Hallux Valgus is so common that there are more than four hundred options for surgical solutions for this problem in medical practice.Of course, not all interventions had equal to success and fully resolved the problem of the patient, therefore, in modern practice, the most productive intervention opportunities remain, in which patients have a great chance of recovery.Today, Hallux Valgus surgery is focused on which it is possible in combination with good therapy performance from the intervention.
Indications
Hallux Valgus is not just an adult problem;It can also occur in children.The formation of a lump on the large toe in the initial phase does not bother the patients until sharp pain occurs when walking, shoe choosing problems and periodic bone inflammation.At this stage, most patients try to alleviate pain using traditional methods.Different compression and baths just extend the course of the disease and lead to the only correct solution for Hallux Valgus Deformy - surgical intervention.
Indications for operation are:
- increased pain in a large toe;
- Chronic inflammation that cannot be stopped, constantly swelling;
- Damage to the skin in the area of curvature of Valgus (cracks, supporal, ulcers);
- A plain of a valgous country with a severe curved joint of a large toe;
- Inability to assist patients with conservative methods;
- the appearance of walking walk;
- Limit of motor activity at the foot.
Doctors insist on the treatment of occasional treatment of Valgus, because most patients are treated in the disease phase when it is not possible to correct the pathology conservative.At the same time, if not treated, Bunion will eventually lead to the redistribution of the load to other toes, causing the second to the fifth toe suffer and become crooked.Only with timely surgical intervention, such complications can be avoided.
Preparation for intervention
During surgery for Hallux Valgus, serious preparation is done in the Orthopedic.The patient underwent all the necessary tests.The key one is a blood test, which results are important to exclude the signs of the inflammatory process in the body.
In some cases, the standard test list can be supplemented by determining the levels of hormones and cancer markers if doctors suspect the development of a malignant process in the foot.
The obligatory phase of orthopedic operations is X-ray diagnostics - during the study, images are taken into two projections to determine the nature of the deformity and severity of pathological disorders.
In severe cases, doctors can resort to magnetic resonance or computer tomography.Such a study gives more precise results.Based on the results of the tests, doctors decide which method is best to perform surgery.
Classification of surgical interventions
All operations performed for Valgus can be divided into two large groups - minimal invasive operations and reconstructive interventions.The first type of surgical intervention on the foot is characterized by low trauma.
Surgery are used in a limited extent - only in the initial phase of disease development, if the deformation is insignificant and in the presence of benign growth of cartilage tissue, which can be easily removed by surgery.In all other cases, minimal invasive operations do not solve the patient's problems.
Most minimally invasive interventions are made quickly and do not cause complications.Scars after this operation are minimal.The doctor makes two to three intervention breaks, whose length does not exceed 0.5 cm.After these operations, the skin is very quickly recovered, and the disability period is up to two weeks.
When performing reconstructive interventions, the amount of soft tissue damage is more important.However, the huge advantage of operations is that they help remove even significant deformities of the legs and help in severe curvature.Rising during reconstructive intervention reaches up to four inches and is located on the media side of the foot.With this type of surgery, the doctors completely return the anatomical position of the large toe.
You can also consider operations depending on the location in which they are performed.There are three groups of interventions - on soft tissues, bone tissue and combined surgery.When performing interventions on soft tissues, the deformation of valgus can be eliminated only if there is no deformation of the metatarizing head.During such an intervention, the doctor works exclusively with soft tissues - tendons, muscles, Bursa.
With the surgical intervention on the bone tissue, it is possible to correct the deformities of the second and third degree.Intervention involves filing part of bones or performing osteotomy.In combined work, the intervention occurs in soft tissue and bones.But the possibilities of such operation are expanding - doctors can remove bone growth and run the ligament plastic surgery.
Operating techniques
Grukovice can be eliminated with several surgical techniques, each of which has its advantages and is selected for certain indications.
McBride Operation
During the surgical intervention, the McBride is referred to in the first interometar space only at the head level.Using the clamp, the doctor pushes soft tissues and makes the cut in the interretary ligament located on the surface.After this, the surgeon receives access to the tendon of the muscle that is responsible for the kidnapping of the first fingers - was mobilized and exceeded with special material for Suture - Vicryl.
Further, the doctor works with Susamoid bones;It exceeds a profound ligament that is attached to the sesame bone, which eliminates its subbruxation.Then the capsule of a metato-fashionable joint is dissected along the outer surface, after which the inner surface of the foot, 5-6 cm long, through which nervousness and retreats to the side.
The capsule dissection is made in the form of English letters V, with its top-directed towards the thumb.Homan hooks are placed above the bone and below her, and the river growth on the metatarzal bone head is removed.If this is not done, patients will experience wrist pain in the future in the future.
In the future, the development of the operation can take place in two ways, depending on the need for osteotomy.With osteotomy, it is necessary to use a PIN that will fasten the tendon to bone fragments.In the final phase, the excess capsule is removed, plastic surgery is performed with a certain tissue tissue, after which the surgeon is caring for the wound edges and treat their surface.
This technique was proposed more than eight decades ago, but for this day, the operation did not lose relevance.To prevent relapse after the intervention, patients are recommended to wear special orthopedic shoes after surgery.
Seri method
Surgical technique using minimally invasive SERI technique proposed in 1998. year by the Cesar Faldini surgeon.It is also actively used in the surgical practice of doctors in many countries.It is a lowrage procedure and is effective in the initial phase of disease development and moderate curved valgus foot, when the angle of deviation of a large toe does not exceed forty degrees.
Reference!The operation is not done due to heavy arthrosis.Patients can also be denied with this type of intervention if the first metatarsophalanguage joint is unstable.
The foot operation is performed under local anesthesia.The doctor is stated in the projection of the head of the metatarsal bone of the large footprint, opens a shared capsule and performs osteotomy with a separate file or chisel.During this procedure, it is possible to achieve further redistribution of loads on the distal part of the metatarsal bone.
During the surgical procedure, doctors use Kirschner wires to create a correct thumb position - are inserted into the medial side of the surface in the basket, after which the doctor manually moves and places it in the desired position.Operation during the rehabilitation process requires that it bears the plaster gypsum - applies at least two weeks.The needle is removed after approximately 1-1.5 months.
Chevron method
Chevron technique is used for smaller deformations if the angle is less than 17 degrees.The main condition for such an intervention is the absence of arthrosis and other serious changes caused by valgus foot.
Surgical treatment is done as follows: In the initial phase, the doctor cuts the skin just above the metatarsophalangued joint of the foot.Abbreviation connections and joints of the capsule are highlighted.Usually degenerative changes in tissues and ligaments are provoked by a thumb deformation.Callus on the wrist is removed using a chisel or saw.
The cut is done on a metatar lip bone at the head level, moves outwards and is placed under the sesamoid bone.Falanx is then ensured by screws or wires, and the capsule is closed.Titanium screws do not require removal after surgery, but the wires are removed for three months after surgery, unless it exists earlier.
School method
In most patients, Bunion can be removed using a scarf otteomy.This operation is performed for moderate valgus deformity of the first toes.Today, the operation is the most universal method of treatment of valgus;There are many advantages over other methods.
Positive aspects of the operation are as follows:
- During the proceedings, it is not only to be transferred, but also for rotating the head of metatarsal bone, which allows to achieve more advanced results than with other surgical interventions;
- If the size is insufficient, the doctor may perform the bone extension process;
- With Varus deformity, the bone can be transferred to the medial side;
- To reduce the load on the inside of the foot and the area of the first toe, you can move the bone slightly down and to the side;
- If necessary, you can shorten the length of the bone;
- When the wrist specifies, bones elements can be rotated.
Surgery is performed under spinal anesthesia.The surgeon is located on the inside of the feet from the beginning of the leg until the beginning of the metatarsal bone.After this, the zigzag was made on the side of the first nose bone, after which the head of the bone is transferred to the desired position, its angular change.At the same time, the doctor also changes the location of tendons that are attached to the thumb.
Then the joint capsule is separated by the separate capsule, and the bones were fixed in the desired position using titanium screws.Usually attachments do not be removed;If they do not cause discomfort, so patients continue to wear bolts.Rehabilitation after the operation lasts three to six weeks.Immediately after the intervention, patients are recommended to wear a special orthosis or rod, in which it is necessary to load the foot as early as possible.Split is carried all over the recovery period.
Laser intervention
It is also possible to remove Hallux Valgus with laser, but patients should not accommodate high hopes in this method of surgery.Although minimally invasive and the most difficult, it is used exclusively at an early stage of the development of the pathological process.
The undoubted advantage of surgical intervention is a small cut that doctors do near the largest bone protrusion point.After healing, such injuries is practically invisible, which enables the maximum renewal of the aesthetics of the foot.Using lasers, doctors are able to perform limited interventions:
- Perform Exetectomy - using a laser, part of the Carthagine growth that is removed at the early stage of Valgus;
- Make osteotomy with a large cut - during surgery, the proximal phalaxes of the first toes has been removed;
- Execute the arthroplasty resection - the joint surfaces of the metataric bone and part of the Falan toe finger are removed.
Laser removal is usually performed in clinics in which there is special equipment.Recovery after surgery is minimal - patients can walk normally after just a few weeks.
The only lack of laser intervention is that the inaccurate position of the bone cannot be corrected, but it is just the soil required parameters.In this case, patients are in danger of relapse.
Arthrodeza
Surgery for removing valgus using arthrodesis is used quite rare today, but sometimes it is the only way to solve the patients with a valgus of a large toe.Surgery is one of the most radical intervention methods.
With the help of such an operation, it is possible to remove the base of the phalang of the first toe and fix the toes together with special screws.
Important! During the operation, the main goal is achieved - elimination of deformities and giving a common accurate position, however, not all patients have become pleasant after such operation.
There are serious contraindications for intervention:
- Vascular atherosclerosis and other circulatory disorders;
- diabetic foot;
- Polineuropathy.
With arthritis and arthrosis, patients can also be denied by surgery if the joints are severely deformed, destroyed, or constantly lit.In this case, patients will be advised to undergo minimally invasive surgery.
Among the complications of surgical intervention, the following pathologies may occur: severe pain, discomfort due to titanium fastening in bones and limping.Rehabilitation after the intervention lasts eight weeks.It is necessary to walk in the cast only in the first days after the operation - it is necessary to fix the elements.You can use Baruk's boot.These are specially designed orthopedic shoes that will relieve stress from the operated leg.
Reviews
If the patient is subject to the operation to eliminate Valgus, he can read the reviews and find out what types of interventions are performed and how effective they are.Here are some similar opinions:
"Last year I had to finish my career as a ballerina for mental deformity Valgus. We did it using a mature scarf, everything seemed to be well, but still hurts when it still hurts when it still hurts."
"I have long suffer from Hallux Valgus, but I didn't dare undergo surgery, recovery lasted more than two and a half months, but after surgery became much easier. I can now walk without a cane and I have no pain."
"The bone on my foot is hereditary - my mother and grandmother also suffered from Gout. As soon as the first signs appeared from me, and now the doctors told me that I told me to oversee the possible relapses."
The revivals for Hallux Valgus in most cases allow a person to solve the problem of bunion on his finger.When the first signs of Valgus appear, you should not delay treatment - the best results appear at an early stage of disease development.