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Onion foot: attention danger for sport

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Have you ever heard of hallux valgus?
It is this large onion on the foot at the big toe joint and prevents one of 10 French to fit properly and sports to significantly reduce its weekly activity.
At a certain stage, it often remains that surgery to relieve the patient and allow a resumption of sporting activity and wearing shoes.
The deformation which is commonly called "the onion is located at the front of the foot.
As anyone can see by looking down his leg, the foot is made up of five toes each comprising 3 phalanges except the largest, which he presents in two.
Each toe is hingedly connected to a bone is called, a metatarsal.
The assembly radius.
The hallux valgus to the first beam, that is to say, the first metatarsal and big toe.
The metatarsal for various reasons will gradually enter a diversion inwards of the foot causing a rotational slip of the big toe (hallux) outward (valgus).
The lateral links (interosseous) for holding up the horizontal alignment of the first ray are no longer effective.
Gradually the big toe will come closer to the second toe and a power struggle between the two will be exercised.
Of course the big will hold sway over the small and oblige latter to deform.
The second toe will raise forming a claw, leaving the field open to the biggest that has plenty of time to continue its slow progress to why not in the most extreme cases form a right angle with his metatarsal.

There is a ray angle that determines the pathological threshold of hallux valgus.
This angle is calculated between the first joint of the big toe and the first metatarsal.
At above 15 ┬░ to 20 can be considered hallux valgus pathological.
In daily practice, we see a significant number of athletes may suffer below these theoretical values.

-it Is a female predisposition?
It turns out that various studies show that out of 100 hallux valgus 5 relate to the man and 95 women.
This disproportion probably do not take account of choice rather very restrictive for shoe-foot (pointed toe and high heel) women.
Nevertheless flexibility or joint laxity in the female may also explain this difference.
Is there a congenital predisposition?
Hallux valgus is not, strictly speaking, a hereditary disease that is transmitted from father to son.
However found in a third of a family tend to this deformation.
SO ?
While the causes are many and often not identified
Yet the search for the cause of this deformation is paramount in the fight against evolution and especially in the case of a surgical prevent a recurrence.
It may be noted as the primary:
The flat foot or valgus foot (most common) which causes a rotation of the foot inward and therefore a rotation of the big toe on its axis and pronated valgus.
More foot pronation will be present hallux valgus and uncorrectable.
Other skeletal abnormalities can be at the origin of this deformation, especially the morphology classification of the forefoot.
There are three:
The Greek foot representing 11% is characterized by a second toe longer than the first
The Egyptian foot (62%) shows a first longer than the second and last square foot (27%) aligns the first three toes.
Found in the square and the Egyptian by the presence of a first toe imposing a significant number of hallux valgus.
Another example is in brief
Deformation of the joint of the first ray and more particularly to joint surfaces
Imbalance between the muscles responsible for lateral movement of the big toe
Micro trauma or real big shock when playing sports
Wearing tight shoes too small or too high heel.
Hallux valgus is characterized outside the visible distortion by forming on the inside of the foot at the joint of a projection which is called "exostosis" or more commonly, onion.
It corresponds to a true benign tumor which is stimulated by the repeated rubbing of the skin surface on the shoe.
As to measurement of the mechanical stress onion increases in volume which generates more friction.
This is the story of the snake biting its tail.
There is a true both dermal inflammatory mechanism but also the whole of the joint.
Sometimes the sports physician is obliged during the formation of bursitis puncture fluid to relieve the athlete.
It subcutaneous bursitis phenomenon onion reoffend as mechanical friction disorder remain.
There are several stages in the development of hallux valgus and the appearance of the onion on the inner face of the joint.
Initially, in consultation sporting asked to look at his foot for several weeks because he felt a dull pain in the big toe.
It's hard to define and especially to locate her pain.
It also feels a little stiff in the race and lateral movements.
Clinical examination is quite poor because they can not find visual signs.
At most, actually a little stiffness and a small deviation of the big toe associated with a small side swelling.
At this stage the prevention and practitioner of the board is important because you can limit by tips and corrections foot the evolution of deformation.
A patient's clinical examination is mandatory.
The second stage is already much more pathological.
The sports accurately describes the location and intensity of pain.
The discomfort becomes significant and athletic performance is problematic.
The sportsman has in some cases halt temporarily its sports and sometimes embarrassed to be wearing shoes.
On examining the deformation is present and onion appears with inflammatory skin lesions.
mobilization of the big toe is painful when lowering and lateral movement
The patient feels a constant pressure of his big toe and especially a tension tendons that would require the diversion
We see the faces plantar hyperkeratosis formation often associated with bruises very painful subcutaneous for the sport.
Celles- are always located at the lateral and inner surfaces of the joints of the big toe.
The lateral surface of the nail of the big toe facing the second can know episodes of ingrown nails by conflict.
There is sometimes a stage two bis or deformation evolves quietly without causing any pain and this for years

The third stage is that of the onion:
The deformation is installed, onion shines in its scope and its deep red color.
We can even feel this fine specimen and enjoy a small area containing a liquid that can suggest a waterbed.
We are no longer at the stage of visual examination but often complementary to that balance.
The patient and the stoppage of sport is necessary because in addition to the pain of the big toe appears another sign of suffering.
The second toe and its follow its articulation with the metatarsal.
We call it, the second beam instability syndrome.
This syndrome that continuously evolves will become unbearable.
The sportsman goes through pain stop his workouts and discover its daily movements are disrupted.
We will ask the help the radiologist to check by ultrasound or MRI the status of the joint capsule and the plantar plate.
Watch your foot

In this third phase you will appreciate that in addition to the rotation of the big toe and the formation of the onion, the second and third toes will support more.
Indeed, the second is to marry the first while the other will come to embrace the fourth describing when the loading of the foot on the floor a beautiful V.
Unfortunately it does not mean the win against disease progression but rather a suffering of two toes.
We are close to a complete dislocation of the joint of the second toe
Foot Complex
The big toe continues to do his job and forces the latter to continue to rise for the final dislocate completely causing a complete imbalance of the whole metatarsal palette.
The pains are total on the front foot but also on the ankle joint and extension of the lower limb.
The foot is completely disorganized (toe claws, before deformed foot ...) posture and walking are found affected.
Also the appearance of hyperkeratosis area on the forefoot and horn complicates the boot.
We are at the stage of the surgery.
This is the question that keeps coming because for the sport that disease progression is a real mess in the practice of his activity
The best treatment is undoubtedly prevention:
First of all the choice of town shoes but also sports.
The athlete must be careful and seek advice in buying his plantar equipment.
The wide foot will focus on shoes with different widths as for running the New Balance.
People showing a big toe of an exaggerated volume will avoid sneakers rather pointed.
Sports such as football, rugby, ice skating, and biking are regarded as favoring the development of the hallux by the shape of the shoe (very sharp and very fine).
Finally it is important to correct all the problems of mechanics by wearing orthotics made up by a podiatrist after static and dynamic clinical examination.
Wearing his braces should be installed in both the city and sneakers.
The pedicure care is also essential to allow the athlete to combat all skin conditions. (Horn, calluses, nails incarnated ....)
Finally in the early stages of evolution the patient may need to consult a physiotherapist to fight against contractures and mobilize the joint of the big toe to give flexibility to the whole of the first ray.
Stages 2 and 3, the situation should be supported very carefully to avoid surgical sentence.
Wearing orthotics becomes essential to relieve the patient of pain including the second radius.
Again they will be in daily use and in sport.
The pain should guide the patient but generally if the brace is tolerated, the sport will totally relieve and can resume full sporting activity.
But beware, the disappearance of symptoms is misleading because in more than two sports, there is a port stop of the equipment after one year.
Understand that it immediately causes a resumption of evolution and recurrence of pain.
Physiotherapy is always appreciated.
Surgical sentence is to book when all other treatments can no longer relieve the patient.
This surgery that still retains today a delicate and painful reputation is now quite settled and has nothing to do with the one that was practiced there in a few years.
The progress is considerable and the postoperative course is not painful.
The results are good and even very good and in a growing number of cases.
The length of stay is 2 to 3 days with a recovery of walking after the third day.
The principle of operation is a repositioning of the first ray and a second alignment work with implementation in most cases of osteosynthesis material (screws, pins ...).
For sports such intervention must be carried out in the most extreme case because even if the judgment of sporting activity is reduced, the fact remains that particularly the practice of running, athletics in general, and other sports where the foot needs to be stable, the sport will know for a long time consecutive postural problems with the modification of the footbed.
When can I return my shoes? After 6 months the type of intervention it is usually possible to fit conventional street shoes
Can operate both feet at once? It is quite possible to operate both feet at once even if for the resumption of walking difficulty will be greater.
Also sometimes one has the courage for one but not the second
Is it painful? Thanks to a better management of pain, the patient does not suffer at all
When could I resume a sporting activity. Swimming is permitted at the end of Day 30
Cycling can begin at the 45th.
Pulse sports-type running, tennis, football from the 4th month on condition that the pain was absent.
For the top athlete it takes 6 months.

Olivier HOMAGE. - 17 f├ęvrier 2011.

Conflicts of interest: the author or authors have no conflicts of interest concerning the data published in this article.


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