Research On Hallux Valgus And Enthesiopathy

1 BackgroundHallux valgus is a kind of common disease in clinic with the influence of the west culture, development of the society and improvement of living standard. The incidence rate has been ascended 10-20% in our country. Among them 95% patients are women. There are almost ten—million people especially middle-aged and old women who need to be treated every year. The research on hallux valgus is a hot spot in the subject of foot-surgery.The pain located in the internal part of the first metatarsal head of the patient is the main symptom. Modern medicine thinks that hallux valgus is a complicate fro-foot deformity and it has great relationship with the heredity and the style of the shoes. Bunion is the major reason caused the pain. The theory above has been used for many years.My editor professor Wen Jian Min has engaged in foot and angle surgery over the years. He has undertaken lots of systemic research on hallux valgus. Based on long-term and a great quantity of clinical practices we found that patients have long course of disease and almost 20 years passed from the beginning of the disease. Different patient has different pain-level and different character. At the beginning, symptom is light and recovery soon that can't influence patient's life and work. With the development of the disease pain become harder accompanying with red swelling of the skin of the internal part of the first metatarsal head. But when the deformity became even severity, the pain level became light. With the scope became larger the character of the pain was changed and some patients can't describe it perfectly.Above all, we think that there are no obvious concordance between pain level and the course of disease. There must have more location that caused the pain of hallux valgus. The theory of bunion can't explain the pathology changes of the disease perfectly.The pain of hallux valgus reflect the disease of Tai-yin Jing-jin of foot when we analysis the symptoms and the course of disease using the theory of Jing-jin.We also found spots of disease such as Da-du-ci and Gong-sun-ci along with the Jing-jin of Tai-yin of foot which concluding the first metatarsal head, the first metatarsophalangeal joint, abductor hallucis and flexor hallucis brevis according to anatomy.The theory of Jing-jin is an important part of the theory of tunnel of Traditional Chinese Medicine. The theory of Jing-jin record the symptoms and how to treat the disease of twelve Jing-jin. Twelve Jing-jin run-on the skeleton and is a part of Jing-luo. The main function is to resist the external disease, associate joints and protect the body. Above all it can help the body to be a good position and make the joint lubricate. "Jin-jing" and " Jin-niu" is the most frequent spots being hurt and the spots is extremital structure according to anatomy of modern medicine. Extremital structure may be damaged by acute or chronic trauma.We refer many literatures in order to know the pathological changes of hallux valgus and found that" most kinds of literatures have focus on the methods of operation and biological mechanics and there almost haven't research on pathology expect the content of bunion. What's more, there are many discuss about the anatomy of the internal part of the foot especially on the insertion of abductor hallucis and the research on enthsiopathy were only limited on big joints such as knee, ankle and shoulder. So it caused many disadvantage for the development of hallux valgus.Various symptoms and uniformity indicated that there must be some unknown reason caused the pain of hallux valgus.There hasn't investigated literature about the pathologic changes of bone and soft tissue of the internal part of the first metatasral head and literature about hallux valgus and enthesiopathy up to now.2 PurposesTo observe the insertion of abductor hallucis by dissecting the specimen of foot.To observe characteristic cf clinic symptoms and pathologic changes of bone and soft tissue of the internal part of the first metatarsal head in order to investigate whether hallux valgus is a kind of enthesiopathy and guide the therapy on clinic.3 Materials and methods3.1General data3.1.1 6 fresh feet specimen were obtained in our study .3.1.2 123 cases (235 feet) were obtained from August 2002 to December 2004 with hallux valgus in our department in Wang-Jing hospital. The data of clinic were collected in to database and the bone and soft tissue of the internal part of the first metatarsal head were put out from the incision.3.2 Diagnostic criteria of enthesiopathy3.2.1 Pain and limited function.3.2.2 Tenderness on the afflicted part accompany with swell or analosis of the muscles around the joint.3.2.3 Limited range of joint's motion.3.3 Method of operationThe length of the first incision is lcm and located in the distal part of the first metatarsophalangeal joint. Milling osteophyma located in the internal part of the metatarsal head. The length of another incision is 0.5cm in the internal part of the first head and neck of the metatarsal bone. Basilar part of the osteophyma was cut and the osteophyma was taken out from the incision.3.4 Method of dealing with specimenThe specimen were fixed, decalcificated^ dehydration, embedding and sliced step by step by using staining of HE.3.5 Observing the pathological coperational conditionThe pathological changes were observed under the microscope. ( ocularlOX objiectivelOX; ocularlOX objiective4X)4 Results4.1 The tendon of abductor hallucis has wide insertion and part of it is insert at the first metatarsal head.The tendon of abductor hallucis and flexorm hallucis were transit together with the articular capsule in the internal part of the first metatarsal head.4.2 The pain located in the internal part of the first metatarsal head of hallux valgus.The pain of hallux valgus located in the internal part of the first metatarsal head has different characters. Pressure pain point was also found along with the abductor hallucis which indicated us that the disease of extremital structure may influence the whole muscle. The main symptom of hallux valgus is consistent with the main symptom of enthesiopathy.4.3 The pathological changes of the soft tissue and bone located in the first metatarsal head are accord with the pathological changes of enthesiopathy.There are five kinds of pathological changes we found which can tell us Hallux vaglus is a kind of enthesiopathy : l).Extremity of the tendon and desmoplasia 2). Reactive hyperplasia of periost. 3). decreasing of bone trabecula 4). Cartilaginification of periost and extremity of the tendon. 5). Bone formation and destration.5 Conclusions5.1 Part of the tendon of abductor hallucis has insertion in the internal part of the first metatarsal head and consistent with extremital structure according to anatomy of modern medicineThe tendon of abductor and medial head of flexor hallucis brevis have insertion in the internal part of the first metatarsal head and consistent with extremital structure according to anatomy of modern medicine5.2 one of the reason caused pain located in the internal part of the Hallux vaglus is enthesiopathy of abductor hallucis.We improve that one of the reason caused pain located in the internal part of the metatarsal head of Hallux vaglus is enthesiopathy of abductor hallucis by analyzing the symptoms and the pathological changes of the soft tissue and bone located in the first metatarsal head comprehensively.