Hallux valgus

Abstract

Hallux valgus je kompleksan deformitet prednjeg stopala. Pored lateralne devijacije prvog metatarzofalan-gealnog zgloba veće od 15-20 stepeni i intermetatrzalnog varusa većeg od 8-9 stepeni, odlikuje se i opsežnim promenama u mekim tkivima svoda, sezamoidnom mehanizmu i metatarzokuneiformnom zglobu. Javlja se gotovo isključivo kod ljudi koji nose obuću. Iako se donekle može tretirati neoperativno, korektivnim separatorima i ulošcima, dominantno lečenje je operativno. Opisan je veliki broj operativnih postupaka čiji je cilj korekcija deformiteta i uspostavljanje normalne biomehanike prednjeg stopala. Postoji sedam konceptualno različitih procedura počevši od jednostavne buniektomije, preko raznih mekotkivnih procedura, metatarzalnih i falangealnih osteotomija, do resekcione artoplastike i metatatrzofalan-gealne artrodeze. Sve imaju jasne indikacije i nijedna od njih nema prednost nad ostalima. U skladu sa etiopatogenezom bolesti prevencija je jednostavna: nošenje udobne obuće.

Hallux valgus is a complex deformity of the forefoot. Beside the lateral deviation of the first metatarsophalangeal joint angle exceeding 15-20 degrees and intermetatarsalvarus exceeding 8-9 degrees, it is also characterized by extensive changes of the soft tissue arch, sesamoid mechanism and metatarsocuneiform joint. It occurs almost exclusively in humans wearing shoes. Although in some measure it can be treated non-operatively, by corrective separators and inserts, operative treatment is predominant. There are numerous operative procedures aimed at the correction of the deformity and inducing normal biomechanics of the forefoot. There are seven conceptually different procedures starting from simple bunionectomy, through various soft tissue procedures, metatarsal and phalangeal osteotomies, to resection arthroplasty and metatarsophalangeal arthrodesis. All have clear indications, and none of them has advantages over the others. In accordance with the etiopathogenesis of the disease prevention is easy; wearing comfortable shoes.