Ankle is a condition caused by the progressive oblique position of the big toe. When it exists for a long time and is of a high degree then it usually pushes the 2nd finger which usually goes below the 1st and over time creates arthritis in the joint at the base of the 2nd finger and formation of a hammer finger, ie the 2nd finger is not straight and has shape like a small hammer.
Risk factors are the hereditary predisposition where then it can appear at a young age, increased age, muscle weakness and flat feet, narrow shoes and high heels.
The pathophysiology concerns the muscular weakness in the middle leg, which results in many times flat feet and pronation in the extremity of the foot, the big toe turns inwards and the abnormal load on the sesame bones below it over the years makes it slowly become oblique. At first we understand it as a lump formation (knuckle) that appears on the inside at the base of the big toe which over the years becomes bigger not because it grows but because the front foot widens and spreads more resulting in the big toe becomes more oblique and the bulge looks bigger.
Instability in the tarsometatarsal joint of the big toe is another cause that results in the 1st metatarsal to flies inwards (thoracic metatarsus) while the big toe becomes oblique outwards.
It manifests itself in the early stages with pain, local irritation and redness on the ankle from the narrow shoes. As the inclination of the finger increases, then the load under the big toe in the sole changes, resulting in pain under the big toe in the sesamoid bones, while in very large joints the weight of the body is transferred to the 2nd metatarsus and creates pain and good sole in the corresponding area (metatarsalgia).
The diagnosis is confirmed by the correct clinical examination and the loading of the bare foot on the floor in the doctor's office together always with an X-ray of the patient comparing both feet on the same radiographic plate with loading, ie standing with all the weight of the body. This is because the angles of the foot and the metatarsals need to be measured to determine the cause of the deformity and the ankle.
Conservative treatment of the knuckle is mainly preventive. This means that wide shoes, flat feet and flat feet, splints for the big toe may help relieve pain, irritation and slow the progression of the disease in the early stages but do not correct the deformity.
Treatment for moderate to severe deformities is surgery. This means that through small incisions an osteotomy is performed in the 1st metatarsus exactly where it is needed (at the base, bulge or peripherals) depending on where there is a cause that created the knuckle. The osteotomy is fixed with screws or when needed with a special anatomical plate. The whole surgery is bloodless due to ischemic ligation in the leg during the operation. It can be done under general anesthesia or with nerve blocks on the back of the knee or at the level of the ankle. The operation is usually performed as a day hospitalization while in larger corrections the patient can be discharged the next morning.
Recovery is at about 4-6 weeks where the patient is charged with a special shoe until complete healing is done.
The international literature describes more than 100 different operations for the correction of the big toe and it is not a simple matter. A very good personalized preoperative plan is needed to find exactly where the problem lies, so that proper surgery can lead to a very good result without recurrence in the future.
2. Hallux Rigidus
The big toe is a degenerative arthritis of the first metatarsophalangeal (MTF) joint, which forms a large dorsal osteophyte and as a result we have stiffness, mainly restricting the dorsal extension of the big toe and severe pain.
The disease is degenerative and can be part of a more general problem, such as rheumatoid arthritis and other systemic diseases.
The disease progresses in the following stages:
Early stage: Simple flattening of the joint without the development of osteophytes, with
stiffness and pain in the first metatarsophalangeal joint. Treatment: Conservative
Intermediate stage: Arthritis is evident mainly on the dorsal side of the joint, with limited dorsiflexion and narrowing of the intervertebral space. Treatment: Surgery - Chilectomy
Advanced stage: Arthritis of the first metatarsophalangeal joint of the big toe is fully developed, with severe limitation of its mobility, dorsal and plantar and with increased osteophyte. Treatment: Arthrodesis
The operations for the correction of the deformities of the foot and ankle (ankles, hammer toes, toes, neuroma Morton, PD arthroscopy and tendon transfers) can be performed under local anesthesia (block):
with day care (no hospitalization)
with direct charge without bacteria
with rapid recovery
3. Hammer toe.
The first phalangeal joint is in flexion, while the second in extension, resulting in the development of good on the dorsal surface of the first phalangeal joint by the pressure of the shoe.
The surgeries are often performed as day surgeries, and the patient may return home the same day.
4. Morton neuroma
It is due to compression perineural fibrosis of the common finger nerve of the third interdigital fissure, which is the most common. However it can grow in any interdigital space.
It is common in road, jump and team athletes due to injury or chronic stress. Also tight inappropriate shoes or in combination with subcutaneous fat atrophy can cause the disease.
The symptoms are metatarsalgia with localized pain in the heads of the metatarsals and intense burning pain, with a feeling of tightness or cramping.
The confirmation of the disease is done by magnetic.
The treatment conservatively lies in special orthotics and shoes, topical steroids in combination with local anesthetics.
Surgery can be done by decompressing the neuroma or surgically removing it. Surgeries are often performed as day surgeries, and the patient can return home the same day.