Hallux valgus is so common that in medical practice there are more than four hundred options for surgical solutions to this problem.Of course, not all interventions were equally successful and completely solved the patient's problem, therefore, in modern practice, they remain the most progressive intervention options, in which patients have a high probability of recovery.Today, hallux valgus surgery focuses on being as invasive as possible combined with a good therapeutic effect of the surgery.
Directions
Hallux valgus is not just a problem for adults;it can also appear in children.The formation of a lump on the big toe in the initial stage does not bother patients until sharp pains appear when walking, problems with the choice of shoes and periodic inflammation of the bone.At this stage, most patients try to relieve pain using traditional methods.Various compresses and baths only prolong the course of the disease and lead to the only correct solution for hallux valgus deformity - surgical intervention.
The indications for the operation are:
- increased pain in the big toe;
- chronic inflammation that cannot be stopped, constant swelling;
- damage to the skin in the area of \u200b\u200bthe valgus curvature (cracks, suppuration, ulcers);
- plana valgus foot with severe curvature of the big toe joint;
- inability to help patients with conservative methods;
- the appearance of a limping gait;
- limitation of motor activity of the foot.
Doctors insist on treating thumb valgus exclusively surgically, since most patients are treated at a stage of the disease where it is not possible to correct the pathology conservatively.At the same time, if left untreated, bunions will eventually lead to a redistribution of load to the other toes, causing pain and sprains from the second to fifth toes.Only with timely surgical intervention can such complications be avoided.
Preparation for surgery
During surgery for hallux valgus, serious preparation is performed in orthopedics.The patient undergoes all necessary tests.The key is a blood test, the results of which are important to exclude signs of an inflammatory process in the body.
In some cases, the standard list of tests can be supplemented by determining the level of hormones and tumor markers if doctors suspect the development of a malignant process in the foot.
An obligatory stage of orthopedic operations is X-ray diagnostics: during the study, images are taken in two projections to determine the nature of the deformity and the severity of pathological disorders.
In difficult cases, doctors may resort to magnetic resonance imaging or computed tomography.Such a study provides more accurate results.Based on the test results, doctors decide which method is best to perform the operation.
Classification of surgical interventions
All operations performed for valgus can be divided into two large groups: minimally invasive operations and reconstructive operations.The first type of surgery on the foot is characterized by low trauma.
Surgical interventions are used to a limited extent - only at the initial stage of development of the disease, if the deformity is insignificant and in the presence of a benign growth of cartilaginous tissue, which can be easily removed by surgery.In all other cases, minimally invasive interventions do not solve the patient's problems.
Most minimally invasive surgeries are performed quickly and cause no complications.The scars after this operation are minimal.For the operation, the doctor makes two to three punctures, the length of which does not exceed 0.5 cm.After these operations, the skin recovers very quickly, and the disability period lasts up to two weeks.
When performing reconstructive surgeries, the volume of soft tissue damage is more significant.However, a huge advantage of operations is that they help remove even significant deformities of the legs and help with severe curvatures.The incision during reconstructive surgery is 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 consider operations depending on where they are performed.There are three groups of operations: on soft tissue, on bone tissue and combined surgery.When performing soft tissue operations, valgus deformity can be eliminated only if there is no deformation of the metatarsal head.During such an intervention, the doctor works exclusively with soft tissues: tendons, muscles, bursa.
With surgical intervention on the bone tissue it is possible to correct second and third degree deformities.The operation involves filing part of the bone or performing an osteotomy.In a combined operation, the operation takes place on both the soft tissues and the bones.But the possibilities of such surgery are wider: doctors can simultaneously remove a bone growth and perform plastic surgery of the ligaments.
Operational techniques
Bunions can be eliminated using different surgical techniques, each of which has its own advantages and is selected for certain indications.
OPERATION MCBRIDE
During McBride surgery, an incision is made in the first intermetatarsal space right at the level of the heads.Using forceps, the doctor pushes away the soft tissue and makes an incision in the intermetatarsal ligament, which is located on the surface.Next, the surgeon accesses the tendon of the muscle responsible for the abduction of the first finger - it is mobilized and sutured with a special suture material - Vicryl.
Next, the doctor works with the sesamoid bones;it crosses the deep ligament, which is attached to the sesamoid bone, thus eliminating its subluxation.Then the capsule of the metatarsophalangeal joint is dissected along the outer surface, after which an incision is made on the inner surface of the foot, about 5-6 cm long, through which the nerve is isolated and retracted laterally.
Dissection of the capsule occurs in the shape of the English letter V, with the apex pointing towards the thumb.Homan hooks are placed above and below the bone, and the cartilaginous growths on the head of the metatarsal bone are removed.If this is not done, patients will experience joint pain in the future.
In the future, the development of the operation can occur in two ways, depending on the need for the osteotomy.With osteotomy it is necessary to use a pin that will fix the tendon to the bone fragments.At the final stage, excess tissue of the capsule is removed, plastic surgery is performed with some tissue tension, after which the surgeon sutures 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.To prevent relapse after surgery, patients are advised to wear special orthopedic shoes after the operation.
SERIOUS METHOD
The SERI minimally invasive surgical technique was proposed in 1998 by surgeon Cesare Faldini.Now it is also actively used in the surgical practice of doctors in many countries.It is a minimally traumatic procedure and is effective in the initial phase of development of the disease and with moderate valgus curvature of the foot, when the angle of deviation of the big toe does not exceed forty degrees.
REFERENCE!The surgery is not performed due to severe arthrosis.Patients may be denied this type of surgery even if the first metatarsophalangeal joint is unstable.
Foot surgery is performed under local anesthesia.The doctor makes an incision in the projection of the head of the metatarsal bone of the big toe, opens the joint capsule and performs an osteotomy with a special file or chisel.During this procedure it is possible to achieve further redistribution of the load on the distal part of the metatarsal bone.
During surgery, doctors use Kirschner wires to create the correct position of the thumb: they are inserted into the medial part of the surface in an oblique direction, after which the doctor manually moves the finger and sets it in the desired position.The operation during the rehabilitation process requires the use of a plaster cast: it is applied for at least two weeks.The needle is removed after approximately 1-1.5 months.
CHEVRON METHOD
The Chevron technique is used for minor deformations if the angle is less than 17 degrees.The main condition for such surgery is the absence of arthrosis and other serious changes caused by valgus foot.
Surgical treatment is performed as follows: at the initial stage, the doctor cuts the skin just above the metatarsophalangeal joint of the foot.The shortened connections and the joint capsule itself are highlighted.Typically, degenerative changes in the tissues and ligaments cause the thumb to deform.The callus on the joint is removed using a chisel or saw.
An incision is made on the metatarsal bone at the level of the head, moved outward and placed under the sesamoid bone.The phalanx is then fixed with screws or wires and the capsule is closed.Titanium screws do not require removal after surgery, but the threads are removed three months after surgery, unless it is necessary to do so sooner.
SCARF METHOD
In most patients, the bunion can be removed using a Scarf osteotomy.This operation is performed for moderate valgus deformity of the first toe.Today surgery is the most universal method of treating valgus;It has many advantages over other methods.
The positive aspects of the operation are the following:
- during the procedure it is possible not only to move, but also to rotate the head of the metatarsal bone, which allows you to achieve a more progressive result than other surgical interventions;
- If the size is insufficient, the doctor may perform a bone lengthening procedure;
- with varus deformity, the bone may be displaced to the medial side;
- to reduce the load on the inside of the foot and the first toe area, you can move the bone slightly downwards and to the side;
- if necessary, you can shorten the length of the bone;
- When the joint is prone, the bony elements can be rotated.
The surgery is performed under spinal anesthesia.The surgeon makes an incision on the inside of the foot from the beginning of the toe to the beginning of the metatarsal bone.Next, a zigzag cut is made on the side of the bone of the first finger, after which the head of the bone is moved to the desired position, its angle changes.At the same time, the doctor also changes the position of the tendons attached to the thumb.
Subsequently the deformed joint capsule is separated from the outside and the bones are fixed in the required position using titanium screws.Fasteners are usually not removed;if they cause no discomfort, patients continue to wear the screws.Rehabilitation after surgery lasts three to six weeks.Immediately after surgery, patients are advised to wear an orthosis or a special splint, in which it is necessary to load the foot as soon as possible.The splint is worn throughout the recovery period.
LASER INTERVENTION
It is also possible to remove hallux valgus with laser, but patients should not place high hopes on this surgical method.Although it is minimally invasive and the most gentle, it is used exclusively in the initial stage of development of the pathological process.
The undoubted advantage of the surgery is the small incision that doctors make near the largest point of the bone protrusion.After healing, such a lesion is practically invisible, which allows maximum restoration of the aesthetics of the foot.Using a laser, doctors are able to perform limited interventions:
- perform exostectomy: using a laser, part of the cartilaginous growth that forms in the initial stage of valgus is removed;
- perform an osteotomy with a large incision: during surgery, the proximal phalanx of the first finger is removed;
- perform a resection arthroplasty: the articular surfaces of the metatarsal bone and part of the phalanx of the big toe are removed.
Laser removal is usually performed in clinics where special equipment is available.Recovery after surgery is minimal: patients can walk normally after just a few weeks.
The only drawback of laser surgery is that the incorrect position of the bone cannot be corrected, but is only rectified to the required parameters.In this case, patients are at risk of relapse.
ARTHRODESIS
Surgery to remove valgus by arthrodesis is used quite rarely today, but sometimes it is the only way for patients to get rid of the valgus of the big toe.Surgery is one of the most radical methods of intervention.
With the help of such surgery it is possible to remove the base of the phalanx of the first finger and fix the fingers together with special screws.
IMPORTANT! During the operation, the main goal is achieved - to eliminate the deformity and give the joint the correct position, however, not all patients feel comfortable after such an operation.
There are serious contraindications to the surgery:
- vascular atherosclerosis and other circulatory disorders;
- diabetic foot;
- polyneuropathy.
With arthritis and osteoarthritis, patients may also be denied surgery if the joints are severely deformed, destroyed, or constantly inflamed.In this case, patients will be advised to undergo minimally invasive surgery.
Among the complications of surgery, the following pathologies may occur: severe pain, discomfort due to titanium fixation structures installed in the bone and lameness.Rehabilitation after surgery lasts eight weeks.It is necessary to walk with a cast only in the first days after surgery: it is necessary to fix the elements.You can use Baruk's boot.These are specially designed orthopedic shoes that relieve stress from the operated leg.
Reviews
If a patient undergoes surgery to eliminate valgus, he can read reviews and find out what types of surgeries are performed and how effective they are.Here are some similar opinions:
"Last year I had to interrupt my dancing career due to a hallux valgus deformity. We did it with the scarf method, everything seemed to be fine, but the leg still hurts during exertion."
"I have been suffering from hallux valgus for a long time, but I did not dare to undergo surgery. I had a complex arthrodesis, the recovery took more than two and a half months, but after the operation it became much easier. Now I can walk without a cane and I have no pain."
"The bone in my foot is hereditary - my mother and grandmother also suffered from gout. I decided to undergo surgery as soon as the first signs appeared. The operation was performed using a laser, all excess growths were removed, now my leg looks normal, but the doctors told me to monitor for any relapses."
Hallux valgus surgeries in most cases allow a person to solve the problem of hallux valgus on the toe.When the first signs of valgus appear, do not delay treatment: the best results appear at an early stage of the development of the disease.