Hallux valgus is so common that there are more than four hundred options for the problem in medical practice.Of course, not all interventions were equally successful and completely solved the patient's problem, so in modern practice, the most advanced intervention options still exist, in which patients have a great chance of healing.Nowadays, Hallux valgus surgery focuses on being as invasive as possible and combined with the good therapeutic effect of the intervention.
Indications
Hallux valgus is not only a problem for adults;It can also appear in children.At the initial stage of the large toe a lot of formation does not interfere with patients until the sharp pain appears when walking, shoe selection problems and periodic inflammation of the bone.At this stage, most patients try to relieve pain by traditional methods.Various compression and baths only extend the course of the disease and lead to the only correct solution to the deformation of Hallux valgus - surgical intervention.
Signs of the operation:
- Increased pain in the big toe;
- chronic inflammation that cannot be stopped, constant swelling;
- skin damage in the valgus curvature (cracks, supervision, ulcers);
- Plana Valgus foot with the severe curvature of the big toe joint;
- Inability to help patients with conservative methods;
- appearance of lame walking;
- Restriction of motor activity on the foot.
Doctors insist on treating thumb values solely, as most patients are treated at one stage of the disease when a conservative correcting of pathology cannot be.However, if not treated, the Bunions will eventually result in redistribution of the cargo to other toes, causing the second -fifth toe to suffer and curve.Only timely surgical intervention can avoid such complications.
Preparing for the intervention
Hallux Valgus surgery is made during orthopedics.The patient undergoes all necessary tests.The key is a blood test, the results of which are important to exclude signs of the inflammatory process of the body.
In some cases, a standard list of tests can be complemented by determining the levels of hormones and cancer markers if doctors suspect that the foot is a malignant process.
The mandatory stage of orthopedic operations is X -ray diagnostics - During the study, the images are taken in two predictions to determine the nature of the deformation and the severity of the abnormal disorders.
In difficult cases, doctors may require magnetic resonance imaging or computer tomography.Such a study gives more accurate results.Based on the results of the tests, doctors decide which method is best to perform the operation.
Classification of surgical interventions
All operations performed for the Valgus can be divided into two large groups - minimally invasive operations and reconstruction interventions.The first type of surgical intervention on the foot is characterized by low trauma.
Surgery is used to a limited extent - only in the early stages of the disease, if the deformation is insignificant and, in the case of a benign increase in cartilage tissue, which can be easily removed through surgery.In all other cases, minimally invasive operations do not solve the patient's problems.
Most minimally invasive interventions are performed quickly and do not cause complications.The scars after the operations are minimal.The doctor performs two three -three punches for the intervention, which does not exceed 0.5 cm length.After these operations, the skin recovers very quickly and the disability is up to two weeks.
The amount of soft tissue damage is more significant when performing reconstruction.However, the enormous advantage of operations is that they help to remove significant deformities in the legs and in severe curvature.The incision during the reconstruction intervention reaches up to four centimeters and is located on the medial side of the foot.With this type of surgery, doctors completely restore the anatomical position of the big toe.
You can also take into account the operations, depending on the place they are performed.There are three intervention groups - soft tissues, bone tissue and combined surgery.If you perform interventions on soft tissues, the deformation of the valgus can only be removed if the metatarsal head is not deformed.In such an intervention, the doctor works only with soft tissues - tendons, muscles, Bursa.
Bone tissue surgical intervention can improve second and third degrees deformations.The intervention involves the submission of part of the bone or the implementation of osteotomy.During a combined operation, there is an intervention in both soft tissue and bones.But the possibilities of such surgery are wider - doctors can remove bone growth at the same time and perform the ligament plastic surgery.
Operating techniques
Bunions can be eliminated with several surgical techniques, each of which has its own advantage and is selected for certain indications.
McBride
During the surgical intervention, McBride says that the first intermetatarsal space is engraved, only at the level of the head.With the help of clamps, the doctor separates the soft tissues and incorporates in the intermetatarsal ligament on the surface.The surgeon then gets access to the muscle tendons, which is responsible for abducting the first finger - mobilized and is sewn with a special seam material - vicryl.
The doctor then works with the sassamoid bones;He crossed the deep ribbon connected to the seasamoid bone, thus eliminating his subluxation.The capsule of the metatarsofalangeal joint is then dissected along the outer surface and then cut into the inner surface of the foot, about 5-6 cm long, through which the nerve is separated and retracted.
The autopsy of the capsule is performed in the form of an English -language V letter, its climax is directed towards the thumb.The hooks of the home are placed above and below the bone and the cartilage growth is removed on the head of the metatarsal bone.If this does not happen, patients will experience joint pain in the future.
In the future, the operation will be developed in two ways, depending on the need for osteotomy.In the case of osteotomy, a needle that secures the tendon to the bone fragments should be used.In the final stage, the excess capsule tissue is removed, plastic surgery is performed with a certain tissue voltage, after which the surgeon sews the edges of the wound and treats its surface.
This technique was proposed more than eight decades ago, but to this day the operation has not lost its relevance.Patients are recommended to wear special orthopedic shoes after surgery to avoid relapses after the intervention.
Agent
Surgeon in 1998 was recommended by surgeon Cesare Faldini for the minimum invasive seri technique.This is also actively used in doctors' surgical practices in many countries.It is a low traumatic procedure and is effective in the early stages of the disease and is moderate for the foot when the big toe difference does not exceed forty degrees.
REFERENCE!Surgery is not performed because of severe arthrosis.Patients can also be denied by this type of intervention if the first metatarsophalangeal joint is unstable.
Foot surgery is performed during local anesthesia.The doctor makes an incision to project the head of the large toe's metatarsal bone, opens the common capsule and performs osteotomy with a special file or chisel.This procedure can be re -distributed further redistribution of the load in the distal part of the metatarsal bone.
During the surgical procedure, doctors use Kirschner wires to create the correct position of the thumb - placed in the medial side of the surface and then manually moves the finger and put it in the desired position.During the rehabilitation process, the surgery requires a plaster - it is used for at least two weeks.The needle is approx.It is removed after 1-1.5 months.
Chevron
Chevron technique is used for smaller deformations when the angle is less than 17 degrees.The main prerequisite for such an intervention is the lack of arthrosis and other serious changes caused by foot religion.
Surgery treatment is performed as follows: In the initial stages, the doctor cuts his foot directly above the metatarsofalangeal joint of the foot.The shortened connections and the joint capsule itself are highlighted.Generally, degenerative changes in tissues and tapes provoke the deformation of the thumb.The callus is removed with a chisel or saw on the joint.
The metatarsal bone is incised at the head level, shifts outward and placed under the seasamoid bone.Phalanx is then secured using screws or wires and the capsule is closed.The titanium screws do not require removal after surgery, but the wires are removed three months after surgery, unless this should be done earlier.
Scarf
Most patients can be removed using Bunion Scarf osteotomy.This operation is performed for moderate deformation of the first toe.Nowadays, surgery is the easiest way to treat valgus;It has many benefits over other methods.
Positive aspects of the operation are as follows:
- Not only is it possible to rotate not only the shift but also the head of the metatarsal bone, which allows you to achieve a more progressive result than other surgical interventions;
- If the size is not sufficient, the doctor can perform a bone extension procedure;
- In addition to the deformation of the varus, the bone can switch to the medial side;
- To reduce the load on the inside of the leg and the front toe area, you can move the bone slightly down and sideways;
- If necessary, you can shorten the length of the bone;
- When the joint is pronounced, the bone elements can be rotated.
The surgery is performed in a spinal sensation.The surgeon makes an incision inside the foot from the front of the toe to the front of the metatarsal bone.Then, on the side of the front toe's bone, a zigzag cut is made and the bone head is pushed into the desired position and the angle changes.However, the doctor also changes the location of the tendons fixed to the thumb.
The deformed joint capsule is then separated from the outside and the bones are secured with titanium screws.Fixes are usually not removed;If they do not cause discomfort, patients will continue to wear screws.Post -surgery rehabilitation takes three to six weeks.Immediately after the intervention, patients are recommended to wear a special orthosis or slaw in which the leg should be filled as soon as possible.The shard is worn during the recovery period.
Laser intervention
Removal of Hallux Valgus with a laser is also possible, but patients should not be hoped for the surgical method.Although minimally invasive and the most beautiful, it is used exclusively in the early stages of the development of the pathological process.
The undoubted advantage of surgical intervention is the small incision that doctors approach the biggest point of the bone protrusion.After healing, such an injury is virtually invisible, which allows maximum recovery of foot aesthetics.By using a laser, doctors can perform limited interventions:
- Perform exostectomy with a laser, part of the cartilage growth that develops in the early stages of the valgus;
- Make osteotomy with a large incision - the proximal phalanx of the first toe is removed during surgery;
- Perform resection artroplastics - the joint surfaces of the metatarsal bone and the phalanx part of the large toe are removed.
Laser removal is usually carried out on clinics with special equipment.Post -surgery healing is minimal - patients can only take a few weeks normally.
The only disadvantage of the laser intervention is that the incorrect position of the bone cannot be corrected, but only considers it the necessary parameters.In this case, patients are at risk of relapse.
Joint control
Today, surgery to remove artrodesis is rarely used, but sometimes this is the only way for patients to get rid of the large toe blood.Surgery is one of the more radical intervention methods.
Such surgery can be used to remove the first toe phalanx base and secure the toes with special screws.
IMPORTANT! During the operation, reaching the main goal - eliminating deformation and giving the joint position properly, but not all patients will be comfortable after such surgery.
There are serious contraindications to the intervention:
- vascular atherosclerosis and other circulatory disorders;
- diabetic leg;
- Polyneuropathy.
In arthritis and arthrosis, patients can also be denied surgery if the joints are severely deformed, destroyed or continuously inflamed.In this case, patients are advised to go through minimally invasive surgery.
The following pathologies may occur among the complications of surgical intervention: severe pain, discomfort due to bone titanium recording structures and affliction.Post -intervention rehabilitation lasts eight weeks.In the first days after surgery, you only need to walk in the actors - this is needed to record the elements.You can use the baruk boot.These are specially designed orthopedic shoes that relieve stress from the operated leg.
Overview
If a patient is undergoing surgery to eliminate the valgus, read reviews and find out what type of interventions they are performed and how effective they are.Here are some similar reviews:
"Last year I had to finish my ballerina career because of the Hallux Valgus deformation.
"I've been suffering from Hallux Valgus for a long time, but I didn't dare to go through surgery. It was a complex artrodesis, healing took more than two and a half months, but it became much easier after surgery. Now I can walk without reed and no pain."
"The bone on my feet is hereditary - my mother and grandmother also suffered in gout.
In most cases, Hallux Valgus surgeries allow people to solve the problem of the Bunion on his finger.When the first signs of the valgus appear, treatment should not be delayed - the best result appears in the early stages of the disease.