Deformation of the toes is observed with flat feet, developmental anomalies, some inflammatory, degenerative, endocrine, hereditary diseases. It is caused by edema, a change in the shape, length, location of the phalanges, restructuring or growth of bones in the joint area. It can be one- or two-sided, local or widespread. Often associated with deformities of the foot. The cause of the pathology is established according to the examination data, the results of radiography, plantography, CT, MRI, and other methods. Tactics of treatment depends on the nature of the identified disease.
Traumatic injuries
Deformations are accompanied by the following injuries:
- Injury. The change in the appearance of the finger is due to swelling of the soft tissues. Soreness, cyanosis, and sometimes hemorrhages are noted. All symptoms disappear within 1-2 weeks.
- Fracture. The deformation is especially noticeable when the fragments are displaced, the phalanx is bent at an angle, rarely shortened. In fractures without displacement, external changes are associated only with edema, so such an injury can be confused with a bruise. A distinctive feature of the fracture is pain during axial load.
- Dislocation. The finger is sharply deformed in the projection of the joint. Movements are impossible, an attempt to move in the affected joint is accompanied by springy resistance.
- Frostbite. After warming, the fingers swell sharply, become purple-bluish. Sometimes bubbles appear. The patient is disturbed by increasing burning pains. The absence of pain, blackening are a sign of severe frostbite with tissue necrosis.
Arthritis
In patients with arthritis in the early stages, the deformity is caused by edema, then by changes in the bone and joint structures of the toes. The symptom is detected in the following types of arthritis:
- Rheumatoid. The lower extremities are affected less frequently than the upper ones, the fingers are affected symmetrically. The pains intensify in the afternoon, at night, weaken in the morning. Swelling of the joints is determined, hammer-shaped or claw-shaped deformities are formed over time.
- Psoriatic. Distal arthritis is associated with skin changes. Due to axial inflammation, the fingers acquire a sausage-like appearance. The defeat is asymmetrical. Flexion restrictions predominate.
- Gouty. 1 metatarsophalangeal joint suffers. The disease proceeds paroxysmal. Unbearable pain, pronounced edema, and an increase in local temperature suddenly appear. The affected area becomes bright red.
In nonspecific infectious polyarthritis, short-term deformation against the background of edema is detected after acute infectious diseases. Post-traumatic arthritis develops after dislocations and fractures, proceeds chronically, affects one joint. A chronic course is also characteristic of arthritis caused by overloading the feet due to excess weight, but in such cases, not mono-, but polyarthritis is observed. A special kind of deformation against the background of overload are the "fingers of ballerinas".
Toe deformity
congenital anomalies
Deformities associated with a change in the number, shape and size of the toes, often combined with similar anomalies of the upper limbs, include the following malformations:
- Ectrodactyly. Underdevelopment or absence of one or more toes is noted. Possible underdevelopment of the bones of the metatarsus. Due to the often present median cleavage, the foot may resemble the claw of a cancer or crab.
- Syndactyly. One or more fingers grow together completely or partially. Simple syndactyly is characterized by fusion of unchanged fingers, complex syndactyly is characterized by a combination with other malformations: shortening, reversal, increase, decrease in the number of phalanges.
- Brachydactyly. Shortening of one or more phalanges. It can be supplemented by a radial deviation of the phalanges, fusion of the phalanges with each other, deformation of the nail plate, underdevelopment of the metatarsal bones.
- Polydactyly. It is due to the appearance of rudimentary, additional (forked) or full-fledged fingers. Other anomalies are often found.
- Clinodactyly. Curvature of the fingers or distortion of their position relative to the axis of the limb. Usually symmetrical. On the legs, in most cases, it is a minor aesthetic defect that does not require special correction. Clinodactyly thumbs are a sign of fibrodysplasia.
hereditary diseases
The congenital anomalies of the development of the legs listed above can form in isolation, be combined with other stigmas of embryogenesis, and be observed in the following hereditary diseases:
- Russell-Silver syndrome. Revealed syndactyly 1-2 toes.
- Down Syndrome. Brachydactyly, a wide distance between 1 and 2 toes are noted.
- Andersen syndrome. characteristic brachydactyly. Possible curvature, fusion of fingers.
- Ataxia Friedreich. Deformities can be congenital, caused by flat feet, clubfoot, neurological disorders.
- Pfeiffer syndrome. In mild cases, the expansion of the main phalanges is determined. Many patients have syndactyly.
Unlike the pathologies listed above, with Ollie's disease, deformations do not appear in utero, but in the first decade of life. Due to uneven growth, the formation of foci of cartilage tissue, the fingers are shortened or bent, covered with spherical "bloating".
Due to the redistribution of the load, the shape of the toes changes with all foot deformities, including clubfoot, hollow, horse and heel foot. The most common deformity is transverse flatfoot, therefore, the most famous acquired disorders are associated with this pathology:
- hallux valgus. Deviation of 1 finger is more often bilateral in nature with some asymmetry. Progresses with age. It is complicated by arthrosis, limited mobility of the 1st metatarsophalangeal joint.
- Hammer fingers. Often come to light simultaneously with Hallux valgus. Deformation is provoked by the pressure of the curved 1st finger, imbalance of the muscles. As a rule, the 2nd finger suffers, less often - the 3rd finger. The main phalanx is extended, the distal phalanx is bent. Initially, the finger is passively brought to the correct position, and later the deformity becomes fixed.
- Claw fingers. As in the previous case, there is an imbalance between the extensor and flexor pull. Several fingers are deformed. Pathology is aggravated by disturbances of local blood circulation in vascular, endocrine, metabolic disorders.
Arthrosis
Osteoarthritis often develops in old age. May occur after injury. Accompanies other deformities. The appearance of the affected joints changes over several years due to bone growths, during exacerbations it is aggravated by edema due to inflammation of the soft tissues. Against the background of arthrosis of the I metatarsophalangeal joint, a rigid big toe is sometimes formed. In this case, external changes are combined with a significant limitation of movement that prevents walking.
Neuroosteoarthropathy
It develops against the background of damage to peripheral nerves. The most common neuroosteoarthropathy is a type of diabetic foot called diabetic arthropathy. At the initial stage, deformations are provoked by edema. Subsequently, due to changes in the structure of bones and joints, the fingers become claw-like. Other pathologies that can cause neuroosteoarthropathy include:
- toxic neuropathy in patients with alcoholism, other chronic intoxications;
- condition after spinal cord injury;
- polio;
- neurosyphilis;
- syringomyelia;
- leprosy.
Local infections
Panaritium affects the legs less often than the arms. In the acute period, deformation is observed in all forms of pathology, caused by edema, accumulation of pus. With deep forms of panaritium (articular, bone, tendon), the cause of the change in the appearance of the leg is the melting of tendons and solid structures. As a result, extensive scars, contractures, ankylosis are often formed, causing permanent gross deformities.
Diagnostics
Orthopedic traumatologists are more often involved in establishing the cause of deformities of the distal legs. According to indications, patients are referred to podologists, rheumatologists, and other specialists. The examination program may include the following diagnostic procedures:
- Interrogation, external examination . The specialist determines when and under what circumstances the deformity appeared, detects external changes, assesses the mobility of the joints, determines the pulsation, evaluates the sensitivity of the foot.
- Radiography. Taking into account the characteristics of the pathology, x-rays of the fingers or the entire foot can be prescribed. Loaded snapshots are taken if necessary. The method visualizes traumatic injuries, flat feet, arthrosis, chronic arthritis, deep panaritium forms.
- Plantography. Allows diagnosing longitudinal and transverse flat feet, identifying valgus and varus deformities of the foot. To increase the information content, it can be supplemented with podometry, podography.
- Laboratory tests . Appointed to determine the markers of rheumatic diseases, metabolic disorders and signs of inflammation, the study of microflora.
Kinesiology taping
Treatment
Help at the prehospital stage
Patients with traumatic injuries, inflammatory diseases are shown rest, elevated position of the limb. In case of injury, cold is applied to the injury site. In case of fractures and dislocations, temporary immobilization is carried out using a splint or a special bandage.
In case of frostbite, a multilayer dry bandage is applied to naturally warm the affected areas. Warming your feet in hot water or using a heating pad is strictly prohibited, as this can aggravate tissue damage. In some pathologies, it is possible to apply local anti-inflammatory and analgesic and painkillers.
Conservative therapy
In case of injuries, the dislocation is reduced or the fracture is repositioned, a plaster cast is applied to the leg, or the sick finger is fixed to the healthy one. Depending on the characteristics of the pathological process, the following conservative methods are used in the treatment of patients with finger deformities:
- Protective mode . May include limiting the load, the use of orthopedic products, crutches, canes.
- Medical therapy . For pain, signs of inflammation, NSAIDs are recommended, and for infectious processes, antibiotic therapy is performed. Patients with diabetes are shown hypoglycemic agents or insulin injections.
- Non-drug methods . Massage and exercise therapy play an important role in the treatment of many finger deformities. Patients are prescribed UHF, laser therapy, magnetotherapy, and other physiotherapy procedures.
Surgery
With pathologies accompanied by deformities of the fingers, the following operations are performed:
- Injuries : fixation of fragments with knitting needles, removal of necrotic areas and amputation of fingers in case of frostbite.
- Developmental anomalies : operations for syndactyly, removal of extra fingers for polydactyly, plastic surgery for ectrodactyly.
- Foot deformities : surgery for Hallux valgus, resection of the hammer toes.
- Local infections : opening panaritium.
In case of improperly fused fractures, osteoarthritis, pronounced contractures and ankylosis of various origins, arthroplasty of the fingers is performed to restore the functions of the foot.