous soft tissue surgery and/or osteotomy.
(iv) 1st metatarsophalangeal joint fusion.
⑤ Small incision surgery.