Hallux Valgus is very common that in medical practice there are more than four hundred options for surgical solutions for this problem.Of course, not all interventions have the same success and solve the patient's problems completely, so in modern practice, the most progressive intervention options remain, where patients have a high chance of recovery.Today, the Hallux Valgus surgery is focused on becoming an invasive that may be combined with a good therapeutic effect of intervention.
Indication
Hallux Valgus is not just a problem for adults;It can also appear in children.The formation of lumps in large feet in the early stages does not interfere with the patient until sharp pain occurs during walking, problems by choosing shoes, and periodic inflammation.At this stage, most patients try to relieve pain using traditional methods.Various compression and bathing only extend the course of the disease and lead to one of the right solutions for Hallux Valgus defects - surgical intervention.
The clues to the operation are:
- increased pain in large feet;
- Chronic inflammation that cannot be stopped, persistent swelling;
- damage to the skin in the area of the valgus curvature (crack, suppuration, ulcer);
- Plana valgus feet with severe curvature of large foot joints;
- inability to help patients with conservative methods;
- walking appearance;
- Limitations of motor activity in the foot.
Doctors insist on treating the thumb valgus exclusively surgery, as most patients are treated at the level of the disease when it is not possible to correct the pathology.At the same time, if left untreated, the bunions will eventually lead to the redistribution of the load to the other toes, causing the second to the fifth toe to suffer and become bent.Only with timely surgical intervention, such complications can be avoided.
Ready to intervene
During surgery for Hallux Valgus, serious preparation is performed in orthopedic.The patient underwent all the necessary tests.The main is a blood test, the result is important to exclude the signs of inflammation in the body.
In some cases, the list of standard tests can be supplemented by determining the levels of hormones and cancer markers if doctors suspect the development of malignant processes in the legs.
The compulsory level of orthopedic operation is diagnostic X -Ray - During the study, the image is taken in two projections to determine the nature of the defect and the severity of the pathological disorders.
In difficult cases, doctors can use magnetic resonance imaging or computed tomography.Such studies provide more accurate results.Based on the test results, the doctor decides which method is best to perform the operation.
Classification of surgical intervention
All operations performed for valgus can be divided into two large groups - minimal invasive operations and reconstructive intervention.The first type of surgical intervention in the foot is characterized by low trauma.
Surgery is used for a limited degree - only in the early stages of the development of the disease, if the defect is not important and in the presence of benign cartilage growth, which can be easily removed through surgery.In all other cases, minimal invasive surgery does not solve the patient's problem.
The minimum invasive intervention is done quickly and does not cause complications.The scars after this operation are minimal.Doctors make two to three punctures for intervention, the length not exceeding 0.5 cm.After this operation, the skin recovers quickly, and the defect period is up to two weeks.
When performing reconstructive intervention, the amount of soft tissue damage is more important.However, the advantage of the major operation is that they help eliminate significant foot defects and help with severe curvature.The current incision of reconstructive intervention reaches up to four centimeters and is located next to the medial foot.With this type of surgery, the doctor completely restores the anatomy of the big foot.
You can also consider operations depending on the location where it is run.There are three groups of interventions - on soft tissue, on bone tissue and combined surgery.When intervening in soft tissue, valgus defects can be eliminated only if there is no metatarsal head deformation.During such intervention, the doctor works exclusively with soft tissue - tendons, muscles, exchange.
With surgical intervention on bone tissue, it is possible to correct the second and third degree defects.Intervention involves filing bone parts or performing osteotomy.In combination operation, intervention occurs in both soft and bone tissue.But the possibility of such surgery is broader - doctors can simultaneously produce bone growth and perform ligament plastic surgery.
Technique
Bunions can be eliminated using several surgical techniques, each of which has its own advantages and is selected for certain instructions.
McBride Operations
During surgical intervention according to McBride, the slice is made in the first intermetatarsal room only at the head level.Using clamps, the doctor pushes soft tissue and slices in the intermetatarsal ligaments, located on the surface.After that, the surgeon gained access to the muscle tendon responsible for kidnapping the first finger - it was moved and sewn with a special stitching material - Vicryl.
Next, doctors work with sesamoid bones;He crossed the deep ligaments, attached to the sesamoid bones, thus eliminating his subluxation.Then the metatarsophalangeal joint capsule is dissolved along the outer surface, and then the slice is made on the inner surface of the foot, about 5-6 cm long, where the nerves are separated and retracted to the side.
Capsule surgery is performed in the form of English V, with its peak directed towards the thumb.Homan hooks are placed on the bones and underneath, and the growth of the cartilagin on the metatarsal bone is removed.If this is not done, the patient will experience pain in the future.
In the future, the development of operations can occur in two ways, depending on the need for osteotomy.With osteotomy, it is necessary to use a pin that will attach a tendon to the bone fragments.In the final stage, excess capsule tissue is removed, plastic surgery is performed with certain tissue tension, and thereafter the seam of the wound edge and treats the surface.
This technique has been suggested more than eight decades ago, but to this day the operation has not lost its connection.To prevent relapse after intervention, patients are recommended to wear special orthopedic shoes after surgery.
Tie method
Surgical techniques using a slightly invasive draw technique was proposed in 1998 by Cesare Faldini surgeon.It is also actively used in doctors' surgery in many countries.It is a low trauma procedure and is effective in the early stages of disease progression and with moderate foot valgus curvature, when the angle of the large leg deviation does not exceed more than forty degrees.
REFERENCE!This operation is not performed due to severe arthrosis.Patients can also be denied this type of intervention if the first metatarsophalangeal joint is unstable.
Foot surgery is performed under local anesthesia.Doctors make slices in the head of the head metatarsal bone, open the capsule together, and perform osteotomy with special files or chisels.During this procedure, it is possible to achieve further distribution of load on the distal bone section.
During the surgical procedure, doctors use kirschner wires to create the right position from the thumb - they are inserted into the medial surface of the oblique direction, after which the doctor manually moves the finger and prescribes it in the desired position.Operations during the recovery process require using plaster cast - it is used for at least two weeks.The needle is removed after about 1-1.5 months.
The chevron method
Chevron techniques are used for small deformation if the angle is less than 17 degrees.The main conditions for such interventions are the absence of arthrosis and other serious changes caused by valgus feet.
Surgical treatment is as follows: in the early stages, the doctor cuts the skin right on the metatarsophalangeal joint.The shortening connection and the capsule together itself are highlighted.Usually, degenerative changes in tissues and ligaments trigger thumb deformation.Calus on the joints is removed using a chisel or saw.
A slice is made on the metatarsal bone at the head level, it moves outward and placed under the sesamoid bone.Phalanx is then guaranteed using screws or wires and capsules are closed.Titanium screws do not require removal after surgery, but the wire is removed three months after surgery, unless there is a need to do this early.
A scarf method
In most patients, the bunion can be removed using a scarf osteotomy.This operation is performed for moderate valgus defects in the first leg.Today, surgery is the most universal method for treating valgus;It has many advantages over other methods.
The positive aspects of operation are as follows:
- During the procedure, it may not only be to move, but also to rotate the metatarsal bone head, which allows one to achieve more progressive results than other surgical interventions;
- If the size is insufficient, the doctor may perform the bone extension procedure;
- With varusity defects, the bones can be transferred to the medial part;
- To reduce the load on the inside of the foot and the first area, you can move the bones slightly down and to the side;
- If necessary, you can shorten the length of the bone;
- When the joints are mentioned, the bone elements can be rotated.
Surgery is performed under the spinal anesthesia.The surgeon made a slice on the inside of the foot from the beginning to the beginning of the metatarsal bone.Subsequently, the zigzag cut was made on the side of the first toes, after which the bone head turned to the desired position, the corner changed.At the same time, the doctor also changes the location of the tendon attached to the thumb.
Then the defective articular capsule is separated from the outside and the bone is prescribed in the required position using a titanium screw.Usually fasteners are not removed;If they do not cause any discomfort, then the patient continues to wear screws.Recovery after surgery takes three to six weeks.Immediately after the intervention, the patient is recommended to wear special orthosis or debris, where it should load as early as possible.Splint is worn throughout the recovery period.
Laser intervention
Removing Hallux Valgus with laser is also possible, but patients cannot put high expectations on this surgical method.Although it is slightly invasive and the softest, it is used exclusively in the early stages of the development of the pathological process.
The advantage of an undeniable surgical intervention is a small slice that doctors make near the largest point of bone highlights.After healing, such injuries are invisible, which allows for the maximum recovery of foot aesthetics.Using lasers, doctors can perform limited interventions:
- Running exostectomy - using laser, part of the growth of cartilagin formed in the early stages of valgus removed;
- Make osteotomy with large slices - during surgery, the first proximal phalanx is removed;
- Perform arthroplasty resection - the articular surface of the metatarsal bone and part of the large foot phalanx is removed.
Laser removal is usually done in a clinic where there are special equipment.Recovery after surgery is minimal - the patient can walk normally after just a few weeks.
One of the weaknesses of laser interventions is that improper bone positioning cannot be corrected, but it is just a reason for the required parameters.In this case, the patient is at risk.
Arthrodesis
Surgery to get rid of valgus using arthrodesis is used quite rarely today, but sometimes it is the only way for patients to get rid of large leg valgus.Surgery is one of the most radical intervention methods.
With the help of such surgery, it is possible to remove the base of the first toes and fix the toes together with a special screw.
IMPORTANT! During surgery, the main goal is achieved - eliminating defects and giving the right position, however, not all patients become comfortable after the surgery.
There is a serious contraindication for intervention:
- vascular atherosclerosis and other blood circulation disorders;
- diabetes feet;
- Polyneuropathy.
With arthritis and arthrosis, patients can also be denied surgery if the joints are defective, destroyed, or constantly inflamed.In this case, the patient will be advised to undergo a slight invasive surgery.
Among the complications of surgical intervention, the following pathologies may occur: severe pain, discomfort due to titanium binding structure installed in the bone, and limping.Recovery after an eight -week intervention.It has to walk in the actor only on the first day after surgery -this is necessary to set the elements.You can use Baruk Boots.These are specially designed orthopedic shoes that will relieve pressure from the controlled feet.
Comment
If the patient underwent surgery to eliminate Valgus, he or she can read the review and find out the type of intervention they do and how effective they are.Here are some similar opinions:
"Last year I had to end my career as Ballerina because of the Hallux Valgus defect.
"I have suffered Hallux Valgus for a long time, but I have not dared to undergo surgery. I have complex arthrodesis, recovery takes more than two and a half months, but after the operation it becomes easier.
"The bones in my feet are descendants - my mother and my grandmother also suffered gout. I decided to undergo surgery as soon as the first signs appeared.
Surgery for Hallux Valgus in most cases allows one to solve the bunion problem on the finger.When the first signs of valgus appear, you cannot slow down the treatment - the best results appear in the early stages of the disease.