Introduction
The big toe, also known as the hallux, is made up of several bones, tendons, and ligaments that work together to allow for movement and support of the foot. The bones of the big toe include:
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Proximal Phalanx: The bone closest to the foot. It is connected to the metatarsal bone at the metatarsophalangeal joint.
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Distal Phalanx: The bone closest to the nail. It is connected to the proximal phalanx at the interphalangeal joint.
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Metatarsal Bone: The long bone in the foot that connects the ankle to the toes. The proximal phalanx is connected to the metatarsal bone at the metatarsophalangeal joint. A metatarsophalangeal joint is formed where the metatarsal (first long bone) in the forefoot meets with the first bone of the big toe.
What Is Metatarsus Primus Varus?
Metatarsus primus varus is a condition that affects the alignment of the bones in the big toe. It is characterized by an abnormal angle that points the big toe inward towards the second toe. According to certain research studies, the condition may have a genetic component, where if one parent has it, there is a 50 % chance of passing it on to their children.
What Are the Causes of Metatarsus Primus Varus?
Metatarsus primus varus is commonly seen in individuals who frequently wear shoes. Wearing shoes with a pointed or narrow toe box, like high heels, increases the chance of developing this condition. Genetics is considered to be a contributing factor. Women are more susceptible than men. This disorder is identified during childhood, as it is commonly present at birth. It is also associated with a bunion (a swelling or bump on the side of the big toe). Most cases are seen associated with the bunion. A bunion or hallux valgus is a bump on the side of the big toe. This condition causes pain and swelling in the first joint of the big toe. As a result, the big toe bends towards the other toes.
What Are the Symptoms of Metatarsus Primus Varus?
Symptoms of metatarsus primus varus include:
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Pain and discomfort in the foot, especially in the first metatarsal bone.
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Abnormality of the foot, such as an angled big toe or an inward-facing first metatarsal bone.
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Difficulty in walking or standing for long periods of time
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A noticeable bump on the inner side of the big toe.
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Restricted range of motion in the foot.
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Skin irritation or blistering (fluid-filled space on skin layers) in some cases.
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Callus (hardened or thickened area of skin) formation on the inner side of the foot.
How Can Metatarsus Primus Varus Be Diagnosed?
Healthcare professionals will diagnose metatarsus primus varus based on physical examination and imaging tests like X-rays. During the physical examination, the doctor will look at the shape and alignment of the foot. They also pay special attention to the first metatarsal bone and the angle at which it sits in relation to the rest of the bones in the foot. The doctor may also assess the range of motion and muscle strength in the foot. Healthcare professionals also inquire about symptoms the patient is experiencing, such as pain or difficulty while walking. In addition to the physical examination, imaging tests, such as X-rays, are usually used to confirm the diagnosis of metatarsus primus varus and determine the condition's severity. X-rays can provide detailed images of the bones in the foot and can show the angle of the first metatarsal bone in relation to the rest of the bones, which can help to diagnose metatarsus primus varus.
How Can Metatarsus Primus Varus Be Treated?
The treatment for metatarsus primus varus varies depending on the severity of the condition and the patient's symptoms. The conservative treatment methods include:
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Orthotics or Shoe Inserts: These can redistribute pressure on the foot and help to alleviate pain and discomfort. Custom-made orthotics can effectively provide support and cushioning to the affected area.
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Physical Therapy: This helps to stretch and strengthen the muscles in the foot, which can improve the alignment of the bones and reduce pain.
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Rest: Avoid prolonged standing and other activities that increase the pain.
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Applying Ice Packs: Applying ice to the affected area can help to reduce pain and inflammation.
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Appropriate Shoes: Change shoes with a wider toe box and soft stretchable material in the toe box. Avoid wearing high heels and pointed-toe shoes to relieve the symptoms.
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Prescription Medicines: Anti Inflammatory medications like Ibuprofen can help to reduce pain and discomfort.
When Is Surgery Needed for Metatarsus Primus Varus?
If conservative treatment is ineffective, surgery is the alternate option. Surgery is done to improve the alignment of bone and thereby relieve the pain and discomfort. Surgical options for treating metatarsus primus varus include soft tissue and bony procedures. Soft tissue procedures for treating metatarsus primus varus include:
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Tendon Transfer: This method involves relocating a tendon from one area to another to correct the deformity.
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Ligament Release: This method involves cutting or freeing the ligaments that are pulling the bone out of alignment. This can help to correct the deformity and improve the alignment of the bones.
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Tendon Lengthening: This method involves cutting the tendon, allowing it to stretch and align the bone better.
Bony procedures for treating metatarsus primus varus include:
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Osteotomy: This procedure involves cutting and repositioning the bone to correct the deformity. Osteotomy can be done on the first metatarsal bone or on the proximal phalanx of the hallux (big toe).
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Arthrodesis: This procedure involves fusing the bones together to correct the deformity. This is usually performed for more severe cases where other methods have failed.
The choice of surgical procedure will depend on the particular case and the surgeon's preference. It is important to note that the recovery time and rehabilitation process will vary depending on the type of procedure performed. Physical therapy will be necessary after surgery to regain the strength, flexibility, and range of motion of the foot.
Conclusion
Metatarsus primus varus commonly occurs because of wearing constrictive footwear, such as shoes that are too tight or narrow. Properly fitting footwear helps to prevent foot deformity to some extent. Metatarsus primus varus treatment aims to regain mobility as quickly as possible and experience permanent medical and cosmetic improvement of the affected foot. It is important to consult healthcare professionals as early as possible to prevent complications. This can help them better understand the extent of the condition and its impact on the patient's daily activities.
