Alluce valgo: cos’è e come si risolve
Table of Contents
Definizione
L’alluce valgo è una delle patologie del piede più diffuse. Si tratta di una deformazione dell’alluce la cui base (primo metatarso) si sposta verso l’esterno, mentre la punta (falange prossimale) si porta verso le altre dita.
L’alluce valgo è una deformità abbastanza frequente caratterizzata da una deviazione dell ‘alluce verso l’esterno e da una deviazione verso l’interno del primo metatarso tale che l’asse dell’alluce forma con l’asse del primo metatarso un angolo aperto all’esterno. L’alluce valgo non è mai un’ entità patologica isolata dell’ avampiede, se non in qualche caso lieve ed iniziale; le associazioni più frequenti sono quelle con una deformità del secondo dito:dito a martello e quello con la patologia plantare da sovraccarico: la metatarsalgia.
Fattori predisponenti
Tra i fattori che determinano l’insorgenza dell’alluce valgo ci sono l’ereditarietà o meglio una predisposizione genetica; la familiarità con il riscontro di alluce valgo in numerose membri di una stessa famiglia, spesso già presente in età giovanile; l’uso di calzature incongrue aventi il tacco alto e la punta molto stretta, sicuramente eleganti ma antifisiologiche in quanto costringono il piede in equinismo e le dita addossate le une alle altre; l’eccessiva lunghezza dell’ alluce chiamatapiede egizio. Un relativamente brusco peggioramento della deformità dell’alluce, fino al raggiungimento di aspetti grotteschi, si verifica quando l’alluce supera, in genere sottoponendosi ad esso, la barriera rappresentata dal secondo dito.
Diagnosi clinica e strumentale
La deformazione del piede affetto da alluce valgo è evidente: il primo dito è deviato verso l’esterno ed è presente la caratteristica “cipolla” per la prominenza con flogosi cronica della testa del primo metatarso. Il dolore, che può essere di intensità molto variabile, spesso è il risultato soltanto dello sfregamento della calzatura sull’ esostosi interna.
La caratteristica borsite, comunemente denominato “cipolla”, determinata dall’ irritazione cronica meccanica della borsa sierosa con la calzatura, inevitabilmente nel tempo si infiamma diventando sede di dolore acuto e a volte di infezione. Per una esatta valutazione diagnostica e quindi per una corretta impostazione della tecnica chirurgica da eseguire è indispensabile l’esecuzione degliesamiradiografici.
Trattamento
E’ importante, prima di parlare del trattamento, ribadire alcuni concetti diprevenzione.I pazienti con una predisposizione all’alluce valgo, ed in particolare confamiliarità,con primo dito più lungo del secondo (piede egizio), è indispensabile che portino delle calzature con un tacco non troppo alto (massimo 3 cm) e con la parte anteriore abbastanza larga in modo tale che le dita non prendano contatto con la punta della calzatura. Sono assolutamente da evitare, invece, le calzature cosiddette a punta stretta che costringono il primo dito ad un obbligata posizione invalgismoe il quinto dito ad un obbligata posizione invarismo.Nei casi iniziali, in pazienti giovani, è importante l’esecuzione di ginnastica dell’ avampiede e l’ uso ditutori interdigitali.
I tutori interdigitali al silicone, modellati anatomicamente sul piede, hanno lo scopo di proteggere l’ alluce e, potendo essere usati in carico con le calzature, aiutano a prevenire un peggioramento della deviazione in valgismo.
L’intervento chirurgico è riservato solo ed
esclusivamente ai casi dolorosi e non deve mai essere praticato per il solo fine estetico. Più di cento sono le metodiche operatorie che sono state proposte per il trattamento chirurgico dell’alluce valgo ed inoltre numerosi autori hanno attuato delle modifiche personali. Ciò a dimostrazione della complessità della patologia e della necessità di evitare possibili recidive e complicanze, quali
l’ ipercorrezione, la rigidità, l’infezione, presenti comunque nelle casistiche personali di tutti i chirurghi del piede. Il tipo di trattamento chirurgico deve essere deciso caso per caso dopo una valutazione globale dell’aspetto del piede. L’intervento dovrà comprendere: la correzione del valgismo dell’alluce; la resezione dell’ossoesostosico della superficie mediale della testa del 1° metatarso. La correzione del varismodel primo metatarso; la correzione di eventuali altre deformità associate: dita a martello, sub- lussazioni articolari, metatarsalgie, valgismo di retropiede.
Appare improprio parlare di “intervento unico per alluce valgo” ma piuttosto è importante studiare bene l’aspetto clinico, radiografico e funzionale dell’ avampiede onde poter effettuare un intervento chirurgico specifico che corregga la deformità e ripristini la funzionalità.
L’intervento viene eseguito in regime di ricovero ospedaliero convenzionato. Non è necessario nessun tipo di immobilizzazione e si deambula già in seconda giornata con calzature ortopediche predisposte. È importante uno studio accurato clinico e strumentale della patologia, caso per caso, onde programmare un’appropriata terapia e ridurre il più possibile le complicanze per recidive.
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